E. Nural KİPER, H. Uğur ÖZÇELİK, Ferda TUNÇKANAT, Güzin CİNEL, Deniz DOĞRU ERSÖZ, Elmas Ebru YALÇIN, Burçin ŞENER, Özlem DOĞAN

Kistik fibrozisli hastalarda anaerop bakterilerin rolünün araştırılması

Giriş: Kistik fibrozis (KF) hastalarının en önemli mortalite nedeni akut alevlenme ve iyileşme dönemlerinin birbirini izlediği tekrarlayan akciğer hastalığıdır.Son yıllarda ileri teknoloji ile gerçekleştirilen kültür dışı yöntemlere dayananmetagenomik çalışmalar, KF hastalarının akciğer ortamının mikrobiyolojikaçıdan karmaşık dinamiğini göstermiş, anaerop bakterilerin artan öneminedikkat çekmiştir. Gerek moleküler temelli gerekse anaerop kültür yöntemleriile yapılan çalışmalar, KF hastalarının akciğer ortamında aerop ve fakültatifanaerop bakteriler kadar ya da daha fazla olmak üzere anaerop bakterilerinde bulunduğunu göstermiştir. Ancak literatürde bu konuda yapılmış çalışmalarsınırlıdır.Materyal ve Metod: Hacettepe Üniversitesi Tıp Fakültesi, Çocuk GöğüsHastalıkları polikliniğine başvuran ve izlemde olan KF'li hastaların balgamörneklerinden kantitatif kültür yöntemi ile anaerop bakteri varlığının öneminiirdelemek ve üreyen anaerop bakterilerin antibiyotik duyarlılık durumlarınıaraştırarak tedaviye katkı sağlamak amacıyla izole edilen bakteriler klasik veyarı otomatize yöntemlerle tanımlanmıştır. Anaerop bakterilerin duyarlılık testleri için referans yöntem olan agar dilüsyon yöntemi kullanılmıştır.Bulgular: Çalışmaya alınan 43 hastanın 35 (%81.4)’inde, toplam 77 zorunluanaerop bakteri izole edilmiştir. Toplanan balgam örneklerinde zorunlu anaerop/fakültatif bakterilerin toplam sayısı (ortalama 16 x 106), yalnızca aerop/fakültatif bakterilerin toplam sayısından (ortalama 14.1 x 106) daha fazlabulunmuştur. Anaerop kültür yapılmadığı durumda izolatların sadece %63.5’isaptanabilmektedir. Polimorfonükleer lökosit orta ve bol olarak gözlenenörneklerden ise çok sayıda zorunlu anaerop bakteri izole edilmiştir (p= 0.046). Yaşın anaerop bakteri izolasyonuna etkisi irdelendiğinde, 18 yaşından büyük hastalarda, anaerop bakteri izolasyonununbelirgin olarak arttığı görülmüştür. İzole edilen 77 zorunlu anaerop bakteriden 72’sinin ampisilin, sulbaktam-ampisilin, piperasilin,piperasilin-tazobaktam, moksifloksasin, metronidazol, imipenem ve klindamisine karşı duyarlılıkları test edildiğinde, en etkisiz antibiyotiğin klindamisin olduğu, izolatların hiçbirisinde imipenem direnci görülmediği saptanmıştır.Sonuç: Bu çalışma ülkemizde KF hastalarında anaerop bakterilerin rolü ve önemini gösteren ilk çalışmadır. KF hastalarından izoleedilen anaerop bakterilerde saptanan direnç oranlarının yüksekliği kaygı vericidir. Bu nedenle bu hastaların takibinde aralıklı olarakanaerop kültür yapılması ve direnç oranlarının takip edilmesi tedavide yol gösterici olacaktır.

Investigation of role of anaerobic bacteria in cystic fibrosis patients

Introduction: Repetitive pulmonary infections are the main cause of morbidity and mortality in cystic fibrosis (CF) patients. In recent years, non-culture dependent metagenomic studies showed complex dynamics of the pulmonary environment of CF patients and pointed out the importance of anaerobic bacteria. Molecular-based studies indicate that anaerobic bacteria can be found more than aerobic or facultative anaerobic bacteria in CF lung environment. However, limited number of studies are far away to clarify the importance of anaerobic bacteria in CF pulmonary disease. Materials and Methods: The aim of this study was to evaluate the role of anaerobic bacteria in CF patients admitted to Hacettepe University, Pediatric Respiratory Diseases Department, by using quantitative culture method for both aerobic and anaerobic bacteria. Anaerobic bacteria were identified by conventional and semi-automated methods. Antibiotic susceptibilities were performed by agar dilution method. Results: Seventy-seven anaerobic bacteria were isolated from 35 (81.4%) of 43 patients. The total count of anaerobes and facultative bacteria (mean 16 x 106), was higher than aerobes and facultative bacteria (mean 14.1 x 106). If anaerobe culture were not performed merely 63.65% of all species could be obtained. In patients whose samples yielded intermediate or high numbers of PMNLs, significantly more obligate anaerobic bacteria were isolated (p= 0.046). Patients older than 18 years were colonized with higher number of anaerobic bacteria. Susceptibilities of 72 isolates out of 77, against ampicillin, sulbactam-ampicillin, piperacillin, piperacillin-tazobactam, moxifloxacin, metronidazole, imipenem, and clindamycin were also evaluated. Clindamycin was found to be the least effective antibiotic among all. None of the isolates was resistant to imipenem. Conclusion: This is the first study to show the role and importance of anaerobic bacteria in CF patients in our country. The resistance rates in anaerobic bacteria isolated from CF patients is concerning. Therefore, intermittent anaerobic culture and follow-up of resistance rates will be helpful in the follow-up of these patients.

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