Nurşen CİĞERCİ GÜNAYDIN, Birsen DURMAZ ÇETİN, Banu BAYRAKTAR, Feyzullah ÇETİNKAYA

Bir Eğitim ve Araştırma Hastanesi Çocuk Kliniklerinde Alınan Kültür Sonuçlarının Değerlendirilmesi

Amaç: Çoklu ilaç direnci olan mikroorganizmalar ile enfeksiyon sıklığı giderek artmakta olup; enfeksiyonların erken tanınması, etkili tedavisi ve prognoz açısından kültür örneklerinin değerlendirilmesi önemlidir. Bu çalışmanın amacı, yenidoğan yoğun bakım ünitesi dışındaki çocuk servislerinde yatan hastalardan alınan kan ve idrar kültürü sonuçlarının değerlendirilmesidir. Gereç ve Yöntem: Bu çalışmada 2007-2008 yılları arasında bakılan 2277 kan kültürü ve 857 idrar kültürü retrospektif olarak değerlendirilmiştir. Kan kültüründe %6,8 (n=156), idrar kültüründe ise %6 (n=52) üreme anlamlı görülerek çalışmaya dahil edilmiştir. Alınan kan kültürleri Bact-Alert 3D otomatize kan kültür sistemlerinde, idrar örnekleri MacConkey ve %5 koyun kanlı agar besiyerlerine ekimi yapılarak üreyen mikroorganizmalar tanımlanmış, antibiyotik duyarlılık testleri yapılmıştır. Bulgular: Çocuk kliniklerinde bakteriyemi saptanan hastalarda %79,4 gram pozitif (%69’u Koagülaz-negatif stafilokok, KNS), idrar kültüründe ise %86,5 gram negatif (%61,5 Escherichia coli, %11,5 Enterokoklar) mikroorganizma üremiştir. Kan kültürlerinde üreyen mikroorganizmalar: %48 (n=75) Metisilin-dirençli KNS, %21(n=33) Metisilin-hassas KNS, %7,5 (n=12) Klebsiella pneumoniae (%4,5 genişlemiş spektrumlu beta-laktamaz, GSBL pozitif), %4,5 (n=7) Pseudomonas suşları, %3,2 (n=5) Enterococcus spp., %2,6 (n=4) Streptococcus pneumoniae, %2,6 (n=4) Metisilin-hassas Staphylococcus aureus, %2 (n=3) Acinetobacter, %2,6 (n=4) Candida tropicalis, %2 (n=3) Escherichia coli, %2 (n=3) Enterobacter, %1,3 (n=2) Hemofilus influenza, %0,6 (n=1) Brucella spp. idi. İdrar kültürlerinde saptanan mikroorganizmalar; %61,5 (n=32) E. coli, (%40 genişlemiş spektrumlu beta-laktamaz, GSBL pozitif), %11,5 (n=6) Enterococcus spp., %5,8 (n=3) Proteus spp., %3,8 (n=2) Pseudomonas spp., %3,8 (n=2) Stenotrophomonas maltophilia, %2 (n=1) Metisilin-hassas Staphylococcus aureus, %2 (n=1) Acinetobacter baumannii, %2 (n=1) Klebsiella spp. idi. Sonuç: Enfeksiyon etkeni mikroorganizmaların ve antibiyotik duyarlılıkları ile direnç oranlarının belirlenmesi uygun ve etkili ampirik antimikrobiyal tedavi başlanmasında ve enfeksiyonların tedavisinde önemlidir.

Evaluation of Culture Results in Pediatric Clinics of the Training and Research Hospital

Aim: Infections due to drug resistant microorganisms are increasing and it is important to evaluate culture specimens for early recognition, fast and effective therapy, epidemiological and prognosis of the infections. The aim of the study is to evaluate the results of blood and urine cultures taken from patients hospitalized in pediatric services outside the neonatal intensive care unit. Materials and Methods: In this study, 2277 blood cultures and 857 urine cultures taken between the years of 2007 and 2008 were evaluated retrospectively. 6.8% (n=156) positive blood cultures and 6% (n=52) positive urine cultures were included in the study. Blood cultures were put onto Bact-Alert 3D automotized blood culture systems and urine cultures were put onto MacConkey and 5% sheep blood agar plates. Microorganisms were identified with routine bacteriological procedures and antibiotic sensitivity tests were performed.Results: In pediatrics clinics, 79.4% gram positive microorganisms (69% coagulase-negative staphylococcus CNS) among positive blood cultures 86.5% gram negative microorganisms (61.5% Escherichia coli) among positive urine cultures were produced. Microorganisms grew in blood cultures were as follows: 48% (n=75) Methicillin-resistant CNS, 21% (n=33) Methicillin-sensitive CNS, 7.5% (n=12) Klebsiella species (4.5% ESBL positive), 2.6% (n=4) Streptococcus pneumoniae, 2.6% (n=4) Methicillin-sensitive staphylococci 2% (n=3) Acinetobacter, 2.6% (n=4) Candida tropicalis, 2% (n=3) Escherichia coli, 2% (n=3) Enterobacter, 1.3% (n=2) Haemophilus influenzae, 0.6% (n=1) Brucella spp. Microorganisms detected in urine cultures are as follows: 61.5% (n=32) Escherichia coli (40% ESBL positive), 11.5% (n=6) Enterococcus spp., 5.8% (n=3) Proteus spp., 3.8% (n=2) Pseudomonas spp., 3.8% (n=2) Stenotrophomonas maltophilia, 2% (n=1) Methicillin-sensitive staphylococci, 2% (n=1) Acinetobacter baumannii, 2% (n=1) Klebsiella spp. Conclusion: Identifying the infectious agents and their antibiotic susceptibility and resistance rates is important for adequate and effective initial empiric antimicrobial therapy and treatment of infections.

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