Antibiyotikle ilişkili ishal olgularında Clostridium difficile' nin araştırılması
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2010
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info:eu-repo/semantics/openAccess
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Selçuk Üniversitesi Meram Tıp Fakültesi hastanesinde yatan, antibiyotiğe bağlı ishal düşünülen hastalarda C.difficile varlığı araştırılarak, risk faktörlerinin ve epidemiyolojisinin belirlenmesi amaçlanmıştır.Gereç ve Yöntem: Mart 2009-Mayıs 2010 tarihleri arasında, çeşitli kliniklerde yatan, son 3 hafta içinde antibiyotik kullanan, antibiyotiğe bağlı ishal düşünülen 250 hastanın gaita örneği makroskopik ve mikroskopik olarak incelendi. ELISA yöntemiyle C.difficile toksin A-B varlığı araştırıldı ve pozitif bulunan örnekler CCFA besiyerine ekildi. Ekimleri yapılan örnekler hemen jara yerleştirilerek anaerop ortam sağlandı ve 37oC'de 48 saat inkübe edildi. CCFA besiyeri, C.difficile'ye özgü 2-5 mm çapında, kenarları yuvarlak, sarı-yeşilimsi kolonilerin varlığı açısından değerlendirildi. Bu kolonilerden Gram boyama yapıldı. Gram pozitif terminal ve subterminal sporlu basiller görüldü. API 20A paneli kullanılarak bakterinin biyokimyasal özellikleri araştırılarak tanı konuldu.Bulgular: Toplam 250 gaita örneğinin 10 (%4)'unda toksin A-B pozitif olarak saptandı. Bakterilerin oksijene maruziyeti sonucunda 10 suşun 4'ünde üreme görülmedi. Pozitif bulunan 10 hastanın 8'i (%80) erkek, 2'si (%20) kadındır. Bu hastalara ait gaita örneklerinin 4'ü (%40) pediatrik kliniklerden, 3'ü (%30) dahili kliniklerden, 3'ü (%30) yoğun bakım ünitelerinden gönderilmiştir. Toksin A-B pozitif bulunan 10 hastanın 4'ü 0-4, 1'i 10-24, 1'i 25-44, 1'i 45-64 yaş grubunda ve 3 hasta da 65 yaş üstündedir. Pozitif bulunan hastalardan 3'ü immün yetmezlik, 2'si malignite, 1'i pnömoni, 1'i gastroenterit, 1'i sepsis, 1'i menenjit, 1'i C.difficile ile ilişkili hastalık tanısı almıştır. Bu hastaların en sık kullandığı antibiyotiğin 3. kuşak sefalosporinler olduğu; bunu meropenem, amikasin, teikoplanin, netilmisin ve tigesiklin gibi antibiyotiklerin izlediği saptanmıştır.Sonuç: Günümüzde C.difficile ile ilişkili hastalık geniş spektrumlu antibiyotiklerin yaygın ve uygunsuz biçimde kullanıldığı hastanede yatan hastalarda önemli bir sağlık sorunu oluşturmaktadır. Klinik mikrobiyoloji laboratuvarlarında bu mikroorganizmayı saptayan tetkiklerin rutin tanı testleri arasında yer almaları gereklidir. Hastanelerde C.difficile ile ilişkili hastalık oranını azaltmanın başlıca yolu akılcı antibiyotik kullanımı ve infeksiyon kontrol önlemlerine gereken önemin verilmesidir.Anahtar kelimeler: Clostridium difficile, antibiyotikle ilişkili ishal, toksin A-B
C.difficile is investigated in patients thought to be antibiotic-associated diarrhea at Selcuk University Meram Medical Faculty hospitals and aimed to identify risk factors and epidemiology.Materıals And Methods: Between March 2009-May 2010, stool samples of 250 patients hospitalized at different clinics and using antibiotics at last three weeks and thought to be antibiotic associated diarrhea were examined macroscopically and microscopically. C.difficile toxin A-B was investigated by ELISA and positive samples were inoculated on cycloserine-cefoxitin fructose agar (CCFA). Inoculated samples immediately placed in a jara and were incubated at 48 hours at 37°C in anaerobic conditions. CCFA medium was evaluated for the presence of C.difficile colonies which were 2-5 mm in diameter, yellow-greenish color and with rounded edges. Gram staining was done from these colonies. Gram-positive bacilli were seen with terminal and subterminal spores. Using API 20A panel biochemical properties of the bacteria was investigated and diagnosed.Results: 10 (4%) of 250 stool samples were found to be C.difficile toxin A-B positive. As a result of exposure to oxygen, growth was not seen in 4 of 10 strains of bacteria. Positive in 8 (80%) of the 10 patients were male, 2 (20%) were female. 4 (40%) positive stool samples of 10 patients were from pediatric clinics and 3 (30%) were from internal medicine clinics and 3 (30%) were from intensive care units. 4 of 10 patients with positive toxin A-B were age group of 0-4, 1 patient was 10-24, 1 patient was 25-44, 1 patient was 45-64 and 3 patients were over 65 years. 