Çocuk acil ve yetişkin acil servisten alınan kan kültür örneklerinde kontaminasyon oranlarının değerlendirilmesi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
T.C.Maltepe Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kan kültürleri, bakteriyemi, fungemi, nedeni bilinmeyen ateşin tanısı için son derece önemlidir. Sebebi bilinmeyen ateş, sepsis gibi nedenlere bağlı acil servise başvurularda ayırıcı tanıda kan kültürü kullanılmaktadır. Antibiyotetapi öncesi kan kültürlerinin acil serviste alınması olası etkenlerin saptanmasını kolaylaştırmaktadır. Kan kültürü için otomatize kan kültür sistemleri kullanılmaktadır. Bu sistemler, inkübasyon süresini kısaltmakta, pozitiflik oranını arttırmakta, kontaminasyon riskini azaltmaktadır. Ancak yöntemin hassasiyeti nedeniyle cilt antisepsisinin ve şişe kapağı dezenfeksiyonunun uygun yapılmadığı durumlarda, kan kültür şişelerinin zengin besiyeri içeriği nedeniyle kontaminasyon oranlarında artış görülmektedir. Çalışmamızda, çocuk acil servis ve yetişkin acil servisten alınan kan kültür örneklerinin değerlendirilmesi ve kontaminasyon oranlarının belirlenmesi amaçlanmıştır. Materyal-Metotlar: 01.01.2022-30.11.2022 tarihleri arasında çocuk acil servis ve yetişkin acil servisten alman kan kültür örnekleri araştırmaya dahil edildi. Kan kültürleri Plus Aerobic/F kan kültür şişelerine (Becton Dickinson Diagnostic Instrument System, ABD) inoküle edilerek BACTEC 9120 (Becton Dickinson Diagnostic Instrument System, ABD) sisteminde beş gün süreyle inkübe edildi. Pozitif sinyal veren şişelerden 7o5 koyun kanlı ağara ve BMb ağara ekimleri yapıldı, hş zamanlı Gram boyalı preparatlarda maya hücresi görülmesi durumunda SDA besiyerine de ekim yapılarak inkübe edildi. Mikroorganizmaların tanımlamaları ve duyarlılık testleri VITEK®2 (BioMerieux Clinical Diagnostics, Fransa) otomatize sistemi ile çalışıldı. Bulgular: Hastanemizde tüm servislerden alınarak Mikrobiyoloji laboratuvarına gönderilen 6781 kan kültürü değerlendirildi. Çocuk acilden 85, yetişkin acilden de 544 numune değerlendirmeye alındı. Çocuk acilden gönderilen 85 örneğin 50'si erkek, 35'i kız olgulardan alınmıştı, olguların yaş aralığı 0-17(ortalama yaş 2,64) arasındaydı. Çocuk acilden gelen örneklerin 12'sinde (%14) üreme saptanmıştır. Örneklerin sadece birisinde (%1) Staphylococcus aureus üredi, diğer 11(%13) örnekte kontaminant bakteriler üremiştir (yedisinde Koagülaz negatif stafilokok (KNS), ikisinde kontaminant basil, ve diğer ikisinde ise Micrococcus spp. üredi). 73 örnekte üreme saptanmadı. Yetişkin acilden toplamda 544 örnek değerlendirmeye alınmıştır. Örnek alman olguların 301'i erkek, 243'ü kadındı. Olguların yaş aralığı 19-95(ortalama yaş: 71,71) idi. Örneklerin 218'inde (%40) üreme saptanmış olup bunların 116'smdaki üremenin (%21) kontaminasyon (109'u KNS, altısı kontaminant basil, birisi Micrococcus spp.), 102'sindeki (%18) üremenin ise etken olduğu düşünülmüştür [99'u bakteri (51'i Gram pozitif, 48'i Gram negatif), üç örnekte ise maya üredi]. Toplam 327 örnekte üreme saptanmamıştır. Sonuç: Yetişkin acilden gönderilen ve üreme saptanan 218 numunenin 116'smda (%53), çocuk acil servisten laboratuvarımıza gelen ve üreme saptanan 12 numunenin ll'inde (%92) kontaminasyon saptanmıştır. Bu kadar yüksek oranlarda kontaminasyon görülmesi kan kültürü aliminin ne derece önemli olduğunu bir kez daha göstermiştir. Kan kültürü alınırken oluşan kontaminasyonların minimum indirilmesi için bu konu ile ilgili olarak belli periyotlarla eğitimler verilmeli, kan kültürü alınırken antisepsi kurallarına uyulmalı, hastanelerde özellikle kan kültürü alımıyla ilgilenen ekipler kurulmalıdır.
