Kanserli Hastalarda Febril Nötropeni Sýrasýnda Alýnan Kültürlerin Deðerlendirilmesi

Febrile neutropenia is a common complication in patients receiving cancer treatment. According to the results of several investigations bacterial infections are the most common causes of morbidity and mortality, in these patients, so, empiric broad-spectrum antibiotics should be initiated promptly. Prevalence and antimicrobial susceptibility of suspected microorganisms and epidemiologic characteristics of patient population shoud be considered in the initiation of empiric antimicrobial treatment. In this study we evaluated retrospectively cultures obtained from hospitalized adult cancer patients during febrile neutropenic attacks over a one year period (January 2005-January 2006). In microbiologic identification and susceptibility testing we used standard culture methods and BBL semi automatic system. Infection was documented microbiologically in 17.98% of obtained samples. Blood cultures were positive in 21.21% and cultures obtained from other body sites were positive in 16.93% of samples. The rate of positive cultures in sputum and skin lesions were higher than other sites (46.77% and 43.75% respectively). In blood cultures, gram-negative agents were isolated in 61.90% and gram-positives in 38.10% of cultures. In cultures obtained from other sites of the body gram-negatives, gram-positives and fungal agents were isolated in 53.85%, 15.38% and 30.77% of cultures respectively. As a result, in diagnosis and treatment of neutropenic patients a detailed medical history, physical examination, cultures from blood and other clinically suspicious body sites and initiation of empirical antimicrobial treatment according to the hospital infectious surveyance reports are life saving issues.

Evaluation of Cultures Obtained from Cancer Patients During Febrile Neutropenia

Febril nötropeni, kanser tedavisinin en yaygýn komplikasyonlarýndan biridir. Bu hastalarda morbidite ve mortalitenin en önemli nedeni bakteriyel infeksiyonlar olarak bilindiði için vakit kaybetmeden ampirik geniþ spektrumlu antibiyotiklerin baþlanmasý kuvvetle tavsiye edilir. Bu çalýþmada febril nötropeni nedeniyle Ocak 2005-Ocak 2006 tarihleri arasýnda hastanemizde yatýrýlarak takip edilen kanserli eriþkin hastalardan alýnan kültürlerde üreme oranlarý ve üreyen mikroorganizmalarý retrospektif olarak deðerlendirdik. Hastalardan alýnan örnekler konvansiyonel yöntemlerle ekilip, ileri identifikasyon, BBL yarý otomatik sistemi ile yapýldý. Alýnan toplam 406 kültürden %17.98’inde üreme saptandý. Alýnan kan kültürlerinden %21.21’inde ve kan kültürü haricinde alýnan kültürlerin %16.93’ünde üreme görüldü. Ýnfeksiyon etkeni en yüksek oranda balgam (%46.77) ve yara yeri kültürlerinde (%43.75) saptandý. Kan kültürlerinde üreyen gram-negatiflerin oraný %61.90, gram-pozitiflerin üreme oraný ise %38.10 idi. Kan dýþýndaki kültürlerde gram-negatiflerin üreme oraný ise % 53.85, gram-pozitiflerin %15.38 ve mantarlarýn üreme oraný ise %30.77 olarak saptandý. Sonuç olarak febril nötropenik hastalarýn taný ve tedavisinde dikkatli bir anamnez ve fizik muayene, kan ve kan dýþý bölgelerden alýnan kültürler ve hastanenin infeksiyon sürveyans verilerine dayalý olarak baþlanan uygun ampirik antibiyotik tedavi, yaþamsal önem taþýmaktadýr.