ALT SOLUNUM YOLU ÖRNEKLERİNDEN İZOLE EDİLEN PSEUDOMONAS AERUGİNOSA DİRENÇ PROFİLİNİN İNCELENMESİ Investigation of Resistance Profile of Pseudomonas Aeruginosa Isolated from Lower Respiratory Tract Samples

Effect of Lumbar Spinal Stenosis on Pain, Daily Activities of Living and Muscular Activity

Bahar Akgün KARAPINAR, Cihan YEŞILOĞLU, Mehmet Akif DURMUŞ, Onur TOSUN, Nezahat GÜRLER, Çiğdem KAYACAN

Özet

Amaç: Pseudomonas aeruginosa hastane enfeksiyonlarına neden olması ve antibiyotiklere direnci ile mortalite ve morbiditeyi yüksek oranda etkilemektedir. Bu çalışmada alt solunum yolu örneklerinden izole edilen P. aeruginosa’nın antibiyotik direnç profili incelenmistir. Gereç ve Yöntemler: Haziran 2016-Eylül 2017 tarihleri arasında gelen alt solunum yolu örneklerinin kültürü yapılmış ve bakteri identifikasyonu konvansiyonel yöntemler ile, antibiyotik duyarlılık testi ise European Committee on Antimicrobial Susceptibility Testing önerilerine göre yapılmıştır. Bulgular: Laboratuvarımızda 5.367 alt solunum yolu örneği incelenmiştir. Toplam 185 hastadan (%70’i Göğüs Hastalıkları, %2’si Çocuk Yoğun Bakım Ünitesi hastası) 378 (%7) P. aeruginosa suşu izole edilmiştir. En yüksek antibiyotik direnç oranı %33 ile imipeneme, sonrasında %25 ile meropeneme ait bulunmuştur. Sonuç: Ülkemizde yapılan çalışmalar incelendiğinde izole edilen P. aeruginosa direnç oranlarına ait farklı veriler olduğu görülmüştür. Buna çalışmaların planlanmasındaki farklılıklar, antibiyotik kullanım politikaları ve tekrar eden hasta örneklerinin istatistiksel verilerden çıkarılamaması gibi durumların neden olduğu dü- şünülmektedir. Ülkemizde yayınlanan bir meta-analiz çalışmasında son 11 yılda gözlenen P. aeruginosa direnç profili incelenmiş, antibiyotiklere direncin azalmakta olduğuna dikkat çekilmiştir. Bu bilgiler göz önünde bulundurulduğunda bu çalışmada karbapenemler hariç tüm antibiyotik gruplarında ülke genelinde direnç oranlarının geçmiş yıllara kıyasla daha düşük düzeyde olduğu görülmüştür. Karbapenem grubunda mevcut direnç artışı ve diğer gruplarda olan azalmaların daha iyi ortaya konulabilmesi ve genellenebilmesi için ülke genelinde geniş kapsamlı, çalışmaların yapılmasının yararlı olacağı düşünülmektedir. Anahtar Kelimeler: Alt Solunum Yolu; Pseudomonas aeruginosa; Antibiyotik Direnci ABSTRACT Objective: Pseudomonas aeruginosa has a high rate of mortality and morbidity due to hospital infections and resistance to antibiotics. In this study, antibiotic resistance profile of P. aeruginosa isolated from lower respiratory tract samples was investigated. Material and Methods: Lower respiratory tract samples from June 2016 to September 2017 were cultured and identification was made by conventional methods and antibiotic susceptibility testing was performed according to the recommendations of European Committee on Antimicrobial Susceptibility Testing. Results: Totally 5.367 lower respiratory tract samples were examined. 378 (7%) P. aeruginosa were isolated from 185 patients (70% of them were Pulmonary Diseases section and 2% of them were Pediatric Intensive Care Unit patients). Among the antibiotics tested, the highest resistance rate was found as 33 % against imipenem and 25 % against meropenem. Conclusion: When the studies conducted in our country were examined, it was seen that there are different data on the resistance rates of P. aeruginosa isolated. This is thought to be caused by differences in planning of trials, antibiotic use policies, and the inability to extract repetitive patient samples from statistical data. In our country a meta-analysis study examined the resistance profile of P. aeruginosa in the last 11 years and it was noted that the resistance to antibiotics was decreasing. When this information is taken into consideration, the resistance rates in all antibiotic groups except carbapenems were lower in the country compared to previous years. It is thought that it is useful to conduct extensive studies throughout the country in order to better identify and generalize the increases in the carbapenem resistance and decreases in other groups. Keywords: Lower Respiratory Tract; Pseudomonas aeruginosa; Antibiotic Resistance

Abstract

Objective: The aim of this study was investigate whether or not lumbar spinal stenosis (LSS) had effect onpain, daily living activities and muscular activation.Material and Methods: Individuals diagnosed as lumbar spinal stenosis with average of 55,19 ± 10,41 yearsold was included to the study. Individuals were divided into three groups as mild, moderate and severe bydural pouch magnetic resonance imaging inspection. Resting and activity pain assessment was made withvisual analog scale (VAS), muscular activity of the rectus femoris, biceps femoris, tibialis anterior and medialpart of the gastrocnemius was measured with surface electromyography (sEMG), and daily living activitieswas assessed with Oswestry lower back disability index.Results: Significant difference was found in VAS and ODI values according to the LSS severity (p<0,05). Painin resting and during activities were different from each other (p<0,05). It was found that individuals withsevere LSS had more lower limb muscular activity compared to moderate and mild individuals, and individuals with moderate LSS had more muscular activity compared to the mild ones (p<0,05).Conclusion: It was determined that disability and pain increases as the LSS severity increases. It was observed that more pain occurs while patients are active. It was concluded that early diagnosis of LSS is importantand necessary preventions should be taken to prevent further increase in severity.

Anahtar kelimeler: ALT SOLUNUM YOLU ÖRNEKLERİNDEN, İZOLE EDİLEN PSEUDOMONAS AERUGİNOSA, DİRENÇ PROFİLİNİN İNCELENMESİ