Türkiye’de mikrobiyoloji laboratuvarlarının kültür ve antibiyotik duyarlılık testi performans değerlendirmesi ve Ulusal Antimikrobiyal Direnç Sürveyans Sistemine veri sağlayacak laboratuvarların seçimi: Anket uygulaması

Yıl 2015, Cilt: 72 Sayı: 3, 175 - 272, 01.09.2015

Murat Duman Nilay Çöplü Dilber Aktaş Hüsniye Şimşek Gül Bahar Erdem İpek Mumcuoğlu

Öz

Amaç: Antimikrobial direnç sorununun artmakta olması nedeniyle ülkemizde Ulusal Antimikrobiyal Direnç Sürveyans Sistemi UAMDSS kurulma çalışmaları başlatılmıştır. UAMDDS’ye dahil olacak laboratuvarların sisteme güvenilir veri sağlayabilmesi önemlidir. Bu amaçla ülkedeki mikrobiyoloji laboratuvarlarının kültür ve antibiyotik duyarlılık testleri ADT yapabilme kapasitelerini değerlendiren bir anket uygulaması yapılmıştır. Yöntem: Bu çalışma 2009-2010 yılları arasında yapılmış olup mikrobiyoloji laboratuvarlarının kültür ve ADT yapabilme kapasitelerine odaklanan 90 soru içermektedir. Anket formları T.C. Sağlık Bakanlığı tarafından mikrobiyoloji uzmanı bulunduğu bilgisine ulaşılan kamuya bağlı 354 hastanenin tıbbi mikrobiyoloji laboratuvarına gönderilmiştir. Sonuçlar SPSS 18,0 istatistik programı kullanılarak değerlendirilmiştir. Bulgular: Ankete %70,5’i devlet hastanesi, %16,5’i eğitim ve araştırma hastanesi ve %13’ü üniversite hastanesi olmak üzere 322 laboratuvar cevap vermiştir. Birinci basamak sisteme dahil olma kriterleri olan; mikrobiyoloji uzmanı bulunması %99,1 , bakteriyoloji bölümü olması %97,5 ve kan kültürü çalışılması %83,6 sorularının her üçüne de evet cevabı veren 259 %80,4 laboratuvar ileri değerlendirmeye alınmıştır. İkinci aşama olan skor çalışmasında kullanılan sorular ve bu sorulara verilen cevap yüzdeleri şöyledir: i Escherichia coli ortalama: 74,7 , Klebsiella spp. ortalama: 22,9 , Staphylococcus aureus ortalama: 19,6 , Pseudomonas aeruginosa ortalama: 19,5 , Enterococcus spp. ortalama: 16,1 ve Streptococcus pneumoniae ortalama: 3,7 , için uygulanan aylık ADT sayısının ortalama değerlerinin üzerinde olması, ii klinik olarak anlamlı kabul edilen mikroorganizmalara veya izole edilen hastada klinik olarak önemli kabul edilen mikroorganizmalara kan izolatları için sırasıyla %49,2 ve %30,2; BOS izolatları için sırasıyla %88,7 ve %75,5 ADT uygulaması, iii ADT için standart uygulama prosedürünün olması %81,6 , iv iç kalite kontrol sonuçlarının gözden geçiriliyor olması %82,2 , v ADT için standart yöntemlerden herhangi birinin kullanılıyor olması %95,8 , vi ADT sonuçlarının yorumu için standart rehber kullanılması %94,2 vii sonuçların tutarlılığının değerlendirilmesi %96,9 şeklindedir. 259 laboratuvardan 173’ü skor belirleme sorularının tümüne cevap vermiş olup, bu laboratuvarların skor değerleri 4-7; 8-11 ve 12-15 olacak şekilde gruplandırılmıştır. Laboratuvarlardan 43/173 %24,8 ’ünün 12-15 skor grubuna dahil olduğu görülmüştür. Üniversite hastaneleri ve eğitim ve araştırma hastanelerinin büyük bir kısmı 12-15 arası skor puanı alırken sırasıyla %64,9 ve %53,3’ü , devlet hastanelerinin büyük bir bölümünün 4-7 %50 ve 8-11 %47,2 arası skor puanı aldığı belirlenmiştir. Sonuç: UAMDSS için katılımcı laboratuvar belirlerken; skor değerinin yüksek olması, Türkiye İstatistikî Bölge Birimleri Sınıflandırması’na göre belirlenen 12 bölgeye olabildiğince eşit dağılması ve üniversite, eğitim araştırma ve devlet hastanelerini içerecek şekilde olması dikkate alınmıştır. Buna göre UAMDSS’ye güvenilir veri sağlayabilecek katılımcı 78 laboratuvar seçilmiştir.

Anahtar Kelimeler

Antimikrobiyal direnç, sürveyans

Performance evaluation of the microbiology laboratories in Turkey for culture and antibiotic susceptibility tests and the selection of laboratories to provide data for National Antimicrobial Resistance Surveillance System: Questionnary application

Öz

Objective: Due to the increase in of the antimicrobial resistance problem, in our country, the studies to establish National Antimicrobial Resistance Surveillance System NAMRSS was started. It is important to provide reliable data for the laboratories those will be included in NAMRSS. For this purpose, a questionnaire was applied to evaluate the culture and antimicrobial susceptibility tests performance capacities AST of the laboratories in the country. Method: This study was done between 2009 and 2010 years, and included 90 queries which were focused on the capacities of microbiology laboratories to perform culture and AST. The questionnaires were sent to medical microbiology laboratories of 354 public hospitals, where the presence of a specialist knowledge is achieved by TR Ministry of Health. Results were analysed by using SPSS 18.0 statistical program. Results: Three hundred twenty two laboratories replied the questionnaire among which were 70.5% state hospital, 16.5% training and research hospital and 13% university hospital laboratories. The number of laboratories which have positive reply to all three questions which are the first stage of the selecton criteria; presence of microbiolog specialist 99.1% ,presence of bacteriology laboratory 97.5% and performance of blood culture 83.6% , were 259 80.4% and they were included in further evaluation. The queries and percentage of the replies used for the second stage were: i The number of AST performed to be more than the average monthly number for Escherichia coli mean: 74.7 , Klebsiella spp. mean: 22.9 , Staphylococcus aureus mean: 19.6 , Pseudomonas aeruginosa mean: 19.5 , Enterococcus spp. mean: 16.1 and Streptococcus pneumoniae mean: 3.7 , ii performance of AST when a microorganism that is generally accepted as clinically significant or significant for the patient from whom the microorganism was isolated; 49.2% and 30.2% for blood culture, and 88.7% and 75.5% for CSF, respectively, iii the presence of standard operating procedures for AST 81.6% , iv revising the internal quality control results 82.2% , v usage of any of the standard methods for AST 95.8% , vi using standard guidelines for the interpretation of results 94.2% , and vii the evaluation of the consistency of the results 96.9% . Among 259 laboratories 173 of them replied all the queries for score determination, and these laboratories were grouped as 4-7; 8-11 and 12-15 according to their scores. Among 173 laboratories, 43 of them were found to be involved in the group 12- 15 score. While most of the teaching and research hospitals and university hospitals received score 12-15 points 64.9% and 53.3% respectively , most of the state hospitals received 4-7 50% and 8-11 47.2% score points. Conclusion: For the determination of participant laboratories; having a high score, equally distribution in 12 regions determined by Turkey Statistical Classification of Territorial Units include university, training and reserach and state hospitals were taken into consideration. Accordingly 78 laboratories which can provide reliable data for NAMRSS were chosen as participant

Anahtar Kelimeler

Drug resistance microbial, surveillance

Kaynakça

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