Gürkan MERT, Süleyman METİN, ŞENOL YILDIZ, Engin KARAKUZU, Tolga ÇAKMAK

Diyabetik ayak ülseri nedeniyle hiperbarik oksijen tedavisi planlanan hastalarda yara kültürü ile tespit edilen enfeksiyon ajanlari

AMAÇ: Çalışmada diyabetik ayak ülserlerini mikrobiyolojik yönden incelemek, uygun antibiyoterapilerin seçimi konusunda bilgi elde etmek ve tedavinin etkinliğinin arttırılmasına katkı sağlamak amaçlanmıştır. YÖNTEM: 2010 yılında Hiperbarik Oksijen Tedavisi (HBOT) için merkezimize başvuran 30 diyabetik ayak ülserli hasta çalışmaya dahil edildi. Yaralar Meggitt-Wagner evreleme sistemi ile derecelendirildi. Hastalardan HBOT ve antibiyoterapi öncesi yara kültürü alındı. Enfeksiyon ajanlarının antibiyotik duyarlılığının tespitinde Phoenix sistemi (Becton Dickinson, ABD) ve Kirby Bauer�in disk difüzyon metodu kullanıldı. Hastaların HBO seans sayıları, glisemik kontrol düzeyleri ve tedaviye yanıtları değerlendirildi. BULGULAR: Yaş ortalamaları 61,3 (35�83 yaş) olan hastaların 18�i erkek, 12�si kadındı. 24 hastada glisemik kontrol iyi, 6 hastada kötüydü. Hastalara ortalama 20 seans (5-55 seans) HBO tedavisi uygulandı. Tedavi sonunda 19 (%63,33) hastada klinik iyileşme görülürken, 11 (%36,67) hastada tedaviye yanıt alınamadı. Toplam 14 farklı enfeksiyon ajanı tespit edildi. 30 hastanın 12�sinde gram pozitif etkenler (%40), 18�inde gram negatif etkenler üredi (%60). En sık pseudomonas aeruginosa izole edildi. Enterococcus faecalis, klebsiella pneumoniae ve staphylococcus aureus diğer sık izole edilen ajanlardı. SONUÇ: Çalışmayı kısıtlayan faktörler nedeniyle elde ettiğimiz sonuçların toplum genelini temsil etmesi zordur. Diyabetik ayak enfeksiyonlarında görülebilecek mikrobiyolojik ajanlar ve antibiyotik duyarlılıkları konusunda ön fikir verebilecek niteliktedir. Daha çok hastane ortamında rastladığımız pseudomonas aeruginosa�nın toplum kaynaklı da olabileceği konusu dikkate alınarak uygun antibiyotik politikaları ve protokoller belirlemek faydalı olacaktır.

Infection agents detected with wound culture in patients with diabetic foot who will undergo hyperbaric oxygen treatment

AIM: We aimed to obtain the knowledge of appropriate antibiotic therapy and to make a contribution to improving treatment efficacy by conducting a microbiological study of diabetic foot ulcers. METHOD: 30 patients (18 male and 12 female) with diabetic foot ulcer applying to our center for hyperbaric oxygen (HBO) treatment in 2010 were enrolled in this study. The wounds were graded according to Meggitt-Wagner classification system. Wound cultures were obtained before starting antibiotic therapy and HBO treatment. Phoenix system (Becton Dickinson, USA) and Kirby-Bauer disk diffusion antibiotic sensitivity testing were used in order to detect the antimicrobial susceptibility of the infection agents. The number of HBO sessions, glycemic control and treatment results were assessed. RESULTS: Mean age of the patients was 61.3 years (range: 35-83). 24 patients had a good glycemic control and 6 patients had not. The patients were given 5 to 55 HBO sessions (mean: 20). Of the 30 patients 19 (63.33%) recovered from the infection but 11 (36.67%) have not responded to the treatment. 14 different infectious agents were detected in diabetic foot ulcers we examined. Gram-positive agents were isolated in 12 (40%) out of 30 wound cultures and gram-negative agents were isolated in 18 (60%) wound culture. Pseudomonas aeruginosa was predominantly isolated and the other agents isolated were enterococcus faecalis, klebsiella pneumoniae, staphylococcus aureus and escherichia coli. CONCLUSION: The outcomes can not represent the general population rates due to the restriction factors. They give only an idea about the probability of infectious agent spectrum in diabetic foot ulcers and their antibiotic susceptibility. We want to attract attention to the fact that although pseudomonas aeruginosa infections are mostly encountered in hospital, they can also be acquired from the community and it will be useful to develop appropriate antibiotic policies and treatment protocols.

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