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Ev Tipi Mekanik Ventilatör ile Takip Edilen Hastalarda Trakeal Aspirat Kültürlerinin Değerlendirilmesi

Year 2023, Volume: 7 Issue: 3, 340 - 345, 20.12.2023

Esra Akyüz Özkan Demet Gür Vural

https://doi.org/10.46332/aemj.1192753

Abstract

Amaç: Evde mekanik ventilator (EMV) ile takip edilen hastaların altta yatan hastalıkları, başvuru şikayetleri, trakeal aspirat (TA) kültürlerinden alınan örneklerden izole edilen mikroorganizmalar ve antibiyotiklere dirençlerinin araştırılması amaçlandı.

Araçlar ve Yöntem: 1 Ocak 2020 – 1 Ocak 2021 tarihleri arasında TA kültürleri, bakterilerin tanımlanması ve antibiyotik duyarlılıkları VITEK 2 (bioMeriux, Fransa) otomatik tanımlama sistemi ile değerlendirildi. Hasta dosyalarından hastaların yaşı, cinsiyeti, altta yatan hastalıkları, evde ventilatör kullanım süreleri, şikayetleri ve laboratuvar verileri incelendi.

Bulgular: Çalışmada incelenen 91 ventilatör ilişkili pnömoni (VİP) hastalarının 72'si (%79) erkek ve ortalama yaş 91.64 ± 64.07 ay idi. En sık başvuru nedeni ateş ve nefes darlığı olup, hastaların %43.76'sı serebral palsi/epilepsi ve %10.4'ü sendrom tanısı aldı.
Örneklerden; 12'si (%13.3) Gram pozitif, 79'u (%86.7) Gram negatif olarak tanımlandı. 44 (%48.4) örnekte Pseudomonas aeruginosa, 9 (%9.9) örnekte Serratia marcescens, 8 (%8.8) örnekte Klebsiella spp, 12 (%13.3) örnekte Staphylococcus aureus tespit edildi. Karbapenem direnci Pseudomonas aeruginosa için %18.75, Klebsiella spp için %16, Escherichia coli için %12.5 ve Acinetobacter baumannii için %12 idi.

Sonuç: Ateş ve solunum sıkıntısı gibi enfeksiyon bulguları ile başvuran EMV hastalardan TA kültürü alınmalı ve sonuca göre tedavi düzenlenmelidir. Evde EMV ile takip edilen hastaların TA kültürü antibiyotik direnç oranlarının literatürdeki yoğun bakımda yatan hastalardan gönderilen TA kültürlerine göre daha düşük olduğu gözlendi.

