Guillain-Barre sendromu nedeniyle hastanede yatan bir hastada gelişen Burkholderia cepacia sepsisi

Yıl 2011, Cilt: 68 Sayı: 4, 197 - 202, 01.12.2011

Orhan Baylan Mehmet Burak Selek Semih Alay Oral Öncül Mustafa Özyurt Tunçer Haznedaroğlu

Öz

Burkholderia cepacia, yoğun bakım ünitelerinde takip edilen, özellikle kistik fibrozisli veya bağışıklık sistemi baskılanmış hastalarda nekrotizan pnömoni, sepsis/bakteriyemi ve salgınlara yol açan fırsatçı Gram negatif basildir. Bu olgu sunumunda, Guillain-Barre sendromu nedeniyle hastanemizin nöroloji servisi yoğun bakım ünitesinde yatmakta iken 15 gün içerisinde değişik zamanlarda alınan üç seri kan kültür örneğinde B. cepacia üreyen, bağışıklık sistemi yeterli bir sepsis olgusu sunulmuştur. İzolatın, “Clinical and Laboratory Standards Institute CLSI ” kriterleri doğrultusunda Kirby-Bauer disk difüzyon yöntemiyle yapılan antibiyotik duyarlılık seftazidim ve meropeneme duyarlı, minosikline orta duyarlı olduğu tespit edilmiştir. Hastanın mevcut kolistin ve levofloksasin kombinasyon tedavisine doripenem eklenmiştir. Tedavinin üçüncü gününde ateş yanıtı alınan hastanın antibiyotik tedavisi 14 güne tamamlanmış, hasta tedavi bitiminde herhangi bir komplikasyon gelişmeksizin iyileşmiştir. Aynı dönemde nöroloji yoğun bakım ünitesinden kaynak araştırması amacıyla alınan çevresel örneklerin hiçbirisinden söz konusu etken üretilememiştir. Bağışıklık sisteminde sorun olmasa da uzun süre hastanede yatan, kataterli ve tıbbi cihazlara bağlı yoğun bakım ünitesi olgularında B. cepacia sepsisi görülebileceği akılda tutulmalıdır

Anahtar Kelimeler

Guillain-Barre sendromu, hastane enfeksiyonu, sepsis, Burkholderia cepacia

Burkholderia cepacia sepsis observed in a hospitalized patient with Guillain-Barre syndrome

Öz

Burkholderia cepacia, is an opportunistic Gramnegative bacillus that causes necrotizing pneumonia, sepsis/bacteremia and epidemics especially in cystic fibrosis or immunosupressed patients hospitalized in intensive care units. In this report, a case of B. cepacia sepsis in an immunocompetent patient with a diagnosis of Guillain-Barre syndrome hospitalized in the neurological intensive care unit, is being presented. B. cepacia was isolated from three serial blood cultures taken at different times within 15 days. The antibiotic susceptibility testing of the isolates was performed by Kirby-Bauer disc diffusion method according to the “Clinical and Laboratory Standards Institute CLSI ” criteria. The isolates were found to be susceptible to trimethoprim/sulfamethoxazole, ceftazidime and meropenem, and intermediately susceptible to minocycline. Doripenem was added to patient’s ongoing combination treatment with colistin and levofloxacin. On the third day of the treatment, the patient started having fever and therefore the antibiotic therapy was prolonged for additional 14 days. At the end of the therapy, the patient was cured without any complication. In the mean time, the agent could not be isolated from any other environmental samples taken from the neurological intensive care unit. It should be kept in mind that B. cepacia sepsis can be seen in intensive care unit patients with prolonged hospitalization, indwelling catheters and medical devices, even if they are not immunosupressed

Anahtar Kelimeler

Guillain-Barre syndrome, nosocomial infection, sepsis, Burkholderia cepacia

Kaynakça

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