Çalışmamızda Ege Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı tarafından yatırılarak veya ayaktan takip edilmiş karbapenemaz üreten Enterobacteriaceae ile gelişen üriner sistem enfeksiyonu tanısı alan toplam 100 hasta incelenmiş olup hastalar demografik özellikler, klinik özellikler, laboratuvar verileri ve tedavi yanıtları ile mortallite açısından değerlendirilmiştir.
Çalışmamızda karbapenem dirençli Enterobacteriacea ile gelişen üriner sistem enfeksiyonlu olgularda en sık eşlik eden yandaş hastalık malignite (%40) olarak saptanmış olup hastaların %70’inde cerrahi operaayon öyküsü bulunmaktaydı. Mikrobiyolojik yanıt oranı toplam (79/89) %88.7 oranında saptanmış olup en yüksek yanıt oranları ikili karbapenem tedavisi ve/veya karbapenem tedavisini uzun infüzyon şeklinde alan hastalarda sırası ile %93.8 ve %96.4 oranlarında saptanmıştır. Toplam mortalite oranı %19 olarak saptanmış olup tedavi rejimi ile (kombinasyon/monoterapi) mortalite üzerine anlamlı bir ilişki gösterilemese de kombinasyon tedavisi ile mortalite üzerine etki eden bağımsız risk faktörü olarak saptanan mikrobiyolojik yanıt oranı istatiksel olarak daha fazla sağlanmıştır (p=0.019). Çalışmamızda bir diğer dikkat çekici sonuç ise kontrolleri yapılabilen 47 hastada
53 relaps oranı %61.7 ve reenfeksiyon oranı ise %29.7 gibi yüksek oranlarda saptanmıştır. Kontrolleri yapılan toplam 47 hastada relaps ve reenfeksiyon saptanmayanların oranı ise %23.4 saptanmıştır.
Çalışmamızın verileri ışığında CRE ile enfeksiyon sıklığının ve etkilerinin azaltılabilmesi açısından endikasyon doğrultusunda antibiyotik kullanımlarına dikkat edilmesi, gereksiz yere ertapenem kullanılmaması, tedavi rejimi olarak ön planda kombinasyon tedavisinin tercih edilmesi, yüksek mikrobiyolojik başarı oranları açısından ikili karbapenem tedavisi ve/veya karbapenem tedavisinin uzun infüzyon şeklinde verilmesi başlıca öneriler arasında yer almaktadır.
Çalışmamız literatür incelendiğinde özellikle erişkin yaş grubunda karbapenem dirençli Enterobacteriacea ile gelişen üriner sistem enfeksiyonlarının incelendiği ülkemizden yapılmış olan sınırlı çalışmalar arasında yer almakta olup klinik olarak hastaların değerlendirildiği ilk çalışma olarak görülmektedir ancak bu konu ile ilgili randomize kontrollü çalışmalar başta olmak üzere daha fazla çalışma yapılmasına ihtiyaç vardır.
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10. EKLER
EK1: Olgu rapor formu
İdrar Kültüründe Karbapenem Dirençli Patojen Üreyen Üriner Sistem Enfeksiyonu Olan Hastaların Retrospektif Değerlendirilmesi
A.Olgu: Tarih: ../../....