Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi göğüshastalıkları yoğun bakım ünitesinde entübe halde takip edilenpnömonili hastalarda bronkoalveolar lavaj ve trakeal aspiratmateryallerinin kültürlerinin ve gram boyamalarının kıyaslanması
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Tarih
2023
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
Amaç. Pnömoni önemli bir morbidite ve mortalite nedenidir ve her yıl dünya çapında milyonlarca insanı etkilemektedir. Pnömoniye sebep olan mikrobiyolojik etkenin saptanması uygun antibiyotik verilmesi, morbidite ve mortalite oranını düşürmek açısından oldukça önemlidir. Çalışmamızda ventilatör ilişkili pnömoni(VİP) sebebiyle takip edilen hastalarda mikrobiyolojik etkeni saptamaya yönelik endotrakeal aspirat yöntemiyle bronkoskopik bronkoalveolar lavaj yöntemini mukayese etmeyi amaçladık.
Gereç ve yöntem. Bu çalışma prospektif olarak 1 Mart 2022-1 Şubat 2023 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi göğüs hastalıkları yoğun bakım ünitesinde yatan VİP tanılı hasta grubu ile gerçekleştirilmiştir. Çalışmamızda anamnezleri, fizik muayene bulguları, yoğun bakım takipleri, radyolojileri ve laboratuvar tetkikleri ile klinik pulmoner enfeksiyon skoru incelenerek ventilatör ilişkili pnömoni düşünülmekte olan 31 hastaya yoğun bakım ünitemizde yatarken endotrakeal aspirasyon ile eş zamanlı bronkoalveolar lavaj yapılıp elde edilen örnekler en kısa sürede klinik mikrobiyoloji laboratuvarına iletilmiştir. Mikrobiyoloji laboratuvarında örneklerin gram boyamaları, ARB, mantar ve tüberküloz kültürleri ile bakteriyolojik kantitatif kültürleri ve antibiyogramları incelenip kaydedildi. Hastaların demografik verileri, örnekleme öncesi antibiyoterapi bilgileri, APACHE II, SAPS II, SOFA, PSI skorları ve 30 ile 90 günlük mortalite verileri kaydedildi. Araştırma sonucu elde edilen veriler bilgisayar ortamında SPSS (Statistical Package for Social Sciences) 18.0 paket programı ile analiz edildi.
Bulgular. İncelenen 31 hastadan, dahil edilme ve dışlama kriterlerini karşılayan 29 hasta çalışmaya alındı. Çalışmaya alınan hastaların 20’si (%69,00) erkek, 9’u (%31,00) kadındı ve yaş ortalaması 68,24 ± 17,32 yıl olarak saptandı. Bu hastalarda belirlenen komorbiditelerden en sık %37,90 ile hipertansiyon, %27,60 ile kronik obstrüktif akciğer hastalığı (KOAH) ve %24,10 ile diabetes mellitus idi. Hastaların ortalama SAPS II skoru 55,66 ± 18,30, APACHE II skoru 24,62 ± 7,09, SOFA skoru 7,14 ± 2,85 PSI skoru 144,14 ± 36,71 olarak hesaplandı. 30
vi
günlük mortalite oranı %20,70 olarak, 90 günlük mortalite oranı %72,40 olarak saptandı. Radyolojik olarak pnömoni lokalizasyonu değerlendirilen hastaların %41,40’ında bilateral, %41,40’ında sağ akciğer, %17,20’sinde sol akciğer olarak saptandı. ETA kültürüne göre anlamsız üreme olan hastaların 8’inde (%44,40) BAL kültürü üremesi anlamlı olarak tespit edildi ve ETA ve BAL kültür anlamlı-anlamsız üreme oranlarının dağılımında istatistiksel olarak anlamlı fark bulundu (p=0,003).
Sonuç. Çalışmamızda bronkoskopik BAL yönteminin pnömoni etkenini saptamasında endotrakeal aspirasyona üstün olduğu saptandı. ETA yönteminin invaziv olmaması, maliyetinin daha az olması ve özel uzmanlık getirmemesi gibi avantajlarına rağmen orofarengeal flora ile kontamine olabilmesi, etken mikroorganizmanın saptanamaması gibi dezavantajları mevcuttur. YBÜ’de VİP sebebiyle takip edilen hastalar da bronkoskopik BAL ile etkenin saptanıp uygun antibiyoterapi verilmesi mortalite ve morbiditeyi azaltmaya katkı sağlayacağını düşünmekteyiz.
