GENİŞLEMİŞ SPEKTRUMLU BETA-LAKTAMAZ SALGILAYAN KLEBSIELLA PNEUMONIAE VE ESCHERICHIA COLI’YE BAĞLI BAKTERİYEMİLERDE MORTALİTE İLE İLİŞKİLİ RİSK FAKTÖRLERİNİN BELİRLENMESİ VE AMPİRİK PİPERASİLİN- TAZOBAKTAM İLE KARBAPENEM TEDAVİSİ SONUÇLARININ KARŞILAŞTIRILMASI

Son yıllarda genişlemiş spektrumlu beta-laktamaz (GSBL) salgılayan Gram negatif enterik bakterilerin görülme sıklığı artmaktadır. Bu bakterilere bağlı ciddi enfeksiyonlarda öncelikle karbapenem grubu antibiyotikler önerilmesine rağmen son yıllarda piperasilin-tazobaktam (PTZ) gibi ajanlar alternatif tedaviler arasında gösterilmektedir. Çalışmamızda GSBL pozitif Escherichia coli ve Klebsiella pneumoniae bakteriyemisi nedeniyle PTZ veya karbapenem tedavisi almış olan olgularda mortalite oranları arasında anlamlı "bir fark olup olmadığı eşlik eden hasta risk faktörleri ile birlikte araştırılmıştır".Hastanemizde Ocak 2015-Haziran 2017 tarihleri arasında, GSBL pozitif E.coli ve K.pneumoniae bakteriyemisi tespit edilip karbapenem veya PTZ tedavisi almış olan 94 yetişkin hasta çalışmamıza dahil edilmiştir. Hastalarda yaş, cinsiyet, eşlik eden hastalıklar, enfeksiyonun sağlık bakımı ile ilişkili olup olmadığı, travma öyküsü, son üç ayda hastaneye yatış öyküsü, santral kateter varlığı, mekanik ventilasyon, total parenteral nütrisyon (TPN) uygulanması, kan veya kan ürünü transfüzyon öyküsü, son bir ayda antibiyotik kullanımı, bakteriyemi sırasındaki toplam yatış günü gibi mortaliteyi etkileyebilecek risk faktörleri incelenmiştir. Hastaların olası enfeksiyon kaynakları, bakteriyemiden itibaren 7. gün ve 30. gündeki mortaliteleri, kan kültürlerinde üreyen bakterilerin karbapenem ve PTZ duyarlılıkları araştırılmıştır. Bakteriyemi saptanan 94 hastanın 61'inde (% 64.9) K.pneumoniae ve 33'ünde (% 35.1) E.coli izole edilmiştir. Ampirik tedavide 54 hastaya (% 57) PTZ, 40 (% 43) hastaya karbapenem grubu antibiyotik başlanmıştır. Bu iki farklı antibiyotik grubunda 7. ve 30. günde mortalite oranları arasında anlamlı fark görülmemiştir. K.pneumoniae'ya bağlı bakteriyemilerde mortalite oranı daha yüksek görünmekle birlikte E.coli bakteriyemisi ile aradaki fark istatistiksel olarak anlamlı bulunmamıştır. Tek değişkenli analizde yedi günlük mortalite üzerine anlamlı etkisi olan durumların; hematolojik malignite (p=0.008), TPN almış olmak (p=0.009), son 30 gün içerisinde antibiyotik almış olmak (p=0.009) ve ağır sepsis veya septik şok gelişmesi (p

Determination of the Risk Factors Associated with Mortality in Bacteraemia due to Extended Spectrum Beta-lactamase Producing Klebsiella pneumoniae and Escherichia coli and Comparison of Empirical Piperacilin-Tazobactam Versus Carbapenem Treatment

In recent years, the incidence of extended spectrum beta-lactamase (ESBL) producing Gram negative Enterobacteriaceae is increasing. Although carbapenems are recommended primarily for serious bacterial infections, agents such as piperacillin-tazobactam (PTZ) have been shown among alternative therapies in recent years. In our study difference in mortality rates between patients treated with piperacillin-tazobactam or carbapenem, with associated risk factors, due to ESBL positive Escherichia coli and Klebsiella pneumoniae bacteremia was investigated. In our hospital, 94 adult patients with ESBL positive E.coli and K.pneumoniae bacteremia that had received carbapenem or PTZ treat- ment between January 2015 and June 2017, were included into the study. Risk factors that may affect mortality such as age, gender, co-morbid diseases, health care related infections, trauma history, history of hospitalization in the last three months, presence of central catheter, mechanical ventilation, total parenteral nutrition (TPN), blood or blood product transfusion, antibiotic use within one month, total hospitalization day at the time of bacteremia were investigated. Probable sources of infection, carbapenem and PTZ susceptibilities of bacterial isolates, mortality rates on the 7th day and 30th day from the detection of bacteremia were investigated. In 61 (64.9 %) patients K.pneumoniae and in 33 (35.1 %) patients E.coli were isolated. Empirical PTZ and a carbapenem were star- ted in 54 (57 %) and 40 (43 %) patients respectively. Difference of mortality rates at 7th and 30th days were not statistically significant between two groups. Although mortality rates at 7th and 30th days were higher in K.pneumoniae bacteremia than in E.coli bacteremia, the difference was also not statistically significant. Univariate analysis of factors that had significant effect on seven-day mortality rates were; hematological malignancy (p = 0.008), receiving TPN (p = 0.009), receiving antibiotics within the last 30 days (p = 0.009) and having seve- re sepsis or septic shock (p

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