3 of 10 patients with positive C.difficile toxin A-B had immunodeficiency, 2 patients had malignancy, 1 patient had pneumonia and 1 patient had gastroenteritis, 1 patient had sepsis, 1 patient had meningitis and 1 patient was diagnosed as C.difficile associated disease. The most frequently used antibiotics among toxin-positive patients were third generation cephalosporins. A variety of antibiotics such as meropenem, amikacin, teicoplanin, netilmicin and tigecycline were found to follow third generation cephalosporins.Conclusion: Today, at hospitals, C.difficile associated disease and broad-spectrum antibiotics commonly used in inappropriate manner in hospitalized patients constitutes a major health problem. Tests that detect these microorganisms are required to take place among the routine diagnostic procedures at clinical microbiology laboratories. The main way of reducing the rate of C.difficile associated diseases at hospitals is to take necessary attention to rational use of antibiotics and infection control measures.Key words: Clostridium difficile, antibiotic associated diarrhea, toxin A-B
C.difficile is investigated in patients thought to be antibiotic-associated diarrhea at Selcuk University Meram Medical Faculty hospitals and aimed to identify risk factors and epidemiology.Materıals And Methods: Between March 2009-May 2010, stool samples of 250 patients hospitalized at different clinics and using antibiotics at last three weeks and thought to be antibiotic associated diarrhea were examined macroscopically and microscopically. C.difficile toxin A-B was investigated by ELISA and positive samples were inoculated on cycloserine-cefoxitin fructose agar (CCFA). Inoculated samples immediately placed in a jara and were incubated at 48 hours at 37°C in anaerobic conditions. CCFA medium was evaluated for the presence of C.difficile colonies which were 2-5 mm in diameter, yellow-greenish color and with rounded edges. Gram staining was done from these colonies. Gram-positive bacilli were seen with terminal and subterminal spores. Using API 20A panel biochemical properties of the bacteria was investigated and diagnosed.Results: 10 (4%) of 250 stool samples were found to be C.difficile toxin A-B positive. As a result of exposure to oxygen, growth was not seen in 4 of 10 strains of bacteria. Positive in 8 (80%) of the 10 patients were male, 2 (20%) were female. 4 (40%) positive stool samples of 10 patients were from pediatric clinics and 3 (30%) were from internal medicine clinics and 3 (30%) were from intensive care units. 4 of 10 patients with positive toxin A-B were age group of 0-4, 1 patient was 10-24, 1 patient was 25-44, 1 patient was 45-64 and 3 patients were over 65 years. 3 of 10 patients with positive C.difficile toxin A-B had immunodeficiency, 2 patients had malignancy, 1 patient had pneumonia and 1 patient had gastroenteritis, 1 patient had sepsis, 1 patient had meningitis and 1 patient was diagnosed as C.difficile associated disease. The most frequently used antibiotics among toxin-positive patients were third generation cephalosporins. A variety of antibiotics such as meropenem, amikacin, teicoplanin, netilmicin and tigecycline were found to follow third generation cephalosporins.Conclusion: Today, at hospitals, C.difficile associated disease and broad-spectrum antibiotics commonly used in inappropriate manner in hospitalized patients constitutes a major health problem. Tests that detect these microorganisms are required to take place among the routine diagnostic procedures at clinical microbiology laboratories. The main way of reducing the rate of C.difficile associated diseases at hospitals is to take necessary attention to rational use of antibiotics and infection control measures.Key words: Clostridium difficile, antibiotic associated diarrhea, toxin A-B
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Anahtar Kelimeler
Antibiyotikler, Diyare, Komplikasyonlar, Toksinler
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Gündem, N. S. (2010). Antibiyotikle ilişkili ishal olgularında Clostridium difficile' nin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Temel Tıp Bilimleri Tıbbi Mikrobiyoloji Anabilim Dalı, Konya.
