Yücel DUMAN, Yusuf YAKUPOĞULLARI, Mehmet Sait TEKEREKOĞLU, Nilay GÜÇLÜER, Barış OTLU

A Three years retrospective analysis of agents isolated from cerebrospinal fluid in a University Hospital

Amaç: Bu çalışmada, hastanemizde üç yıllık dönemde beyin omurilik sıvısından (BOS) izole edilen ajanların geriye dönük analizi yapıldı. Gereç ve yöntem: Eylül 2008 ile Eylül 2011 yılları arasında laboratuvarımıza BOS örneği gönderilmiş olan hastaların sonuçları retrospektif olarak incelendi. Soyutlanan bakteri türleri konvansiyonel yöntemler, biyokimyasal testler ve/veya Phonix (BD, US) ticari identifikasyon sistemleri kullanılarak tanımlandı. Elde edilen türlerin antimikrobiyal du-yarlılık testleri Clinical Laboratory Standards Institute (CLSI) önerileri doğrultusunda çalışıldı. Bulgular: Toplam 1408 hastaya ait BOS örneğinden 11 Streptococcus pneumoniae, 8 Klebsiella pneumoniae, 7 Pseudomonas aeruginosa, 7 Acinetobacter baumannii, 5 Escherichia coli, 4 Enterococcus spp., 2 Enterobacter spp., 25 koagülaz negatif stafilokok, 1 Morganella morganii, 2 Neisseria meningitidis, 1 Brucella spp., ve 1 Candida albi-cans olmak üzere toplam 74 (%5.2) üreme saptandı. Yapılan antibiyotik duyarlılık testinde 2 S.pneumoniae suşunda penisilin direnci saptanırken; bir E.coli ve iki K.pneumoniae suşunda genişlemiş spektrumlu beta-laktamaz (GSBL); üç acinetobacter ve bir pseudomonas suşunda ise karbapenem direnci saptandı. Sonuç: Farklı bölgelerde ve hasta topluluklarında etken ve antimikrobiyal direnç epidemiyolojisinin belirlenmesi koru-yucu ve tedavi edici sağlık politikaların yapılandırılmasında faydalı olacaktır.

Anahtar Kelimeler:

Menenjit, beyin omurilik sıvısı, antimikrobiyal duyarlılık

A Three years retrospective analysis of agents isolated from cerebrospinal fluid in a University Hospital

Objectives: In this study, we aimed to investigate the agents which were isolated from cerebrospinal fluid (CSF) samples in our hospital for three years, retrospectively. Materials and methods: The CSF samples, which were sent our laboratory, of the patients those had presumptive diagnosis of meningitis between September 2008 and September 2011 were included into the study. Isolated bacte-ria were identified with conventional methods, biochemical tests and/or Phonix (BD, US) kits. Antimicrobial suscepti-bility of the strains were investigated according to Clinical Laboratory Standards Institute (CLSI) recommendations. Results: 11 Streptococcus pneumoniae, 8 Klebsiella pneumoniae, 7 Pseudomonas aeruginosa, 7 Acinetobacter baumannii, 5 Escherichia coli, 4 Enterococcus spp., 2 Enterobacter spp., 25 Coagulase-negative staphylococcus, 1 Morganella morganii, 2 Neisseria meningitidis, 1 Brucella spp., and 1 Candida albicans were isolated (overall n:74; 5.2%) from total 1408 CSF samples. In susceptibility test, 2 S.pneumonia was found as penicillin-resistant, and one E.coli and two K.pneumoniae were found as extended spectrum of beta-lactamase producers. Additionally, carbap-enem resistance was detected in three A.baumannii and one P.aeruginosa strains. Conclusion: Determination of agent profile and antimicrobial resistance pattern from different localizations and pa-tients\' groups will help to improve protective and therapeutic health policies.

Keywords:

Meningitis, cerebrospinal fluid, antimicrobial susceptibility.,

PDF

___

Ross KL: Bacterial meningitis, “Ross KL (ed): Central Nervous System Infectious Disease and Therapy, Marcel Dekker Inc., New York .1997: 99-126.
Tunkel AR, Scheld WM. Acute meningitis. In: Mandell GL, Douglas RG, Bennett JE, eds. Mandell, Douglas and Bennett.s Principles and Practice of Infectious Diseases. Sixth ed. New York: Churchill Livingstone, 2005:1083- 126.
Silva WA, Pinheiro AM, Coutinho LG, Marinho LAC, Lima LFA. Epidemiological profile of acute bacterial meningitis in the State of Rio Grande do Norte, Brazil. Rev Soc Bras Med Trop 2010; 43(4): 455-7.
Özdemir H, Tapısız A, Çiftçi E, İnce E, Doğru Ü. Çocuklarda akut bakteriyel menenjit. Çocuk Enf Derg 2010;4(1):9-14.
Segreti J, Harris AA. Acute bacterial meningitis. Infect Dis Clin North Am 1996; 10(6): 797-809.
Traore Y, Tameklo TA, Njanpop-Lafourcade BM et al. Inci- dence, seasonality, age distribution and mortality of pneu- mococcal meningitis in Burkina Faso and Togo. Clin Infect Dis 2009;48(2): 181-9.
Pehlivanoğlu F, Yaşar KK, Şengöz G. Beyin omurilik sivisin- dan izole edilen mikroorganizmalar ve antibiyotik duyarlı- lıkları. ANKEM Derg 2011;25(1):1-5.
Heyderman RS, Lambert HP, O’Sullivan I et al: Early man- agement of suspected bacterial meningitis and meningo- coccal septicaemia in adults. J Infect 2003;46(2):75-7.
Clinical and Laboratory Standards Institute.2008.Perfor- mance Standards for Antimicrobial Susceptibility Testing. eighteenth informational supplement ; CLSI, Wayne, PA
World Health Organization: Initiative for vaccine research. Bacterial Infections. 2009 [http://www.who.int/vaccine_re- search/diseases/ soa_bacterial/en/index2.html]. WHO, Ge- neva.
World Health Organization: Control of epidemic meningo- coccal disease. 1999. Who, Geneva.
Schut ES, Gans J, van de Beek D. Community-acquired bacterial meningitis in adults. Review. Pract Neurol 2008; 8(1): 8-23.
Harrison LH. Prospects for vaccine prevention of meningo- coccal infection. Clin Microbiol Rev. 2006; 19(1): 142-64.
Saez-LIorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet 2003; 361(9375): 2139-48.
Neuman HB, Wald ER. Bacterial meningitis in childhood at the Children’s Hospital of Pittsburgh: 1988-1998. Clin Pediatr (Phila) 2001; 40(11): 595-600.
Brouwer MC, Tunkel AR, Beek D. Epidemiology, diagno- sis, and antimicrobial treatment of acute bacterial meningi- tis. Clin Microbiol Rev 2010;23(3): 467-92.
Centers for Disease Control and Prevention. 2008. Progress in introduction of pneumococcal conjugate vaccine-world- wide, 2000-2008. MMWR Morb Mortal Wkly Rep 57(42): 1148-51.
Esel D, Doğanay M, Alp E, Sumerkan B. Prospective eval- uation of blood cultures in a Turkish university hospital: epidemiology, microbiology and patient outcome. Clin Mi- crobiol Infect 2003; 9(10): 1038-44.
Yurdakul AS, Calisir HC, Atasever M, Ordulu L, Ogreten- soy M. Resistance to penicillin among the Streptococcus pneumoniae in Turkey. Eur Respir J 2001; 18(2): 436.
Zarakolu P, Soyletir G, Gur D, Unal S. Antimicrobial resis- tance patterns of respiratory pathogens: a local report from Turkey. Clin Microbiol Infect 2003; 9(12): 1257-8.
Fırat M, Ersoy Y, Esel D, Bayraktar M, Caylan R, Durmaz R. Antimicrobial susceptibility and serotype distribution of pneumococci strains isolated from meningitis patients. Mi- krobiyol Bult 2006;40(3):169-77.
Durand ML, Calderwood SB, Weber DJ et al: Acute bacte- rial meningitis in adults. A review of 493 episodes, N Engl J Med. 1993;328(1):21-8.
Sümer Z, Bakıcı Z, Özüm Ü Menenjit Ön Tanılı Hastaların BOS Örneklerinin Bir Yıllık Bakteriyolojik İnceleme So- nuçlarının Değerlendirilmesi. C.Ü. Tıp Fakültesi Dergisi 2000; 22(3): 127-30.
Bulut C, Tekiner A, Yetkin M.A, Hatipoğlu C A, Bayar M.A, Tulek N. Beyin Cerrahi Girişimleri Sonrası Gelişen Hastane Kokenli Menenjitlerin Değerlendirilmesi. Hastane İnfeksiyonları Dergisi 2005; 9(4): 218-24.
Palabıyıkoğlu I, Tekeli E, Cokca F et al. Nosocomial menin- gitis in a university hospital between 1993 and 2002. Hosp Infect 2006;62(1):94-7.
Saba R, İnan D, Günseren F, Özçelik FT, Mamıkoğlu L: Ak- deniz Üniversitesi Hastanesi’nde nozokomiyal menenjitler. Hastane İnfeksiyon Derg 2000;4(1):47-50.
Sarguna P, Lakshmi V. Ventriculoperitoneal shunt infec- tions. Ind J Med Microb 2006;24(1):52-4.
Güçlü AÜ, Kılıç A, Küçükkaraaslan A ve ark. Beyin omuri- lik sıvılarından izole edilen mikroorganizmalar ve antibiyo- tik duyarlılıkları. Gülhane Tıp Dergisi 2005;47(2): 204-8.