Tuncer TUĞ, Muhammet Güzel KURTOĞLU, Mustafa BEHÇET, Fatma AVCIOĞLU, Emine ÖZSARI

KOAH Akut Atak Nedeniyle Yatan Hastalarda Bakteriyel Enfeksiyon Etkenleri, Antibiyotik Direnci ve Komorbiditenin Araştırılması

Amaç: Kronik obstruktif akciğer hastalığı (KOAH) akut ataklarının yaklaşık %50’sinden bakteriyel enfeksiyonlarsorumludur. Ampirik antibiyoterapi uygulamasında görülen en ciddi sorunlar direnç gelişimi ve artmış sağlıkharcamalarıdır. Bu çalışmada daha önceden KOAH tanısı almış orta veya ağır şiddette akut atak nedeniyle yatırılaraktedavi edilen hastalardan izole edilen bakteriyel enfeksiyon etkenlerini, antibiyotik direnç oranlarını ve komorbiditeyiretrospektif olarak incelemeyi amaçladık.Gereç ve Yöntemler: 2015-2017 yıllarında hastanede yatırılarak tetkik ve tedavi edilen orta veya ağır derecede KOAHakut atak geçiren toplam 138 hastanın bakteriyel tanımlama ve antimikrobiyal duyarlılık testleri konvansiyonelyöntemler ve Phoenix (Becton Dickinson, ABD) tam otomatik bakteri tanımlama sistemi kullanılarak, antibiyogramsonuçları ise European Committee on Antimicrobial Susceptibility Testing (EUCAST) kriterlerine göredeğerlendirilmiştir. KOAH sınıflaması için, atak sayısına ve semptom düzeyine göre belirlenen GOLD-2017 sınıflamasıkullanılmıştır.Bulgular: Çalışmamızda yatarak tedavi edilen 297 hastanın 138’inde (%46,5) bakteri kültüründe üreme saptanmıştır.En sık izole edilen bakteriler Pseudomonas aeruginosa %19,6, Acinetobacter baumanni %15,2 ve Klebsiellapneumonia %10,1 olarak saptanmıştır. Pseudomonas aeruginosa’da direnç oranları siprofloksasin ve levofloksasin için%30, sefepim ve seftazidim için %26, imipenem için %19, meropenem ve gentamisin için %15, piperasilin/tazobaktamiçin %11 ve amikasin için %7 olarak saptanırken kolistine direnç saptanmamıştır. KOAH’a eşlik eden hastalıklardan(komorbidite) gastroözafagial reflü (GÖR) (%27,5) daha fazla oranda görülmüştür.Sonuç: Hastaneye yatırılarak tedavi edilmesi gereken orta ve ağır derecede akut atak tanısı alan KOAH’lı olgulardaantibiyotik tedavisine başlanmadan önce kültür antibiyogram yapılması hem direnç gelişiminin engellenmesi hem detedavide etkinlik ve maliyetin azaltılması açısından fayda sağlayacaktır.

Investigation of Bacterial Infectious Agents, Antibiotic Resistance and Comorbidities in Patients Hospitalized with COPD Acute Attack

Aim: Chronic Obstructive Pulmonary Disease (COPD) is responsible for approximately 50% of all bacterial infections of lung. The most serious problems seen in empirical antibiotherapy application are resistance development and increased health expenditures. In this study, we aimed to retrospectively examine the bacterial infection agents, antibiotic resistance rates and comorbidities isolated from patients who were hospitalized due to severe acute or moderate acute attack. Material and Methods: Bacterial identification and antimicrobial susceptibility tests of 138 patients who had moderate or severe COPD acute episodes who were hospitalized in 2015-2017, were performed using conventional methods and Phoenix fully automated bacterial identification system. Antimicrobial susceptibilities were interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. According to GOLD-2017 for COPD classification, number of exacerbations and symptom levels were used. Results: In our study, bacterial growing in culture was found in 138 (46.5%) of 297 patients who were hospitalized. The most frequently isolated bacteria were Pseudomonas aeruginosa 19.6%, Acinetobacter baumanni 15.2% and Klebsiella pneumonia 10.1%. In Pseudomonas aeruginosa, resistance rates were 30% for ciprofloxacin and levofloxacin, 26% for cefepime and ceftazidime, 19% for imipenem, 15% for meropenem and gentamicin, 11% for piperacillin/tazobactam, and 7% for amikacin. There was no resistance for colistin. Among the comorbidities of COPD, gastroesophageal reflux (GER) (27.5%) was at higher rate. Conclusion: In patients with COPD who are diagnosed with moderate to severe acute attack requiring hospitalization and treatment before starting antibiotic treatment, antibiogram will be beneficial in terms of prevention of resistance and reduction of efficacy and cost in treatment.

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