Aim: Blood cultures are extremely important for the diagnosis of bacteremia, fungemia, and fever of unknown origin. Blood culture is used in the differential diagnosis of fever of unknown origin and sepsis in admissions to the emergency department. Taking blood cultures before antibiotic therapy in the emergency room facilitates the detection of possible factors. Automated blood culture systems are used for blood culture. These systems shorten the incubation period, increase the positivity rate and reduce the risk of contamination. However, there is an increase in contamination rates due to the sensitivity of the method, improper skin antisepsis and bottle cap disinfection, and the rich media content of blood culture bottles. It was aimed to evaluate the blood culture samples taken from the pediatric emergency department and adult emergency department and to determine the contamination rates. Material-Methods: Blood culture samples taken from pediatric emergency department and adult emergency department between 01.01.2022 and 30.11.2022 were included in the study. Blood cultures were inoculated into Plus Aerobic/F blood culture bottles (Becton Dickinson Diagnostic Instrument System, USA) and incubated in the BACTEC 9120 (Becton Dickinson Diagnostic Instrument System, USA) system for five days. Bottles with positive signals were inoculated on 5% sheep blood agar and EMB agar. If yeast cells were observed in simultaneous Gram-stained preparations, they were incubated in SDA medium. Identification of microorganisms and Diagnostics, France) automated system. Results: In our hospital, 6781 blood cultures taken from all units and sent to the Microbiology laboratory were evaluated. 85 samples from the pediatric emergency department and 544 samples from the adult emergency department were evaluated. Of the 85 samples sent from the pediatric emergency department, 50 were male and 35 were female. The age range of the cases was between 0 17 (mean age 2.64 years). Bacterial growth was detected in 12 (14%) of the samples from the pediatric emergency department. Staphylococcus aureus grew in only one (1%) of the samples, while contaminant bacteria grew in the other 11 (13%) samples (Coagulase-negative staphylococci (CNS) in seven, contaminant bacilli in two, and Micrococcus spp. in the other two). No growth was detected in 73 samples. A total of 544 samples from adult emergency department were evaluated. Of 544 cases, 301 were male and 243 were female. The age range of the cases was 19-95 (mean age: 71.71 years). Growth was detected in 218 (40%) of the samples, 116 (21%) of them were thought to be contamination (109 CNS, six contaminated bacilli, one Micrococcus spp.), 102 (18%) growth was thought to be causative [99 bacteria (51 Gram-positive, 48 Gramnegative), three samples grew yeast.] No growth was detected in a total of 327 samples. Conclusion: Contamination was detected in 116 (53%) of 218 samples sent from adult emergency and 11 (92%) of 12 samples sent from pediatric emergency department. The fact that such a high rate of contamination is seen once again shows how important the blood culture method is. In order to minimize the contaminations that occur while taking blood cultures, training should be given periodically on this subject, antisepsis rules should be followed while blood culture is being taken, and teams should be established in hospitals, especially dealing with blood culture collection.
Aim: Blood cultures are extremely important for the diagnosis of bacteremia, fungemia, and fever of unknown origin. Blood culture is used in the differential diagnosis of fever of unknown origin and sepsis in admissions to the emergency department. Taking blood cultures before antibiotic therapy in the emergency room facilitates the detection of possible factors. Automated blood culture systems are used for blood culture. These systems shorten the incubation period, increase the positivity rate and reduce the risk of contamination. However, there is an increase in contamination rates due to the sensitivity of the method, improper skin antisepsis and bottle cap disinfection, and the rich media content of blood culture bottles. It was aimed to evaluate the blood culture samples taken from the pediatric emergency department and adult emergency department and to determine the contamination rates. Material-Methods: Blood culture samples taken from pediatric emergency department and adult emergency department between 01.01.2022 and 30.11.2022 were included in the study. Blood cultures were inoculated into Plus Aerobic/F blood culture bottles (Becton Dickinson Diagnostic Instrument System, USA) and incubated in the BACTEC 9120 (Becton Dickinson Diagnostic Instrument System, USA) system for five days. Bottles with positive signals were inoculated on 5% sheep blood agar and EMB agar. If yeast cells were observed in simultaneous Gram-stained preparations, they were incubated in SDA medium. Identification of microorganisms and Diagnostics, France) automated system. Results: In our hospital, 6781 blood cultures taken from all units and sent to the Microbiology laboratory were evaluated. 85 samples from the pediatric emergency department and 544 samples from the adult emergency department were evaluated. Of the 85 samples sent from the pediatric emergency department, 50 were male and 35 were female. The age range of the cases was between 0 17 (mean age 2.64 years). Bacterial growth was detected in 12 (14%) of the samples from the pediatric emergency department. Staphylococcus aureus grew in only one (1%) of the samples, while contaminant bacteria grew in the other 11 (13%) samples (Coagulase-negative staphylococci (CNS) in seven, contaminant bacilli in two, and Micrococcus spp. in the other two). No growth was detected in 73 samples. A total of 544 samples from adult emergency department were evaluated. Of 544 cases, 301 were male and 243 were female. The age range of the cases was 19-95 (mean age: 71.71 years). Growth was detected in 218 (40%) of the samples, 116 (21%) of them were thought to be contamination (109 CNS, six contaminated bacilli, one Micrococcus spp.), 102 (18%) growth was thought to be causative [99 bacteria (51 Gram-positive, 48 Gramnegative), three samples grew yeast.] No growth was detected in a total of 327 samples. Conclusion: Contamination was detected in 116 (53%) of 218 samples sent from adult emergency and 11 (92%) of 12 samples sent from pediatric emergency department. The fact that such a high rate of contamination is seen once again shows how important the blood culture method is. In order to minimize the contaminations that occur while taking blood cultures, training should be given periodically on this subject, antisepsis rules should be followed while blood culture is being taken, and teams should be established in hospitals, especially dealing with blood culture collection.
Açıklama
Anahtar Kelimeler
Bakteriyemi, Kan kültürü, Kontaminasyon, Blood culture, Contamination
Kaynak
EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kılınç, Ç. ve Yaşar Duman, M. (2023). Çocuk acil ve yetişkin acil servisten alınan kan kültür örneklerinde kontaminasyon oranlarının değerlendirilmesi, Akgün, Feride Sinem, (ed.). EMOS III. Maltepe acil günleri sempozyumu / Acil toksikoloji günleri - Bildiriler / EMOS III. Emergency Medicine Online Symposium / Emergency Toxicology Days; İstanbul: T.C.Maltepe Üniversitesi. s.59-64.
