Erol KELEŞ, Murat ARAL, Hayrettin Cengiz ALPAY

Maksiller ve etmoid sinüslerden izole edilen Streptokok pnömoni, Streptokok viridans ve A grubu hemolitik Streptokok'larm antibiyotik dirençleri

Amaç: Kronik sinüzit nedeniyle fonksiyonel endoskopik sinüs cerrahisi hastaların sinüslerinden alınan kültür materyallerinden izole edilen Streptokok pnömoni,Streptokok viridans, A grubu hemolitik streptokok’ların antibiyotik dirençleri araştırıldı.Hastalar ve Yöntemler: Çalışmaya, kronik sinüzit nedeniyle fonksiyonel endoskopik sinüs cerrahisi uygulanan 93 hasta alındı. Cerrahi girişim öncesi nazal mukoza, deri ve komşu yapılar olası bir kontaminasyonu önlemek amacıyla povidone-iodine solüsyonuyla temizlendi. Tüm hastalardan povidone-iodine solüsyonu uygulamadan önce vesonra burun sürüntü örnekleri alındı. Ameliyat sırasında da etmoid sinüsten vemaksiller sinüs ostiumundan kültür için materyal alındı. Kültürlerde izole edilenStreptokok pnömoni, Streptokok viridans ve A grubu hemolitik streptokok’lara antibiyotik duyarlılık testleri yapıldı.Bulgular: Ameliyat öncesi burun sürüntü kültürlerinden povidone-iodine solüsyonu uygulamadan önce 58 hastadan %62.3 72 aerop bakteri üremesi olurken, povidone-iodine solüsyonu uygulandıktan sonra alınan kültürlerde 12hastadan %12.9 toplam 16 izolasyon oldu. Ameliyat sırasında maksiller sinüslerden alınan kültürlerde hastaların %95.6’sında 89/93 , etmoid sinüstenalınan kültürlerde ise %91.3’ünde 85/93 mikroorganizma izole edildi. Her ikisinüste de en sık izole edilen mikroorganizma koagülaz negatif stafilokok, ikinci sıklıkta viridans streptokok’lar daha sonra sırasıyla koagülaz pozitif stafilokok, Streptokok pnömoni ve A grubu hemolitik streptokok idi. İzole edilen viridans streptokok suşunun %33.3’ü tetrasikline, %23.8’i kloramfenikole,%19.04’ü penisiline dirençli bulunurken, A grubu hemolitik streptokok suşununtümü penisilin, ofloksasin, seftriakson, sefepime duyarlı, %50’si eritromisin vekloramfenikole, tamamı tetrasikline dirençli bulundu. İzole edilen Streptokokpnömoni suşlarının %25’i pensiline, %66.6’sı trimetoprim/sülfametoksazole,%41.6’sı eritromisine, %58.3’ü tetrasikline, %33.3’ü kloramfenikole ve%16.6’sı rifampine dirençliydi. İzole edilen suşların tümü vankomisine duyarlıydı.Sonuç: Kronik sinüzitli hastalardan sık olarak izole edilen Streptokok pnömoni,viridans streptokok’lar ve A grubu hemolitik streptokok’ların antimikrobiyal duyarlılıklarının araştırılmasının, klinikte uygulanacak ampirik tedavinin seçilmesindeve kronik sinüzitli hastalarda viridans streptokok’ların tedavide göz önünde bulundurulması gerektiğini düşünüyoruz

Anahtar Kelimeler:

Kronik sinüzit, Streptokok pnömoni, viridans streptokok, A grubuHemolitik Streptococ, antibiyotik duyarlılığı

Antibiotic sensitivities of Streptococcus pneumoniae, Viridans streptococci and group A hemolytic Streptococci isolated from the maxillary and ethmoid sinuses

O bjectives: To investigate antibiotic sensitivities ot Streptococcus pneumoniae, Viridans streptococci and Group A hemolytic Streptococci isolated trom the cul- ture materials obtained trom the sinuses ot patients undergoing tunctional endo- scopic sinüs surgery due to chronic sinusitis.Patients and Methods: We recruited 93 patients 63 males, 30 temales; mean age 36±17.47; range 19 to 68 years who were undergoing tunctional endoscopic sinüs surgery due to chronic sinusitis into this study. Betore the surgical interven- tion, in order to eliminate a possible contamination trom skin and neighboring struc- tures, nasal mucosa was cleansed with povidone-iodine solution. Nasal smear samples were obtained trom ali the patients betore and after applying povidone- iodine solution. Streptococcus pneumoniae, Viridans streptococci and Group A hemolytic Streptococci that were isolated trom the cultures were tested tor antibi otic sensitivity.Results: İn the preoperative nasal smear cultures, total number ot anaerobic bacteria isolated trom 58 patients 62.3% betore applying povidone-iodine was 72, following the application ot povidone-iodine a total ot 16 microorganisms were identitied trom 12 %12.9 patients. Microorganisms were isolated trom 95.6% 89/93 ot the samples obtained trom maxillary sinuses and 91.3% 85/93 ot the samples obtained trom ethmoid sinuses. The most commonly identitied microorganisms trom both sinuses were coagulase - staphylococcus followed by Viridans streptococci, coagulase + staphylococcus, Streptococcus pneumo niae and Group A hemolytic streptococci. For the Viridans streptococcal strains that were isolated, 33.3% were resistant to tetracycline, 23.8% to chlorampheni- col, and 19.04% to penicillin. A hemolytic streptococci strains were sensitive to penicilin, ofloxacine, ceftriaxone and cetepime in ali groups; however they had 50% resistance to eritromycin and chloramphenicol and 100% resistance to tetracycline. The resistance pattern ot the isolated Streptococcus pneumoniae strains were as follows: 25% to penicillin, 66.6% to trimethoprim/sulphometaxa- zole, 41.6% to eritromycin, 58.3% to tetracycline, 33.3% to chloramphenicol and 16.6% to ritampin. AH ot the isolated strains were sensitive to vancomycin.Conclusion: We suggested that identitication ot the strains that are resistant to penicillin and other antibiotics is an important tool tor choosing the empirical treatment to the Streptococcus pneumoniae, Viridans streptococci and group A hemolytic streptococci in clinical practice. Viridans streptococci which were fre- quently isolated trom chronic sinusitis patients should be kept in mind.

Keywords:

Chronic sinusitis, Streptococcus pneumoniae, Viridans streptococcus, Group A hemolytic streptococci, antibiotic sensitivity,

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The Turkish Journal of Ear Nose and Throat-Cover

ISSN: 2602-4837
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 1991
Yayıncı: İstanbul Üniversitesi

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