Zehra Çağla KARAKOÇ, Taner BEKMEZCİ, Ahmet BAŞEL, Binnur PINARBAŞI ŞİMŞEK

LİBYA İÇ SAVAŞ YARALANMALARININ ÇOKLU DİRENÇLİ BAKTERİLERLE OLAN İNFEKSİYONLARI: NE ÖĞRENDİK?

Amaç: Savaş yaralanmalarında gelişen yara yeri enfeksiyonlarında; geç dönemde nozokomiyal bulaş ve empirik uygulanan geniş spektrumlu antibiyoterapiler nedeniyle dirençli gram negatif mikroorganizmalar sorumlu etken olarak karşımıza çıkmaktadır. Çalışmamızda Libya’dan hastanemize transfer edilen 45 sivil savaş yaralanmalı olgunun demografik, klinik ve mikrobiyolojik özelliklerinin retrospektif olarak araştırılması amaçlanmıştır. Gereç ve Yöntem: Dirençli bakteri kolonizasyonlarını saptamak amacı ile sürveyans kültürleri (burun, rektal, idrar, yara, endotrakeal aspirat, kan kültürü) alınmış ve üreyen mikroorganizmalar ve antibiyotik duyarlılıkları VITEK® 2 (bioMérieux, Marcy l’Etoile, Fransa) otomatize sistemi ile tanımlanmıştır. Bulgular: Toplam 45 hastanın ortalama yaşı 30,7±12,9 olup, 44’ü (%97,8) erkekti. Yaralanmaların çoğunluğu (%66,7) ateşli silah yaralanmasıydı ve 22’si (%48,9) alt ekstremitedeydi. Hastaların 30’unda (%66) açık kemik kırığı ve 28’inde (%62,2) primer yara yeri infeksiyonu vardı. Surveyans kültürlerinde 29 hastada 40 mikroorganizma üremesi saptandı ve bunların 22’si (%55) gram-negatif çomak, 17’si (%42,5) gram-pozitif kok ve 1’i (%2,5) mantardı. İzole edilen mikroorganizmaların 13’ünde (%32,5) direnç saptanmazken; 10’unda (%22,2) çoklu ilaç direnci (ÇİD), 13’ünde (%28,9) ise genişletilmiş ilaç direnci (GİD) saptandı. Hiçbir hastada mortalite gelişmedi. Sonuç: Çalışmamızda; savaş yaralanması nedeni ile kabul edilen olgulara ait tek merkez deneyimimiz paylaşıldı. Çoğu hastanın ÇİD/GİD bakterilerle infekte veya kolonize oldukları görüldü. Olgularımızın genç ve komorbiditelerinin bulunmaması, tedavide uzun süreli antibiyoterapilerin kullanımına olanak sağlarken, sık yara debritmanı ve negatif basınçlı yara kapama tedavisinin de iyi sonuçlarımıza katkıda bulunduğu düşünüldü. Savaş yaralanmalarında; erken cerrahi debritman, uygun doz ve spektrumda antibiyotik uygulamaları, gerekli durumlarda yara yeri ve surveyans kültürlerinin alımı ile sonuçlar yüz güldürücü olabilmektedir.

Anahtar Kelimeler:

Çoklu ilaç direnci, Libya, savaş

MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?

Objective: Complicated by nosocomial infections and wide spectrum antibiotherapy, combat related injuries (CRI) are associated with resistant gram-negative microorganisms, especially at the later stage. The aim of this study is to retrospectively investigate demographic, clinical and microbiologic characteristics of 45 CRI patients transferred from Libya and hospitalized in a private clinic. Material and Method: Surveillance cultures (nasal, rectal, wound swabs, trakeal aspirates, urine and blood cultures) were obtained and isolated bacteria and their antibiotic susceptibility were identified using VITEK® 2 system (bioMérieux, Marcy l’Etoile, France). Results: The median age of 45 patients (44 [97.8%] male) was 30.7±12.9 years. The majority of the injuries were due to firearms (66.7%) and 22 (48.9%) patients were injured on the lower extremities. Open bone fractures were present in 30 (66.6%) patients. Primary wound site infection was present in 28 (62.2%) patients. Surveillance cultures revealed 40 microorganisms from the samples of 29 patients, which were gram-negative rods in 22 (55%), gram-positive cocci in 17 (42.5%) and fungus in 1 (2.5%) patients). Of the 40 isolated microorganisms, 13 (32.5%) were non-resistant, 10 (22.2%) were MDR, and 13 (28.9%) were XDR. None of the patients died in the study period. Conclusion: Despite the limited number of cases, this study presents the characteristics of the Libyan combat victims treated by a multidisciplinary team at a single center. Surveillance cultures revealed many victims to be infected or colonised by MDR/ XDR bacteria. Early surgical wound debridement, early initiation of antibiotic therapy in the proper dose and spectrum, and obtaining wound site cultures whenever necessary may help to provide more favorable outcomes in CRI victims.

Keywords:

Combat extensively drug resistant, Libyan, multidrug-resistant,

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