Apendektomi yapılan hastaların kültür ve antibiyotik duyarlılıkları, antibiyotik seçimleri ve klinik duruma etkileri

Giriş: İntraabdominal infeksiyonlar genellikle antibiyotik tedavisinin ampirik olarak başlandığı infeksiyonlardır. Artan antibiyotik direnci ampirik antibiyotik seçiminde önemlidir. Doğru antibiyotik seçiminde toplumumuzdaki mevcut direnç durumunun bilinmesi gereklidir. Güncel rehberlerde sadece antibiyotik tedavisi ile tedavi edilmesi önerilen apandisit olguları bulunmaktadır. Bu durum ampirik antibiyotik tedavi uygunluğunun önemini daha da arttırmaktadır. Bu çalışmada hastanemizde apendektomi yapılan hasta grubunda ameliyat materyalinde üreyen etken bakteriler ve direnç durumları araştırılmıştır. Sonuçlar, başlanılan ampirik antibiyotik tedavi seçimleri ve hastaların klinik durumları ile karşılaştırılmıştır. Materyal ve Metod: Hastanemizde Haziran 2015-Haziran 2017 tarihleri arasında apandisit nedeniyle opere edilen hastalardan operasyon sırasında doku örneği kültürleri alınabilmiş olanlar çalışmamıza dahil edildi. Hastaların başlanmış olan antibiyotik tedavileri, demografik özellikleri kayıt altına alındı. Operasyon sırasında alınan doku örnekleri mikrobiyoloji laboratuvarımız tarafından aerobik kültür ekimi yapılarak incelendi. Üreyen bakterilerin antibiyotik duyarlılık testleri EUCAST standartlarına uygun olarak disk difüzyon yöntemi ile çalışıldı. Vitek 2 (BioMerieux, Fransa) otomatize identifikasyon sistemi kullanılarak bakteri identifikasyonu yapıldı. Bulgular: Toplam 90 hasta çalışmamıza dahil edilmiştir. Bu hastaların 54 (%60.0)’ü erkekti. Ortalama yaş 29.5 ± 9.08 (16-51) idi. Alınmış olan kültürlerden 31 (%34.4)’inde üreme olmamıştır. Üreme olan doku kültürlerinde en sık üreyen mikroorganizma (51/90, %69.9) Escherichia coli idi. Genişlemiş spektrumlu beta-laktamaz (GSBL) üreten gram-negatif bakteri izole edilme oranı 17 (%18.9) idi. On iki hastada kültürde birden fazla bakteri üremiştir. Ampirik antibiyotik tedavisi olarak 20 (%22.2) hastaya sefazolin ve metronidazol kombinasyon tedavisi, 65 (%72.2) hastaya ise seftriakson ve metronidazol kombinasyon tedavisi başlanmıştır. En sık başlanılan antibiyotik olan seftriaksona duyarlılık oranı %63.4 olarak saptanmıştır. Sonuç: Hastalardan alınan doku kültürlerinin üçte birinde bakteri üremesi saptanmadı. GSBL pozitif gram-negatif bakteri üreme oranı %18.9 idi. Ampirik olarak başlanan antibiyotik tedavilerinin hiçbiri GSBL pozitif bakterilerde etkili değildi. Bu çalışmada hastalarımızın tamamında apendektomi uygulandığından etken bakterilerdeki direnç oranları, ampirik tedavi seçimleri GSBL pozitif bakteri üreyen hastalara uygun olmasa da tedavi başarısızlığı olarak klinik pratiğe yansımadı. Ancak yaygın intraabdominal infeksiyonu olan hastalarda ve sadece antibiyotik tedavisi ile tedavi edilen apandisit hastalarında uygunsuz ampirik antibiyotik seçimleri klinik tedavi başarısızlığına sebep olabilir

In Our Intensive Care Unit the Experience of the Checklist Use to Prevent Ventilator Associated Pneumonia