Aim. Pneumonia is a major cause of morbidity and mortality and affects millions of people worldwide each year. Detection of the microbiological factor causing pneumonia is very important in terms of giving appropriate antibiotics and reducing the morbidity and mortality rate. In our study, we aimed to compare the endotracheal aspirate method and the bronchoscopic bronchoalveolar lavage method to detect the microbiological agent in patients followed up for ventilator-associated pneumonia (VAP). Material and Methods. This study was carried out prospectively between March 1, 2022 and February 1, 2023, with a group of patients with a diagnosis of VAP hospitalized in the chest diseases intensive care unit of Necmettin Erbakan University Meram Faculty of Medicine. In our study, bronchoalveolar lavage was performed simultaneously with endotracheal aspiration in 31 patients who were thought to have ventilator-associated pneumonia, by examining their anamnesis, physical examination findings, intensive care follow-ups, radiology and laboratory tests, and clinical pulmonary infection score, and the samples were sent to the clinical microbiology laboratory as soon as possible. . Gram stains, ARB, fungal and tuberculosis cultures, bacteriological quantitative cultures and antibiograms of the samples were examined and recorded in the microbiology laboratory. Demographic data of the patients, pre-sampling antibiotic information, APACHE II, SAPS II, SOFA, PSI scores, and 30- to 90-day mortality data were recorded. The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. Results. Of the 31 patients examined, 29 patients who met the inclusion and exclusion criteria were included in the study. Twenty (69.00%) of the patients included in the study were male, 9 (31.00%) were female, and the mean age was 68.24 ± 17.32 years. The most common viii comorbidities in these patients were hypertension with 37.90%, chronic obstructive pulmonary disease (COPD) with 27.60% and diabetes mellitus with 24.10%. The mean SAPS II score of the patients was 55.66 ± 18.30, the APACHE II score was 24.62 ± 7.09, the SOFA score was 7.14 ± 2.85, the PSI score was 144.14 ± 36.71. The 30-day mortality rate was 20.70%, and the 90-day mortality rate was 72.40%. Radiologically, pneumonia localization was evaluated bilaterally in 41.40%, right lung in 41.40%, and left lung in 17.20%. BAL culture growth was found to be significant in 8 (44.40%) patients with insignificant growth according to ETA culture, and a statistically significant difference was found in the distribution of ETA and BAL culture significant-insignificant growth rates (p=0.003). Conclusion. In our study, it was found that the bronchoscopic BAL method was superior to endotracheal aspiration in detecting the pneumonia agent. Despite the advantages of the ETA method such as being non-invasive, less costly and not providing special expertise, there are disadvantages such as contamination with oropharyngeal flora and the inability to detect the causative microorganism. We think that determining the causative agent with bronchoscopic BAL and administering appropriate antibiotic therapy in patients followed up in the ICU for VAP will contribute to reducing mortality and morbidity.
Aim. Pneumonia is a major cause of morbidity and mortality and affects millions of people worldwide each year. Detection of the microbiological factor causing pneumonia is very important in terms of giving appropriate antibiotics and reducing the morbidity and mortality rate. In our study, we aimed to compare the endotracheal aspirate method and the bronchoscopic bronchoalveolar lavage method to detect the microbiological agent in patients followed up for ventilator-associated pneumonia (VAP). Material and Methods. This study was carried out prospectively between March 1, 2022 and February 1, 2023, with a group of patients with a diagnosis of VAP hospitalized in the chest diseases intensive care unit of Necmettin Erbakan University Meram Faculty of Medicine. In our study, bronchoalveolar lavage was performed simultaneously with endotracheal aspiration in 31 patients who were thought to have ventilator-associated pneumonia, by examining their anamnesis, physical examination findings, intensive care follow-ups, radiology and laboratory tests, and clinical pulmonary infection score, and the samples were sent to the clinical microbiology laboratory as soon as possible. . Gram stains, ARB, fungal and tuberculosis cultures, bacteriological quantitative cultures and antibiograms of the samples were examined and recorded in the microbiology laboratory. Demographic data of the patients, pre-sampling antibiotic information, APACHE II, SAPS II, SOFA, PSI scores, and 30- to 90-day mortality data were recorded. The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. Results. Of the 31 patients examined, 29 patients who met the inclusion and exclusion criteria were included in the study. Twenty (69.00%) of the patients included in the study were male, 9 (31.00%) were female, and the mean age was 68.24 ± 17.32 years. The most common viii comorbidities in these patients were hypertension with 37.90%, chronic obstructive pulmonary disease (COPD) with 27.60% and diabetes mellitus with 24.10%. The mean SAPS II score of the patients was 55.66 ± 18.30, the APACHE II score was 24.62 ± 7.09, the SOFA score was 7.14 ± 2.85, the PSI score was 144.14 ± 36.71. The 30-day mortality rate was 20.70%, and the 90-day mortality rate was 72.40%. Radiologically, pneumonia localization was evaluated bilaterally in 41.40%, right lung in 41.40%, and left lung in 17.20%. BAL culture growth was found to be significant in 8 (44.40%) patients with insignificant growth according to ETA culture, and a statistically significant difference was found in the distribution of ETA and BAL culture significant-insignificant growth rates (p=0.003). Conclusion. In our study, it was found that the bronchoscopic BAL method was superior to endotracheal aspiration in detecting the pneumonia agent. Despite the advantages of the ETA method such as being non-invasive, less costly and not providing special expertise, there are disadvantages such as contamination with oropharyngeal flora and the inability to detect the causative microorganism. We think that determining the causative agent with bronchoscopic BAL and administering appropriate antibiotic therapy in patients followed up in the ICU for VAP will contribute to reducing mortality and morbidity.
Açıklama
Anahtar Kelimeler
Bronkoalveolar lavaj, Endotrakeal aspirasyon, Vip, Yoğun bakım
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Öğe, N. (2023). Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi göğüshastalıkları yoğun bakım ünitesinde entübe halde takip edilenpnömonili hastalarda bronkoalveolar lavaj ve trakeal aspiratmateryallerinin kültürlerinin ve gram boyamalarının kıyaslanması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Göğüs Hastalıkları Anabilim Dalı, Konya.