Keywords

antibiyotik direnci trakeal aspirat evde mekanik ventilasyon pediatri

References

  • 1. Trachsel D, Hammer J. Indications for tracheostomy in children. Paediatr Respir Rev. 2006;7(3):162-168.
  • 2. Butnaru CS, Colreavy MP, Ayari S, Froehlich P. Tracheotomy in children: evolution in indications. Int J Pediatr Otorhinolaryngol. 2006;70(1):115-119.
  • 3. Brenner M, O’Shea MP, Larkin P, Berry J. Key constituents for integration of care for children assisted with long-term home ventilation: a European study. BMC Pediatr. 2020;20(1):71.
  • 4. Lewarski JS, Gay PC. Current issues in home mechanical ventilation. Chest. 2007;132(2):671-676.
  • 5. King AC. Long-term home mechanical ventilation in the United States. Respir Care. 2012;57(6):921-930.
  • 6. Venkatachalam V, Hendley JO, Willson DF. The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med. 2011;12(3):286-296.
  • 7. Rello J, Ollendorf DA, Oster G, et al. VAP Outcomes Scientific Advisory Group. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122(6):2115-2121.
  • 8. Kollef MH, Burnham CD. Ventilator-associated pneumonia: the role of emerging diagnostic technologies. Semin Respir Crit Care Med. 2017;38(3):253-263.
  • 9. Houck PM, Bratzler DW, Nsa W, Ma A, Barlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164(6): 637-644.
  • 10. Prinzi A, Parker SK, Thurm C, Birkholz M, Sick-Samuels A. Association of Endotracheal Aspirate Culture Variability and Antibiotic Use in Mechanically Ventilated Pediatric Patients. JAMA Netw Open. 2021;4(12):e2140378.
  • 11. Wallis C, Paton JY, Beaton S, Jardine E. Children on longterm ventilatory support: 10 years of progress. Arch Dis Child. 2011;96(11):998-1002.
  • 12. Mehel DM, Çelebi M, Özdemir D, Akgül G, Yavuz. E. Evaluation of home health service care children with tracheotomy and mechanical ventilator. Türk Aile Hek Derg. 2020;24(1):3-11.
  • 13. Gowans M, Keenan HT, Bratton SL. The population prevalence of children receiving invasive home ventilation in Utah. Pediatr Pulmonol. 2007;42(3):231-236.
  • 14. Ertuğrul A, Baykacı B, Ertuğrul I, Kesici S, Yalçın EG. Clinical Evaluation of Invasive Home Mechanical Ventilation Dependent Pediatric Patients. Iran J Pediatr. 2017;27(4):9531.
  • 15. Can FK, Anıl AB, Anıl M, et al. The outcomes of children with tracheostomy in a tertiary care pediatric intensive care unit in Turkey. Turk Pediatri Ars. 2018;53 (3):177-184.
  • 16. Palfrey JS, Sofis LA, Davidson EJ, Liu J, Freeman L, Ganz ML. The pediatric alliance for coordinated care: evaluation of a medical home model. Pediatrics. 2004;113(5 Suppl):1507-1515.
  • 17. Baker CD, Martin S, Thrasher J, et al. A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children. Pediatrics. 2016;137(4): 20150637.
  • 18. Erdoğan H, Baykam N, Erdoğan A, Balaban E. Ventilatörle ilişkili pnömoni. Hastane İnfeksiyon Derg. 2003;7(1):45-50.
  • 19. Akalın H. Ventilatörle ilişkili pnömoni ve önlenmesi. Hastane İnfeksiyon Derg. 2004;8(2):112-115.
  • 20. Ağca H. Yoğun bakımda antibiyotik duyarlılıkları. Journal of Clinical and Analytical Medicine. 2013;4(1):27-29.
  • 21. Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries, J Infect Control. 2008;36(4 Suppl):93-100.
  • 22. Kollef MH, Shorr A, Tabak YP, Liu LZ, Johannes RS. Epidemiology and Outcomes of Health-care– Associated Pneumonia results from a large US database of culture-positive pneumonia. Chest. 2005;128(6): 3854-3862.
  • 23. Küme G, Demirci M. Yoğun bakım ünitelerindeki hastaların alt solunum yolu örneklerinden izole edilen non-fermentatif Gramnegatif bakterilerin antimikrobiyal duyarlılıkları ve alt solunum yolu infeksiyonu ile ilişkili risk faktörleri. Dokuz Eylül Üniv Tıp Fak Derg. 2012;26(1):37-44.
  • 24. Sağmak-Tartar A, Özer AB, Ulu R, Akbulut A. Microbiological Evaluation of the Pathogens Isolated From the Endotracheal Aspirate Samples of the Patients Followed in the Intensive Care Units: A One-Year Retrospective Analysis. Klimik Dergisi. 2018;31(1):56-60.
  • 25. Dede B, Kadanalı A, Karagöz G, Çomoğlu Ş, Bektaşoğlu MF, İrvem A. Yoğun bakım ünitemizden gönderilen derin trakeal aspirat kültürleninin değerlendirilmesi. Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2014;54(1):15-20.
  • 26. Demirdağ K, Cihangiroğlu M, Yüce P, Özden M, KalkanA. Mekanik ventilasyon desteği alan hastaların trakeal aspirat örneklerinden izole edilen bakteriler ve antibiyotik duyarlılıkları. Klimik Derg. 2003;16(2): 68-72.
  • 27. Yenişehirli G, Yenişehirli A, Bulut Y, Bulut N. Metisilin dirençli Staphylococcus aureus izolatlarının vankomisin, teikoplanin, linezolid, kinupristin-dalfopristin ve daptomisine in vitro duyarlılıkları. Ankem Derg. 2015;29(1):21-25.

Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators

Year 2023, Volume: 7 Issue: 3, 340 - 345, 20.12.2023

Esra Akyüz Özkan Demet Gür Vural

https://doi.org/10.46332/aemj.1192753

Abstract

Purpose: To investigate the underlying diseases, and complaints of patients upon admission, isolated microorganisms from tracheal aspirate (TA) samples and their resistance to antibiotics in patients followed up with a home mechanic ventilator (HMV).

Materials and Methods: Between January 1, 2020 and January 1, 2021, TA cultures, identification of bacteria and their antibiotic susceptibilities were evaluated by VITEK 2 (bioMeriux, France) automated identification system. The patients' age, gender, underlying diseases, duration of home ventilator use, complaints, and laboratory data were reviewed.

