Gram pozitif bakteri üremesi saptanan kan kültürlerinde genotiplendirme ile idendifikasyon ve direnç tayini
Yükleniyor...
Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Sepsiste etken bakterinin ve antibiyotik dirençlerinin hızlı şekilde tanımlanması çok önemlidir. Tedavinin en kısa sürede başlanması ile morbidite/mortalite azalmakta, hastanede yatış süresi kısalmakta, gereksiz antibiyotik kullanımı önlenmekte ve hastane maliyetlerinin düşmesi sağlanmaktadır. Otomatize kan kültür sistemleri, bakteriyel patojenlerin tanımlanma süresini önemli ölçüde kısaltmıştır. Buna rağmen doğru tedaviye en erken dönemde başlanabilmesi için daha hızlı tanımlama sistemleri gerekmektedir. Çalışmamızda, hastanemiz servislerinde yatan hastalara ait Gram pozitif bakteri üremesi olan kan kültürlerinde "Genotype® BC Gram-positive (Hain Lifesience, Almanya)" testi kullanılarak genotiplendirilmesi, mecA, vanA, vanB, vanC1, vanC2/C3 genlerinin hızlı tespiti amaçlanmıştır. Çalışmaya, bakteri kültürü ile 35(% 77.7)'i MR-KNS olan 45 KNS, 9(%52.9)'u MRSA olan 17 S.aureus, 2(%22.2)'si VRE olan 9 Enterokok ve bir S. grup D tanımlanmış toplam 72 örnek dahil edilmiştir. Genotipleme yöntemiyle 37(%75.5)'sinde Mec A pozitif olan toplam 49 KNS, 9(% 52.9)'unda mecA pozitif olan toplam 17 S.aureus, 2(%20)'sinde vanA pozitif olan toplam 10 Enterococcus, 2 S.pneumoniae ve 2 S. mitis/oralis bulunmuştur. Genotipleme yöntemi ile kültürde tespit edilemeyen 2 S. pneumoniae, 2 S. mitis/oralis belirlenmiştir. İstatistiksel değerlendirmede; tüm bakteri türleri için bakteri kültürü ile genotipleme yöntemleri arasında anlamlı düzeyde bir uyum bulunmuştur (p=0,999). BC Gram pozitif testinin, sepsis etkeni olan bakterileri, bu bakterilere ait direnç genlerini ve miksenfeksiyon etkenlerini 4-5 saatte doğru olarak tespit ettiği gözlenmiştir. Bu nedenlerle genotiplendirmenin sepsis düşünülen hastalarda erken klinik tanıya ve tedaviye katkıda bulunabileceği düşünülmüştür. Ancak çalışmamızda kültürde bakteri saptanan 10 örnekte genotipleme yöntemi sonuçlanmadığı görülmüştür. Bu nedenle sepsis tanısında kültür ve moleküler yöntemlerin birlikte kullanılmasının çok önemli olduğu düşünülmüştür. Anahtar Sözcükler: Sepsis, Kan kültürü, Genotipik testler, Gram pozitif kok, mecA, van genleri, hızlı moleküler test.
Rapid identification of the bacteria and antibiotic resistance causing sepsis is very important. Beginning with the appropriate treatment as soon as possible reduced morbidity/mortality, shortened the hospitalization time, prevented the unnecessary antibiotic use and reduced the hospital costs. Automated blood culture systems have significantly reduced the identification time of bacterial pathogens. However, faster identification systems are required to begin the right treatment as early as possible. The aim of this study is identification and resistant gene detection (mecA gene and vanA, vanB, vanC1, vanC2/C3 genes that cause methicillin and vancomycin resistance) with genotyping method (Genotype® BC Gram-positive) in blood cultures with gram positive bacteria growth which were obtained from inpatient from Düzce University Hospital's services.The study included a total of 72 Gram positive bacteria (which are 45 CNS, 17 S. aureus,9 Enterococci and one S. group D) identified in blood culture samples. Genotyping revealed a total of 49 CNS of which 37 (75%) is mecA positive; a total of 17 S.aureus of which 9 (52.9%) is mecA positive; a total of 10 enterococci of which 2(20%) vanA positive; 2 S.pneumoniae and 2 S. mitis / oralis. Two S. pneumoniae and 2 S. mitis / oralis which could not be detected in the culture, were determined by genotyping method. In the statistical evaluation performed as a result of genotyping study; there was a significant correlation between bacterial culture and genotyping methods for all bacterial species (p = 0.999).Using the BC Gram positive test, sepsis causative bacteria from blood culture bottles and resistance genes of these bacteria were detected correctly within 4-5 hours. For this reason it was found that genotyping may contribute to early clinical diagnosis and treatment of sepsis patients. However, in our study, genotyping method was not found in 10 samples with bacteria detected in culture. Therefore, it is thought that the use of culture and molecular methods together is very important in the diagnosis of sepsis.
Rapid identification of the bacteria and antibiotic resistance causing sepsis is very important. Beginning with the appropriate treatment as soon as possible reduced morbidity/mortality, shortened the hospitalization time, prevented the unnecessary antibiotic use and reduced the hospital costs. Automated blood culture systems have significantly reduced the identification time of bacterial pathogens. However, faster identification systems are required to begin the right treatment as early as possible. The aim of this study is identification and resistant gene detection (mecA gene and vanA, vanB, vanC1, vanC2/C3 genes that cause methicillin and vancomycin resistance) with genotyping method (Genotype® BC Gram-positive) in blood cultures with gram positive bacteria growth which were obtained from inpatient from Düzce University Hospital's services.The study included a total of 72 Gram positive bacteria (which are 45 CNS, 17 S. aureus,9 Enterococci and one S. group D) identified in blood culture samples. Genotyping revealed a total of 49 CNS of which 37 (75%) is mecA positive; a total of 17 S.aureus of which 9 (52.9%) is mecA positive; a total of 10 enterococci of which 2(20%) vanA positive; 2 S.pneumoniae and 2 S. mitis / oralis. Two S. pneumoniae and 2 S. mitis / oralis which could not be detected in the culture, were determined by genotyping method. In the statistical evaluation performed as a result of genotyping study; there was a significant correlation between bacterial culture and genotyping methods for all bacterial species (p = 0.999).Using the BC Gram positive test, sepsis causative bacteria from blood culture bottles and resistance genes of these bacteria were detected correctly within 4-5 hours. For this reason it was found that genotyping may contribute to early clinical diagnosis and treatment of sepsis patients. However, in our study, genotyping method was not found in 10 samples with bacteria detected in culture. Therefore, it is thought that the use of culture and molecular methods together is very important in the diagnosis of sepsis.
Açıklama
YÖK Tez No: 626743
Anahtar Kelimeler
Mikrobiyoloji, Microbiology, Moleküler Tıp, Molecular Medicine, Sepsis, Blood culture, Genotypic tests, Gram positive cocci, mecA, van Genes, rapid molecular testing