Objective: Intensive care units are high risk units for serious infections like ventilator associated pneumonia. Preventing ventilator associated pneumonia is one of the most important infection control practice in intensive care units. In this study, it was aimed to investigate the effect of the ventilator associated pneumonia prevention checklist use in decreasing ventilator associated pneumonia rates. Material and Method: This study was performed in the intensive care units at Yenimahalle Training and Research Hospital between January 2013 and September 2013. In the first 3 months, the routine infection control measurements were used. At the end of this term a lecture about using the checklist was given to the nurses. At the second 3 months period, the checklist was filled by each patient’s nurse. At the last 3 months period there was no checklist use. The ventilator associated pneumonia rates were registered in all these terms. After and before the intervention term tests about ventilator associated pneumonia prevention with 20 questions were given to the nurses. Results: Between January to March 2013, at the first 3 months, ventilator associated pneumonia rate was 38.2%; at the second term, it was 7.4%; at the third term, it was 3.8%. At the front test, the nurses got 84.5 point success rate and at the last test, the rate was 92.6. The success rate differences between these two tests were statistically significant with the Wilcoxon test (z-3.4, p=0.001). Conclusion: At the end of this study, despite any changes in the other routine and patient population, it was seen that there were obvious decrease in the ventilator associated pneumonia rates during the intervention term and the term after the intervention. Also the checklist use increased the nurses’ knowledge level about the ventilator associated pneumonia prevention and hand hygiene adherence rate

Apendektomi Yapılan Hastaların Kültür ve Antibiyotik Duyarlılıkları, Antibiyotik Seçimleri ve Klinik Duruma Etkileri

Introduction: Generally, intraabdominal infections are infections where antibiotic therapy is initiated empirically. Increasing antibiotic resistance is important regarding empirical antibiotic selection. Current resistance status among the causative bacteria in the community must be known to make the correct selection. In current treatment guidelines, some appendicitis patients are treated with only antibiotic therapy. In these situations, empirical treatment choices are even more important. In this study, the causative bacteria cultured from intraoperative tissue samples of acute appendicitis patients and their antimicrobial susceptibility patterns were investigated. The results were compared with empirical antimicrobial selections and clinical outcome of the patients. Materials and Methods: Appendix tissue cultures taken intraoperatively from acute appendicitis patients between June 2015 and June 2017 in our hospital were included into the study. Antibiotic treatments and patient demographics were recorded. Aerobic cultures of the tissue samples taken during the operation were performed in our microbiology laboratory. Antibiotic susceptibility tests of the bacteria were performed by disk diffusion method, according to the EUCAST standards. Bacterial identification was done by using the Vitek 2 (BioMerieux, France) automated identification system. Results: A total of 90 patients were included into the study. Fifty-four (60.0%) of these patients were males, and mean age was 29.5 +/- 9.08 (16-51). Thirty-one (34.4%) of the tissue sample cultures did not grow any bacteria. Escherichia coli was the most common, (51/90, 69.9%) isolated microorganism. Extended-spectrum beta-lactamase (ESBL) producing gram-negative bacterial growth rate was 17 (18.9%). Twelve patients grew more than one bacterium in the culture. As empirical antibiotic therapy, twenty (22.2%) patients received cefazolin and metronidazole and 65 (72.2%) patients received ceftriaxone and metronidazole. The susceptibility rate of ceftriaxone, which was the most commonly used antibiotic, was 63.4%. Conclusion: One-third of the tissue cultures did not grow any bacteria. ESBL positive gram-negative bacteria growth rate was 18.9%. Neither of the empirical treatment regimens initiated was effective for infections caused by ESBL-producing bacteria. Since all of our patients were appendectomized patients, antimicrobial resistance did not cause any clinical treatment failures although empirical treatment choices were not suitable for patients whose cultures grew ESBL positive bacteria. However, among patients with widespread intraabdominal infection and in patients who are treated conservatively only with antibiotic therapy, unsuitable empirical treatment choices may cause clinical treatment failures