Nozokomiyal Spontan Bakteriyel Peritonitte Dikkat Çekici Antibiyotik Direnci

Filiz KIZILATEŞ; Nefise ÖZTOPRAK; Ferda AKBAY HARMANDAR; Hande BERK; Derya SEYMAN; Yasin ŞAHİNTÜRK; Ayhan Hilmi ÇEKİN; Yeşim ÇEKİN

doi:10.4274/mjima.galenos.2019.2019.11

Nozokomiyal Spontan Bakteriyel Peritonitte Dikkat Çekici Antibiyotik Direnci

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Nozokomiyal Spontan Bakteriyel Peritonitte Dikkat Çekici Antibiyotik Direnci

Mediterr J Infect Microb Antimicrob 2019;8:11-11 DOI: 10.4274/mjima.galenos.2019.2019.11

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Giriş: Bu prospektif gözlemsel çalışmanın amacı; nozokomiyal spontan bakteriyel peritonit (SBP) olgularında, ampirik antibiyotik tedavisini planlamak için, etken mikroorganizmaları ve antimikrobiyal ilaçlara duyarlılıklarını ortaya koymaktır.

Gereç ve Yöntem: Çalışmaya Ocak 2011 ile Aralık 2014 arasında SBP ön tanısı ile Antalya Eğitim ve Araştırma Hastanesi Gastroenteroloji Kliniği’ne başvuran hastalar dahil edildi. Assit sıvısında polimorfonüklear hücre sayısı ≥250 hücre/mm³ olan olgular SBP olarak tanımlandı. Hastaneye yatıştan 48 saat veya daha sonra tanı konulan olgular nozokomiyal olarak kabul edildi. Çalışmanın yapıldığı dönemde hastanemizde ampirik tedavide sefotaksim tercih edilmekte idi. Eğer 48 saatte klinik yanıt alınmadıysa veya kültürde sefotaksim dirençli bakteri ürediyse tedavi değişikliği yapılmakta idi.

Bulgular: Kültür-pozitif SBP oranı %13 (57/439) idi. Olguların %46’sı (202/439) nötrositik asitti. Olguların %52,6’sı (30/57) nozokomiyal SBP olarak değerlendirildi. Bir olguda etken Candida spp. idi, bu nedenle hesaplamaya dahil edilmedi. Tüm olgularda doğal/kazanılmış sefotaksim direnci %51,8 (29/56) idi. Nozokomiyal SBP olgularında sefotaksim direnci %66,7 (20/30) idi ve non-nozokomiyal olgulardan anlamlı ölçüde yüksekti (%34,6; 9/26, p=0,04). Nozokomiyal enfeksiyonlarda gentamisin, trimetoprim-sulfametoksazol ve karbapenem direnci de anlamlı derecedeyüksekti (p=0,04, p=0,04, p=0,02).

Sonuç: Nozokomiyal SBP olgularında sefotaksim direnci yüksek olarak saptandı. Bu nedenle ampirik antibiyoterapiyi planlarken, enfeksiyonun nozokomiyal olup olmamasına göre belirlemek faydalı olacaktır.

Anahtar Kelimeler: Genişlemiş spektrumlu beta-laktamazlar, antimikrobiyal direnç, sürveyans, toplum kaynaklı enfeksiyonlar, kültür negatif nötrositik assit

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