Results: Of the 91 prediagnosed ventilator-associated pneumonia (VAP) patients, 72 (79%) were male and mean age was 91.64 ± 64.07 months. The most common reason for referral was fever and dyspnea and 43.76% of the patients were diagnosed with cerebral palsy/epilepsy and 10.4% with syndromes.
Of the samples; 12 (13.3%) were defined as Gram-positive and 79 (86.7%) as Gram-negative. Pseudomonas aeruginosa was detected in 44 (48.4%) samples, Serratia marcescens in 9 (9.9%), Klebsiella spp. in 8 (8.8%) and Staphylococcus aureus was in 12 (13.3%) samples. Carbapenem resistance was 18.75% for Pseudomonas aeruginosa, 16% for Klebsiella spp, 12.5 for Escherichia coli and 12% for Acinetobacter baumannii.

Conclusion: TA culture should be taken from patients with HMV who were admitted with signs of infection such as fever and respiratory distress and treatment should be arranged according to the result. It was observed that the TA culture antibiotic resistance rates of the patients with HMV were lower than the TA cultures sent from the patients hospitalized in the intensive care unit in the literature.

Keywords

Antibiotic resistance tracheal aspirate home mechanical ventilation pediatrics

References

  • 1. Trachsel D, Hammer J. Indications for tracheostomy in children. Paediatr Respir Rev. 2006;7(3):162-168.
  • 2. Butnaru CS, Colreavy MP, Ayari S, Froehlich P. Tracheotomy in children: evolution in indications. Int J Pediatr Otorhinolaryngol. 2006;70(1):115-119.
  • 3. Brenner M, O’Shea MP, Larkin P, Berry J. Key constituents for integration of care for children assisted with long-term home ventilation: a European study. BMC Pediatr. 2020;20(1):71.
  • 4. Lewarski JS, Gay PC. Current issues in home mechanical ventilation. Chest. 2007;132(2):671-676.
  • 5. King AC. Long-term home mechanical ventilation in the United States. Respir Care. 2012;57(6):921-930.
  • 6. Venkatachalam V, Hendley JO, Willson DF. The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatr Crit Care Med. 2011;12(3):286-296.
  • 7. Rello J, Ollendorf DA, Oster G, et al. VAP Outcomes Scientific Advisory Group. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122(6):2115-2121.
  • 8. Kollef MH, Burnham CD. Ventilator-associated pneumonia: the role of emerging diagnostic technologies. Semin Respir Crit Care Med. 2017;38(3):253-263.
  • 9. Houck PM, Bratzler DW, Nsa W, Ma A, Barlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164(6): 637-644.
  • 10. Prinzi A, Parker SK, Thurm C, Birkholz M, Sick-Samuels A. Association of Endotracheal Aspirate Culture Variability and Antibiotic Use in Mechanically Ventilated Pediatric Patients. JAMA Netw Open. 2021;4(12):e2140378.
  • 11. Wallis C, Paton JY, Beaton S, Jardine E. Children on longterm ventilatory support: 10 years of progress. Arch Dis Child. 2011;96(11):998-1002.
  • 12. Mehel DM, Çelebi M, Özdemir D, Akgül G, Yavuz. E. Evaluation of home health service care children with tracheotomy and mechanical ventilator. Türk Aile Hek Derg. 2020;24(1):3-11.
  • 13. Gowans M, Keenan HT, Bratton SL. The population prevalence of children receiving invasive home ventilation in Utah. Pediatr Pulmonol. 2007;42(3):231-236.
  • 14. Ertuğrul A, Baykacı B, Ertuğrul I, Kesici S, Yalçın EG. Clinical Evaluation of Invasive Home Mechanical Ventilation Dependent Pediatric Patients. Iran J Pediatr. 2017;27(4):9531.
  • 15. Can FK, Anıl AB, Anıl M, et al. The outcomes of children with tracheostomy in a tertiary care pediatric intensive care unit in Turkey. Turk Pediatri Ars. 2018;53 (3):177-184.
  • 16. Palfrey JS, Sofis LA, Davidson EJ, Liu J, Freeman L, Ganz ML. The pediatric alliance for coordinated care: evaluation of a medical home model. Pediatrics. 2004;113(5 Suppl):1507-1515.
  • 17. Baker CD, Martin S, Thrasher J, et al. A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children. Pediatrics. 2016;137(4): 20150637.
  • 18. Erdoğan H, Baykam N, Erdoğan A, Balaban E. Ventilatörle ilişkili pnömoni. Hastane İnfeksiyon Derg. 2003;7(1):45-50.
  • 19. Akalın H. Ventilatörle ilişkili pnömoni ve önlenmesi. Hastane İnfeksiyon Derg. 2004;8(2):112-115.
  • 20. Ağca H. Yoğun bakımda antibiyotik duyarlılıkları. Journal of Clinical and Analytical Medicine. 2013;4(1):27-29.
  • 21. Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries, J Infect Control. 2008;36(4 Suppl):93-100.
  • 22. Kollef MH, Shorr A, Tabak YP, Liu LZ, Johannes RS. Epidemiology and Outcomes of Health-care– Associated Pneumonia results from a large US database of culture-positive pneumonia. Chest. 2005;128(6): 3854-3862.
  • 23. Küme G, Demirci M. Yoğun bakım ünitelerindeki hastaların alt solunum yolu örneklerinden izole edilen non-fermentatif Gramnegatif bakterilerin antimikrobiyal duyarlılıkları ve alt solunum yolu infeksiyonu ile ilişkili risk faktörleri. Dokuz Eylül Üniv Tıp Fak Derg. 2012;26(1):37-44.
  • 24. Sağmak-Tartar A, Özer AB, Ulu R, Akbulut A. Microbiological Evaluation of the Pathogens Isolated From the Endotracheal Aspirate Samples of the Patients Followed in the Intensive Care Units: A One-Year Retrospective Analysis. Klimik Dergisi. 2018;31(1):56-60.
  • 25. Dede B, Kadanalı A, Karagöz G, Çomoğlu Ş, Bektaşoğlu MF, İrvem A. Yoğun bakım ünitemizden gönderilen derin trakeal aspirat kültürleninin değerlendirilmesi. Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2014;54(1):15-20.
  • 26. Demirdağ K, Cihangiroğlu M, Yüce P, Özden M, KalkanA. Mekanik ventilasyon desteği alan hastaların trakeal aspirat örneklerinden izole edilen bakteriler ve antibiyotik duyarlılıkları. Klimik Derg. 2003;16(2): 68-72.
  • 27. Yenişehirli G, Yenişehirli A, Bulut Y, Bulut N. Metisilin dirençli Staphylococcus aureus izolatlarının vankomisin, teikoplanin, linezolid, kinupristin-dalfopristin ve daptomisine in vitro duyarlılıkları. Ankem Derg. 2015;29(1):21-25.
There are 27 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Esra Akyüz Özkan 0000-0001-9412-8010

