PNÖMONİ TANISI ALAN ÇOCUK HASTALARDA KAN KÜLTÜRÜ VE KAN PARAMETRELERİNİN DEĞERLENDİRİLMESİ

AMAÇ: Pnömoni tanısı alan çocuk hastalarda kan kültürü testi alınması önerilmektedir. Ancak, kan kültürü testlerinde üretilen patojen mikroorganizma oranı oldukça düşüktür. Bu çalışmada; pnömoni tanısı ile hastaneye yatırılan çocuk hastalarda kan kültürü sonuçları ve bazı kan testi parametreleri araştırıldı.GEREÇ VE YÖNTEM: 2016 - 2018 tarihleri arasında ICD10 kodlamasına uygun olarak pnömoni tanısı ile hastaneye yatırılan ve kan kültürü testi alınan 643 hasta çalışmaya dahil edildi. Kan kültür sonuçları, kan testi parametreleri (WBC (White Blood Count), ANC (Absolute Neutrophil Count), AMC (Absolute Monosite Count), trombosit sayısı, MPV (Mean Platelet Volume), PDW (Platelet Distribution Wide), PCT (Plateletcrit)) ve CRP (C-Reaktif Protein) değerlendirildi.BULGULAR: Ortalama yaş 27.1±38.2ay, %41,8’i kız cinsiyet idi. %4,0 oranında (n=26) kan kültürü sonucu pozitifti. Kan kültürü pozitif olan hastaların trombosit sayısı (307.3/mL) kan kültürü negatif olanlardan (360.2/mL) daha düşüktü (p=0.035), ancak; CRP (p=0.095), toplam beyaz küre sayısı (p=0.069) ve MPV (p=0.846) sonuçları ile fark bulunamadı. Kan kültür sonucu pozitif olanlarda PDW (%12,7±2,6) negatif olanlardan (%10,4±1.7) daha yüksek bulundu (p<0.001). En sık izole edilen patojen Stafilokok Hominis (n=8, %36,4) idi.SONUÇ: Pnömoni tanısı ile hastaneye yatırılan çocuk hastalarda kan kültürü testinde patojen mikroorganizmanın gösterilme oranı oldukça düşük seviyededir. Bu hastalarda; kan kültürü testinde patojen bakterinin gösterilmesi hastalığın tedavisi ve ampirik antibiyoterapi seçimi için kıymetlidir. Çocuklarda pnömoni tanı, tedavi ve klinik izleminde diğer kan parametrelerinin kullanımı konusunda çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Pnömoni, Kültür, Patojen, Kan testi, Pediatri

ASSESSMENT OF BLOOD CULTURE AND BLOOD PARAMETERS IN PEDIATRIC PATIENTS DIAGNOSED WITH PNEUMONIA

OBJECTIVE: It is recommended to take a blood culture test in pediatric patients diagnosed with pneumonia. However, the rate of pathogenic microorganisms produced in blood culture tests is quite low. In this study, the results of blood culture tests and some blood test parameters in pediatric patients hospitalized with pneumonia diagnosis were evaluated.MATERIAL AND METHODS: 643 patients who were hospitalized and diagnosed with pneumonia in accordance with ICD10 coding and whose blood culture test was taken between 2016 and 2018 were included in the study. The results of blood culture tests and blood test parameters ((WBC (White Blood Count), ANC (Absolute Neutrophil Count), AMC (Absolute Monosite Count), MPV (Mean Platelet Volume), PDW (Platelet Distribution Wide), PCT (Plateletcrit)) and CRP (C-Reaktif Protein)) were evaluated.RESULTS: The mean age of the patients was 27.1±38.2 months and 41.8% of the patients were female. Blood culture results were positive in 4.0% of the patients (n=26). The platelet count of the patients with positive blood culture (307.3/ml) was lower than those with negative blood culture (360.2/ml) (p=0.035) but no differences were found in the CRP levels (p = 0.095), total white blood cell count (p = 0.069) and MPV (p= 0.846) values. PDW level was found higher (p <0.001) in patients with positive blood culture (12.7±2.6%) than those with negative blood culture (10.4±1.7%). The most frequently isolated pathogen was Staphylococcus Hominis (n=8, 36.4%).CONCLUSIONS: The rate of detection of pathogenic microorganisms in the blood culture test in pediatric patients hospitalized with the diagnosis of pneumonia is at a very low level. In these patients, the demonstration of pathogen bacteria in the blood culture test is valuable for the treatment of the disease and choice of empirical antibiotherapy. It is necessary to conduct studies on the use of other blood parameters in the diagnosis, treatment and clinical follow-up of pneumonia in children.

