Duygu MERT, Hasan ÖKSÜZOĞLU, Gülşen İSKENDER, Göknur YAPAR TOROS, Ayla YENİGÜN, Mustafa ERTEK

Antibiyotik kullanımı ve altta yatan hastalıklar çoklu ilaca dirençli toplum kökenli pnömoni riskini ve mortaliteyi artırıyor mu?

Amaç: Akciğer parankiminin enfeksiyonu olan pnömoniler, toplum kökenli pnömoni (TKP) ve hastane kökenlipnömoni olarak iki gruba ayrılmaktadır. TKP oldukça sık görülür ve mortal seyredebilir. Sağlık Hizmeti İlişkiliPnömoni (SHİP), son üç ay içinde antibiyotik kullanımı ya da hastaneye yatışı olan ve nazogastrik sonda ilebeslenen hastalarda gelişen pnömoniler olarak tanımlanmıştır. Son yapılan çalışmalarda, SHİP yerine çok ilacadirençli TKP terimi kullanılmaya başlanmıştır. Bu çalışmada TKP ve çok ilaca dirençli TKP hastalarının yatışlarınınilk günü alınan laboratuvar sonuçları, etken bakteriyel patojenleri ve fatalite oranlarının karşılaştırılmasıamaçlanmıştır.Gereç ve yöntem: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği’ne 01/09/2018-20/03/2020 tarihleriarasında yatırılan TKP ve çok ilaca dirençli TKP hastaları alınmıştır.Bulgular: TKP 129 hasta ve çok ilaca dirençli TKP 64 hasta incelenmiştir. Çok ilaca dirençli TKP grubunda%96,9 (62) hastada, TKP grubunda %79,8 (103) hastada altta yatan hastalık bulunmuştur. İki grup arasındaanlamlı bir fark saptanmıştır (p=0,003). Çok ilaca dirençli TKP grubunda %79,7 (51) hasta, TKP grubunda ise%19,4 (25) hasta son üç ay içinde antibiyotik kullanmıştır. Çok ilaca dirençli TKP grubunda anlamlı orandayüksek bulunmuştur (p=0,000).Sonuç: Altta yatan hastalık ve son üç ay içinde antibiyotik kullanımı çok ilaca dirençli TKP gelişme riskiniartırmaktadır. Bu hasta grubunda mortalite oranın daha yüksek olduğu saptanmıştır. Çok ilaca dirençli TKPsorunuyla daha az karşılaşmak için pratik hekimlik uygulamalarında akılcı antibiyotik kullanım kurallarına özengösterilmesi gerekmektedir.

Anahtar Kelimeler:

TKP, çok ilaca dirençli TKP, mortalite

Do antibiotic use and underlying diseases increase the risk and mortality of multidrug-resistant community-acquired pneumonia?

Purpose: Pneumonias, which are infections of the lung parenchyma, are divided into two groups as communityacquired pneumonia (CAP) and hospital acquired pneumonia. CAP is very common and CAP can be mortal.Healthcare-Associated Pneumonia (HAP) is defined as pneumonia that develops in patients who have usedantibiotic or hospitalization in the past three months and who are fed by a nasogastric tube. In recent studies,the term multidrug-resistant CAP has been used instead of HAP. In this study, it was aimed to compare thelaboratory results, causative bacterial pathogens and fatality rates of CAP and multidrug-resistant CAP patientson the first day of hospitalization.Material and method: Patients with CAP and multi-drug-resistant CAP who were admitted to the InfectiousDiseases and Clinical Microbiology Clinic between 09/01/2018-03/20/2020 were recruited.Results: 129 patients with CAP and 64 patients with multidrug-resistant CAP were studied. Underlying diseasewas found in 96.9% (62) patients in the multidrug-resistant CAP group and in 79.8% (103) patients in theCAP group. A significant difference was found between the two groups (p=0.003). 79.7% (51) patients in the multidrug-resistant CAP group and 19.4% (25) patients in the CAP group used antibiotics in the last threemonths. It was found to be significantly higher in the multidrug-resistant CAP group (p=0.000).Conclusion: The underlying disease and the use of antibiotics in the last three months increase the risk ofdeveloping multidrug-resistant CAP. Mortality rate was found to be higher in this patient group. In order toencounter less multidrug-resistant CAP problem, it is necessary to pay attention to the rules of rational use ofantibiotics in medical practice.

Keywords:

CAP, multidrug-resistant CAP, mortality,

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