Say›: 1 Sayfa: 13-17 Al›nd›¤› tarih: 30. 06

Serkan Karaca, Kadri Çirak, Hüseyin Hal‹lçolar, Seren Suat, Hastal›klar› Gö¤üs, Cerrahisi Ve, E¤itim, Araflt›rma Hastanesi
2004 unpublished
ÖZET Bu çal›flmada hastanemiz yo¤un bak›m biriminde ortaya ç›kan "ventilatörle iliflkili pnömoni (V‹P)" lerin mikrobiyolojik tan›s›nda derin trakeal aspirasyon (DTA) ve bronkoalveoler lavaj (BAL) yöntemiyle al›nan örneklerin kantitatif kültürlerinin karfl›laflt›r›lmas› amaçland›. Klinik olarak V‹P oldu¤u düflünülen 20 hastan›n 19'una mikrobiyolojik olarak da V‹P tan›s› konuldu. Bu 19 hastan›n 17'sinde hem DTA hem de BAL kültürü örne¤inden ayn› bakteri izole edildi. Di¤er iki hastada ise
more » ... DTA örne¤inden etken bakteri izole edildi. Bir hastan›n ise BAL ve DTA örne¤i kültürlerinde üreme olmad›. Çal›flmam›zda mikrobiyolojik olarak tan› konulan 19 V‹P'li olgunun yedisinden (%36) polimikrobiyal etken izole edildi. Tek tip bakteri izole edilen 12 olgunun 11'inde (%91) Gram-negatif bakteriler etken idi. Gram-negatifler içinde 7 olgu ile (%63) Acinetobacter spp. en s›k, 3 olgu ile (%25) Pseudomonas aeruginosa ikinci s›kl›kta idi. Klinik olarak V‹P düflünülen ve çal›flmaya dahil edilen 20 olgudan 14'ü (%70) eksitus oldu ve bunlar›n dokuzunda (%64) Acinetobacter spp. ve/veya Pseudomonas aeruginosa üretilmiflti. Çal›flmam›z sonucunda her iki örne¤in kantitatif kültürlerinin istatistiksel aç›dan uyumlu oldu¤u bulundu (kappa uyum de¤eri=0.523). Kantitatif DTA kültürünün, invazif tan› yöntemlerine, özellikle bu yöntemlerin mümkün olmad›¤› birimlerde alternatif oluflturabilece¤i kan›s›na var›ld›. Anahtar kelime: ventilatör iliflkili pnömoni, derin trakeal aspirat, bronkoalveoler lavaj SUMMARY The Results and Comparison of Deep Tracheal Aspirate and Bronchioalveolar Lavage Specimen Quantitative Cultures at Ventilator Associated Pneumonia Diagnosis In this study, deep tracheal aspiration and BAL specimen cultures for microbiological diagnosis of ventilator associated pneumonia in our intensive care unit were compared. Among 20 patients clinically suspected to have VAP, 19 were also microbiologically proven to have VAP. In 17 of the 19 patients, same bacterial isolate was obtained in both DTA and BAL specimen culture. In 2 patients etiologic agent was found in DTA specimen. BAL and DTA cultures of one patient was found to be sterile. Among 19 patients with VAP , 7 (36%) had polymicrobial etiologic agent. Among 12 patients with single etiologic agent, gram (-) bacteria were found in 11(91%) of them. Among Gram(-) bacteria acinetobacter were the mostly encountered organism with 7(36%) patients, Pseudomonas the second mostly encountered organism with 3(25%) patients. Among 20 patients clinically suspected to have VAP, 14 (70%) patients died. In cultures of the 9 (64%) of the 14 patients who died acinetobacter and/or pseudomonas were detected. In our study we found that both sample cultures were statistically significant. Quantitative DTA culture can be an alternative method for invasive procedures especially in units where these invasive procedures are not available.
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