Sürekli Ayaktan Periton Diyaliziyle İlişkili Peritonit: Klinik Özellikler, Etken Mikroorganizmalar ve Antibiyotik Duyarlılıkları
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Öz: Amaç: Bu çalışmanın amacı, hastanemizde gelişen sürekli ayaktan periton diyalizi (SAPD) ile ilişkili peritonitlerde klinik özelliklerin, etken mikroorganizmaların ve antibiyotik duyarlılıklarının belirlenmesidir. Yöntemler: Bu prospektif çalışmaya Ocak 2012-Şubat 2013 tarihleri arasında Fırat Üniversitesi Hastanesi Nefroloji Kliniği, sürekli ayaktan periton diyalizi ünitesinde takip edilen 55 olgudan peritonit atağıyla başvuran 18 yaş ve üstü erişkin 30 hasta alındı. Kültürler Uluslararası Periton Diyalizi Derneği'nin önerdiği şekilde hem katı besiyerine hem de kan kültürü şişelerine ekilerek yapıldı. Antibiyotik duyarlılığı disk difüzyon yöntemiyle araştırıldı.Bulgular: Hastaların 28 (%93.3)'inde batında hassasiyet, 4 (%13.3)'ünde batında defans /"rebound", 9 (%30)'unda ateş, 13 (%43.3)'ünde bulantı ve kusma, 5 (%16.7)'inde ishal saptandı. Bulanık diyaliz sıvısı ve karın ağrısı bütün hastalarda saptandı. Periton sıvısının direkt Gram boyamasında bir (%3.3) hastada pozitiflik mevcuttu. Periton sıvısı kültüründe 28 (%93.3) hastada üreme oldu. Katı besiyerinde 14 (%46.7), kan kültürü şişesinde 28 (%93.3) hastada üreme saptandı. İki (%6.7) hastada ise periton sıvısı kültürlerinde her iki yöntemle de üreme olmadı. Her iki yöntemle idantifiye edilen mikroorganizmalar ve antibiyogramları birbirinin aynısıydı. Gram-pozitif mikroorganizmalardan 16 (%57.1)'sı koagülaz-negatif stafilokok, 4 (%14.3)'ü Staphylococcus aureus, 4 (%14.3)'ü streptokok, 1 (%3.6)'i enterokok olarak tespit edildi. Gram-negatif mikroorganizmalardan 2'si Escherichia coli, 1'i Yersinia enterocolitica idi. Gram-pozitif mikroorganizmalarda penisilin direnci %46.2 olarak saptandı. Stafilokok türlerinde metisiline direnç oranı ise %9.5 olarak bulundu.Sonuçlar: Her merkezin kendi etken ve duyarlılık profilini bilmesi, uygun ampirik tedavi seçeneğini belirlemesi açısından gereklidir. Bu strateji sayesinde gereksiz antibiyotik kullanımının önlenmesi sağlanmış ve antibiyotiklere karşı direnç gelişmesi ihtimali de azaltılmış olacaktır.
Abstract: Objective: The objective of this study was to determine clinical characteristics, etiological agents, and their antibiotic susceptibilities in continuous ambulatory peritoneal dialysis (CAPD)related peritonitis encountered in our hospital.Methods: Thirty patients with peritonitis attack among 55 adult patients aged >=18 years, who applied to Nephrology Clinic of Fırat University Hospital between January 2012 and February 2013 and who were monitored in the CAPD unit were included in this prospective study. Cultures were performed on both solid media and blood culture bottles according to the recommendations of International Society for Peritoneal Dialysis. Antibiotic susceptibilities were investigated by disk diffusion method.Results: During clinical evaluation, abdominal guarding (n=28, 93.3%), rebound tenderness (n=4, 13.3%), fever (n=9, 30%), nausea and vomiting (n=13, 43.3%), and diarrhea (n=5, 16.7%) were detected. Turbid dialysis fluid and abdominal pain were noted in all patients. Direct Gram staining yielded positive result in 1 (3.3%) patient. In 28 (93.3%) patients bacterial growth was detected in the cultures. Bacterial growth was detected on solid culture media in 14 (46.7%), and blood culture bottles in 28 (93.3%) patients. In 2 (6.7%) patients, bacterial growth was not detected in both media. The same microorganisms were identified in both methods, and their antibiograms yielded similar results. Gram-positives included coagulase-negative staphylococci (n=16, 57.1%), Staphylococcus aureus (n=4, 14.3%), streptococci (n=4, 14.3%), and enterococci (n=1, 3.6%). Gramnegatives consisted of Escherichia coli (n=2), and Yersinia enterocolitica (n=1). In 46.2% of Gram-positive microorganisms penicillin resistance was detected, while 9.5% of staphylococci were methicillin-resistant.Conclusions: Each health center should have knowledge of its prevalent microbial agents, and their susceptibility profile, which is essential for the determination of suitable alternative empirical treatment. This strategy will obviate unnecessary use of antibiotics, and contribute to the decrease in the potential development of antibiotic resistance.
Abstract: Objective: The objective of this study was to determine clinical characteristics, etiological agents, and their antibiotic susceptibilities in continuous ambulatory peritoneal dialysis (CAPD)related peritonitis encountered in our hospital.Methods: Thirty patients with peritonitis attack among 55 adult patients aged >=18 years, who applied to Nephrology Clinic of Fırat University Hospital between January 2012 and February 2013 and who were monitored in the CAPD unit were included in this prospective study. Cultures were performed on both solid media and blood culture bottles according to the recommendations of International Society for Peritoneal Dialysis. Antibiotic susceptibilities were investigated by disk diffusion method.Results: During clinical evaluation, abdominal guarding (n=28, 93.3%), rebound tenderness (n=4, 13.3%), fever (n=9, 30%), nausea and vomiting (n=13, 43.3%), and diarrhea (n=5, 16.7%) were detected. Turbid dialysis fluid and abdominal pain were noted in all patients. Direct Gram staining yielded positive result in 1 (3.3%) patient. In 28 (93.3%) patients bacterial growth was detected in the cultures. Bacterial growth was detected on solid culture media in 14 (46.7%), and blood culture bottles in 28 (93.3%) patients. In 2 (6.7%) patients, bacterial growth was not detected in both media. The same microorganisms were identified in both methods, and their antibiograms yielded similar results. Gram-positives included coagulase-negative staphylococci (n=16, 57.1%), Staphylococcus aureus (n=4, 14.3%), streptococci (n=4, 14.3%), and enterococci (n=1, 3.6%). Gramnegatives consisted of Escherichia coli (n=2), and Yersinia enterocolitica (n=1). In 46.2% of Gram-positive microorganisms penicillin resistance was detected, while 9.5% of staphylococci were methicillin-resistant.Conclusions: Each health center should have knowledge of its prevalent microbial agents, and their susceptibility profile, which is essential for the determination of suitable alternative empirical treatment. This strategy will obviate unnecessary use of antibiotics, and contribute to the decrease in the potential development of antibiotic resistance.
Açıklama
Anahtar Kelimeler
Kaynak
Klimik Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
29
Sayı
3
Künye
TARTAR A. S,ÖZDEN M,AKBULUT A,DEMİRDAĞ K,ÖZER Ş. B (2016). Sürekli Ayaktan Periton Diyaliziyle İlişkili Peritonit: Klinik Özellikler, Etken Mikroorganizmalar ve Antibiyotik Duyarlılıkları. Klimik Dergisi, 29(3), 107 - 111.