Keywords:

Pneumonia, Culture, Pathogen, Blood test, Children.,

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1. Unicef Data: Pneumonia in Children. https:/data.unicef.org/topic-child health/pneumonia. (Erişim Tarihi: Haziran 2018)
2. Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372:835-45.
3. Turkiye Ulusal Istatistik Kurumu. Türkiye Sağlık Araştırması. 2016.
4. Bradley JS, Byington CL, Shah SS, et al. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53:617-30.
5. Abe T, Tokuda Y, Ishimatsu S, et al. Usefulness of initial blood cultures in patients admitted with pneumonia from an emergency department in Japan. J Infect Chemother. 2009;15:180-6.
6. Grant CC, Harnden A, Mant D, et al. Why do children hospitalized with pneumonia not receive antibiotics in primary care? Arch Dis Child. 2012;97:21-7.
7. Kwon JH, Kim JH, Lee JY, et al. Low utility of blood culture in pediatric community-acquired pneumonia: An observational study on 2705 patients admitted to the emergency department. Medicine. 2017;96:e7028.
8. Myers AL, Hall M, Williams DJ, et al. Prevalence of bacteremia in hospitalized pediatric patients with community-acquired pneumonia. Pediatr Infect Dis J. 2013;32:736-40.
9. Kerrigan SW, Cox D. Platelet-bacterial interactions. Cell Mol Life Sci. 2010;67:513-23.
10. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17:47-58.
11. Kaito K, Otsubo H, Usui N, et al. Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia. Br J Haematol. 2005;128:698-702.
12. Patrick CH, Lazarchick J. The effect of bacteremia on automated platelet measurements in neonates. Am J Clin Pathol. 1990;93:391-4.
13. Yeaman MR. Platelets in defense against bacterial pathogens. Cell Mol Life Sci. 2010;67:525-44.
14. Hickey RW, Bowman MJ, Smith GA. Utility of blood cultures in pediatric patients found to have pneumonia in the emergency department. Ann Emerg Med. 1996;27:721-5.
15. Iroh Tam PY, Bernstein E, Ma X, Ferrieri P. Blood Culture in Evaluation of Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Hosp Pediatr. 2015;5:324-36.
16. Mendoza-Paredes A, Bastos J, Leber M, et al. Utility of blood culture in uncomplicated pneumonia in children. Clin Med Insights Pediatr. 2013;7:1-5.
17. Haimi-Cohen Y, Shafinoori S, Tucci V, et al. Use of incubation time to detection in BACTEC 9240 to distinguish coagulase-negative staphylococcal contamination from infection in pediatric blood cultures. Pediatr Infect Dis J. 2003;22:968-74.
18. Patterson MJ. Streptococcus. In: th, Baron S, eds. Medical Microbiology. Galveston (TX)1996.
19. Parks T, Barrett L, Jones N. Invasive streptococcal disease: a review for clinicians. Br Med Bull. 2015;115:77-89.
20. Neuman MI, Hall M, Lipsett SC, et al. Utility of Blood Culture Among Children Hospitalized With Community-Acquired Pneumonia. Pediatrics. 2017;140.
21. Shah SS, Dugan MH, Bell LM, et al. Blood cultures in the emergency department evaluation of childhood pneumonia. Pediatr Infect Dis. J 2011;30:475-9.
22. Esin Şenol AA, Erbay A, Alp-Çavuş S, et al. Pneumococcal Vaccine as One of the Immunization Coverage Targets for Adulthood Vaccines: A Consensus Report of the Study Group for Adult Immunization of the Turkish Society of Clinical Microbiology and Infectious Diseases. Klimik Dergisi. 2018;31:2-18.
23. Ceyhan M. Çocuklarda Antibiyotik Kullanımı. Türkiye Klinikleri Farmakoloji. 2004;2:166-73.
24. Loonen AJ, de Jager CP, Tosserams J, et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One. 2014;9:e87315.
25. Long B, Koyfman A. Best Clinical Practice: Blood Culture Utility in the Emergency Department. J Emerg Med. 2016;51:529-39.
26. Anıl AB. Alt Solunum Yolu Enfeksiyonunda Nazofaringeal Örneklerde Polimeraz Zincir Reaksiyonu Sonuçları (letter to editor). J Pediatr Inf. 2012;6:174-7.
27. Turk Toraks Dernegi. Çocuklarda Toplumda Gelişen Pnömoni Tanı ve Tedavi Uzlaşı Raporu (2009).
28. Karadag-Oncel E, Ozsurekci Y, Kara A, et al. The value of mean platelet volume in the determination of community-acquired pneumonia in children. Ital J Pediatr. 2013; (8):39-16.
29. Gorelik O, Tzur I, Barchel D, et al. A rise in mean platelet volume during hospitalization for community-acquired pneumonia predicts poor prognosis: a retrospective observational cohort study. BMC Pulm Med. 2017;17:137.
30. Lee JH, Park M, Han S, et al. An increase in mean platelet volume during admission can predict the prognoses of patients with pneumonia in the intensive care unit: A retrospective study. PLoS One. 2018;13:e0208715.
31. Golwala ZM, Shah H, Gupta N, et al. Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study. Afr Health Sci. 2016;16:356-62.
32. Zhang HB, Chen J, Lan QF, et al. Diagnostic values of red cell distribution width, platelet distribution width and neutrophil-lymphocyte count ratio for sepsis. Exp Ther Med. 2016;12:2215-9.
33. Tzur I, Barchel D, Izhakian S, et al. Platelet distribution width: a novel prognostic marker in an internal medicine ward. J Community Hosp Intern Med Perspect. 2019;9:464- 70.
34. Tuncay A, Ozmen R, Elcik D, et al. The effect of blood biochemistry and hematological parameters on the development of pseudoaneursym. Kocatepe Tıp Dergisi. 2020;21(4):353-358.