Burcu Çalışkan Demirkıran, Mine Filiz, Sümeyye Köşger, Aysun Yalçı, Zehra Karacaer, Cumhur Artuk, Hatice Yağmurdur, Ahmet Coşar, Kemal Tekin, Mehmet Ağıll, İsmail Yaşar Avcı

Kan Dolaşımı Enfeksiyonlarında Etken Mikroorganizma ile Akut Faz Reaktanları Arasındaki İlişkinin İncelenmesi

Amaç: Kan dolaşımı enfeksiyonlarında erken tanı ve hedefe yönelik tedavi mortalite üzerinde belirleyici faktörlerdir. Kan kültürleri sonuçlanana kadar geçen zamanda uygun tedavinin kararında C-reaktif protein (CRP) ve prokalsitonin (PCT) katkı sağlayabilmektedir. Bu çalışmada kan kültüründe üreyen etkenlerin gram özelliklerine göre CRP ve PCT arasındaki ilişkinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Haziran 2017-Aralık 2019 tarihleri arasında yoğun bakım ünitesinde kan dolaşımı enfeksiyonu tanısıyla takip edilen hastaların kan kültürü üremeleri ve kültür alımından 24 saat öncesi veya sonrasına ait CRP ve PCT değerleri retrospektif olarak incelendi. Etken mikroorganizmalar gram özelliklerine göre ayrılarak CRP ve PCT değerleri kıyaslandı. Bulgular: Çalışmaya dahil edilen 123 hastada 348 kan kültüründe etken mikroorganizma üremesi incelendi. Gram-negatif etkenlerde ortanca CRP 136 mg/L iken Gram-pozitif etkenlerde ortanca CRP 109,5 mg/L olarak saptandı (p=0,024). Yine Gram-negatif etkenlerde ortanca PCT 1,4 ng/mL iken Gram-pozitif etkenlerde 0,81 ng/mL olarak saptandı (p=0,041). Sonuç: Çalışmamızda Gram-negatif etkenlerin neden olduğu kan dolaşımı enfeksiyonlarında Gram-pozitif etkenlere kıyasla daha yüksek CRP ve PCT düzeyleri saptanmıştır. Kültür üremesi sonuçlanana kadar geçen zamanda enflamatuvar belirteçlerle etken mikroorganizmanın öngörülmesi ve uygun ampirik tedavinin başlanması düşünülebili

Investigation of the Relationship Between Acute Phase Reactants and Causative Microorganisms in Blood Stream Infections

Objectives: Early diagnosis and targeted therapy are the determinants of mortality in bloodstream infections. In the time until the blood cultures are finalized, C-reactive protein (CRP) and procalcitonin (PCT) can contribute to the decision of the appropriate treatment. In this study, it was aimed to evaluate the relationship between CRP and PCT according to gram characteristics of factors grown in blood culture. Materials and Methods: Blood culture results, CRP and PCT values of the patients who were followed up with the diagnosis of bloodstream infection in the intensive care unit between June 2017 and December 2019, 24 hours before or after the culture collection, were retrospectively analyzed. Causative microorganisms were separated according to their gram characteristics and their CRP and PCT values were compared. Results: Causative microorganisms in 348 blood cultures of 123 patients included in the study were examined. While the median CRP was 136 mg/L in Gram-negative agents, the median CRP was found as 109.5 mg/L in Gram-positive agents (p=0.024). While the median PCT was 1.4 ng/mL in Gram-negative agents, it was found to be 0.81 ng/mL in Gram-positive agents (p=0.04 Conclusion: Higher CRP and PCT levels were found in bloodstream infections caused by Gram-negative agents compared to Gram-positive agents in our study. Prediction of the causative microorganism with inflammatory markers and initiation of appropriate empirical treatment may be considered in the period until the culture results is completed.

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