Ali Korhan SIĞ, Diğdem ÖZER YILDIRIM, Başak GÖL SERİN, Mustafa GÜNEY

Negatif Kan Kültürlerinin Uzatılmış İnkübasyonu Fungal Pozitiflik Verebilir Mi?

Amaç: Standart kan kültürü azami 5-7 günde sonuçlanmaktadır. Çalışmanın amacı, kültür negatif şişelerin uzatılmış inkübasyonu ile mikolojik üreme olup olmayacağının araştırılmasıdır. Gereç ve Yöntem: Atatürk Şehir Hastanesi’nde bir yıl boyunca erişkin hastaların kan kültürleri Render BC Sistemi (Render Biotech Co. Ltd., Çin) ile çalışmaya dahil edildi. Kan kültürlerinden randomize seçilmiş şişelerin (A grubu) inkübasyonu haftalık geleneksel ekimlerle 30 güne tamamlandı. Muhtemel/Olası invazif fungal enfeksiyonu (IFI) olan, ampirik/preemptif antifungal alanların negatif şişeleri ayrıca değerlendirilmiştir (B grubu). Üremelere PhoenixTM 100 sistemi (Becton Dickinson, ABD) ve mısırunu tween 80 agarla (RTA Laboratories, Türkiye) tanımlama, CLSI disk difüzyonla antifungal duyarlılık yapılmıştır. Bulgular: Toplam 6047 kan kültürü seti (%23.06 pozitif) işlendi. Randomize seçilmiş 1040+122 negatif set (sırasıyla A ve B grupları) çalışmaya alındı. A grubunda fungal üreme olmazken, B grubunda (flukonazol-200 mg/gün≤48 saat) 2 sette anlamlı fungal üreme oldu (7-9. günler)(Candida glabrata kompleks). Flukonazol için, bir izolat doza bağımlı duyarlıyken, diğeri dirençliydi. Takip eden ikinci setleri normal sürede pozitif verdi. Sonuç: Kan kültürlerinin izolasyon kapasitesi ile optimizasyonu IFI tanısında kritik önemdedir. Mikroorganizmaların %99’unun tespiti için uygun hacimde en az iki set kan kültürü alınması gerektiğinden, takip eden setlerin normal süreçte pozitif vermesi sebebiyle, üremeler “uzamış pozitif” olarak değerlendirilmedi. Standart inkübasyon süreci tatmin edici olarak kabul edildi.

Anahtar Kelimeler:

invazif fungal enfeksiyonlar, mantarlar, Candida, sepsis

Can Prolonged Incubation of Negative Blood Cultures Show Fungal Positivity?

Objective: Standard duration of one set blood culture (BC) is a maximum of 5-7 days. The aim of this study was to evaluate “culture-negative” vials with a prolonged incubation (max 30 days) time and to observe any mycological growth. Materials and Methods: Routine BCs obtained from adult patients of Balıkesir Atatürk City Hospital for a year period were included. Render BC System BC128 (Render Biotech Co. Ltd., Shenzhen, China) were used. Randomly selected vials were re-incubated for additional three weeks by conventional methods. In case of any growth, identifications were done by PhoenixTM 100 system (Becton Dickinson, MA, USA) with cornmeal tween 80 agar (RTA Laboratories, Kocaeli, Türkiye). Antifungal susceptibility testing was applied with CLSI disk diffusion method. Results: A total of 6047 BC sets were obtained and randomly chosen 1040+122 negative sets (A and B groups, respectively) were included. In group A, none of them had fungal growth. In B (ongoing empiric antifungal ≤48h), only 2 sets showed significant fungal growth, which were observed in 7±2 days, and all strains were identified as Candida glabrata complex and these patients were on empiric fluconazole (200 mg/day). One isolate was susceptible dose dependent; the other one was resistant for fluconazole. Latter sets of these fungemia patients showed positive signals in routine incubation period. Conclusion: Invasive fungal infections are increasingly encountered and isolation capacity and optimization of BCs are crucial. In this study, it was obviously observed that standard incubation period is satisfactory in order to detect almost all fungemia.

Keywords:

invasive fungal infections, fungi, Candida, sepsis,

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