Demet Gür Vural 0000-0003-2974-6589

Early Pub Date October 11, 2023
Publication Date December 20, 2023
Published in Issue Year 2023 Volume: 7 Issue: 3

Cite

APA Akyüz Özkan, E., & Gür Vural, D. (2023). Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators. Ahi Evran Medical Journal, 7(3), 340-345. https://doi.org/10.46332/aemj.1192753
AMA Akyüz Özkan E, Gür Vural D. Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators. Ahi Evran Med J. December 2023;7(3):340-345. doi:10.46332/aemj.1192753
Chicago Akyüz Özkan, Esra, and Demet Gür Vural. “Evaluation of Tracheal Aspirate Cultures of Patients Followed With Home Mechanical Ventilators”. Ahi Evran Medical Journal 7, no. 3 (December 2023): 340-45. https://doi.org/10.46332/aemj.1192753.
EndNote Akyüz Özkan E, Gür Vural D (December 1, 2023) Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators. Ahi Evran Medical Journal 7 3 340–345.
IEEE E. Akyüz Özkan and D. Gür Vural, “Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators”, Ahi Evran Med J, vol. 7, no. 3, pp. 340–345, 2023, doi: 10.46332/aemj.1192753.
ISNAD Akyüz Özkan, Esra - Gür Vural, Demet. “Evaluation of Tracheal Aspirate Cultures of Patients Followed With Home Mechanical Ventilators”. Ahi Evran Medical Journal 7/3 (December 2023), 340-345. https://doi.org/10.46332/aemj.1192753.
JAMA Akyüz Özkan E, Gür Vural D. Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators. Ahi Evran Med J. 2023;7:340–345.
MLA Akyüz Özkan, Esra and Demet Gür Vural. “Evaluation of Tracheal Aspirate Cultures of Patients Followed With Home Mechanical Ventilators”. Ahi Evran Medical Journal, vol. 7, no. 3, 2023, pp. 340-5, doi:10.46332/aemj.1192753.
Vancouver Akyüz Özkan E, Gür Vural D. Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators. Ahi Evran Med J. 2023;7(3):340-5.
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