Ventriküloperitoneal şant enfeksiyonlu hastaların retrospektif klinik değerlendirilmesi
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Tarih
2017
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info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Beyin omurilik sıvısı (BOS) şantları hidrosefali durumlarında, BOS'u absorbsiyon amacıyla vücudun başka bölümlerine taşıyan sistemlerdir. Ancak bu sistemlerde görülebilen enfeksiyonlar şantın çalışmamasına yol açan ve yüksek oranda mortaliteye de neden olabilen ciddi bir sorundur. Bu çalışmada hidrosefali nedeniyle ventriküloperitoneal şant (VPŞ) takılan ve şant enfeksiyonu gelişen olguların epidemiyolojik, klinik ve laboratuvar bulgularının değerlendirilmesi ve şant enfeksiyonuna sebep olan mikroorganizmaların antibiyotik direncinin saptanması amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma Ocak 2014 – Kasım 2016 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Çocuk Enfeksiyon Hastalıkları Bilim Dalı'nda yapıldı. Çalışmaya cinsiyet ayrımı gözetmeksizin yaşları 1 – 18 yaş arasında VPŞ enfeksiyonu olan 81 vaka retrospektif olarak alındı. Bulgular: Vakaların %76,5'inde 0-1 aylıkken VPŞ katateri takılırken, en sık şant katateri takılma nedeni hidrosefali idi. Hastaların tedavi sonrası BOS protein düzeyi başvuru anındaki BOS protein düzeyine göre istatistiksel olarak anlamlı oranda düşük idi (p = 0.028). Vakaların beşinci gün BOS protein düzeyi birinci gün BOS protein düzeyine göre istatistiksel olarak anlamlı oranda düşükken (p = 0.001), tedavi sonrası BOS protein düzeyi de beşinci gün BOS protein düzeyine göre anlamlı oranda düşüktü (p < 0.001). Beşinci gün BOS glukoz düzeyi ise birinci gün (p = 0.007) ve tedavi sonrası (p < 0.001) BOS glukoz düzeyine göre istatistiksel olarak anlamlı derecede yüksekti. Hastaların %64,1'inde BOS kültüründe gram pozitif ve %35,9'unda gram negatif mikroorganizma üredi. En sık üreyen gram pozitif mikroorganizma koagülaz negatif stafilokok iken, en sık üreyen gram negatif mikroorganizma acinetobacter spp idi. Gram pozitif bakterilerden en çok direnç görülen antibiyotikler sırasıyla seftriakson, sefotaksim, tazobaktam iken, en etkili antibiyotikler vankomisin, teikoplanin ve linezolid idi. Gram negatif bakterilerden en çok direnç görülen antibiyotikler sırasıyla klindamisin, seftriakson ve sefotaksim iken, en etkili antibiyotikler kolimisin, amikasin ve seftazidim idi. Çalışmaya alınan vakaların %21'i exitus oldu. Tartışma ve Sonuç: VPŞ enfeksiyonları özellikle çocukluk çağında doğru tedavi edilemezlerse ciddi mortalite ve morbidite ile seyrederler. Bundan dolayı öncelikle şant enfeksiyonlarının oluşmasına engel olabilmek için tedbirler alınmalı, artan antibiyotik dirençlerinin önüne geçebilmek için uygun ve doğru antibiyotik rejimlerinin tercih edilmesi ile uzun süren hastanedeki yatış oranlarının ve yüksek tedavi giderlerinin önüne geçilebileceği kanaatindeyiz. Anahtar Kelimeler: antibiyotik;direnç; enfeksiyon; mortalite; ventriküloperitoneal şant
Introduction: Cerebrospinal fluid (CSF) shunts are the systems for carrying CSF to other parts of the body for absorption in cases of hydrocephalus conditions. However, the infections that can be seen in these systems are a serious problem that cause failure of shunting leading to higher rate of mortality. In this study, it was aimed to evaluate the epidemiological, clinical and laboratory findings of patients with ventriculoperitoneal shunt (VPS) who developed shunt infection as well as determining the antibiotic resistance of microorganisms causing shunt infection. Materials and Methods: This study was conducted between January 2014 and November 2016 in the Dicle University, Faculty of Medicine, Department of Pediatrics, Pediatric Infectious Diseases Department. Eighty-one patients with VPS infections aged between 1 and 18 years were included irrespective of gender in this retrospective study. Results: Of the patients, 76.5% had VPS catheter at the age of 0-1 month, and the most frequent reason for shunt catheter was hydrocephalus. Post-treatment CSF protein levels of patients were statistically significantly lower than that of CSF protein levels on admission (p=0.028). The CSF protein levels of the patients on the fifth day was significantly lower than that of first day CSF protein levels (p = 0.001), and the post-treatment level of CSF protein was also significantly lower than the levels of CSF protein on the fifth day (p < 0.001). The fifth day CSF glucose level, however, was statistically significantly higher than the first day (p=0.007) and post- treatment (p<0.001) CSF glucose levels. Of the patients, 64.1% had gram positive and 35.9% had gram negative microorganism in CSF culture. The most common gram positive microorganism was coagulase-negative staphylococci, whereas the most common gram negative microorganism was acinetobacter spp. For the gram positive bacteria, antibiotics with the highest resistance were ceftriaxone, cefotaxime and tazobactam, respectively; and, the most effective antibiotics were vancomycin, teicoplanin and linezolid. For the gram negative bacteria, antibiotics with the highest resistance were clindamycin, ceftriaxone and cefotaxime, respectively, whereas the most effective antibiotics were colimycin, amikacin and ceftazidime. Of the patients studied, 21% was exitus. Conclusion: VPS infections are associated with severe mortality and morbidity, especially if they cannot be treated properly in childhood. Therefore, first the measures should be taken to prevent the development of shunt infections, and proper and correct antibiotic regimes should be preferred in order to avoid increased antibiotic resistance, long-term hospitalization rates and high treatment costs. Keywords: antibiotics; resistance; infection; mortality; ventriculoperitoneal shunt
Introduction: Cerebrospinal fluid (CSF) shunts are the systems for carrying CSF to other parts of the body for absorption in cases of hydrocephalus conditions. However, the infections that can be seen in these systems are a serious problem that cause failure of shunting leading to higher rate of mortality. In this study, it was aimed to evaluate the epidemiological, clinical and laboratory findings of patients with ventriculoperitoneal shunt (VPS) who developed shunt infection as well as determining the antibiotic resistance of microorganisms causing shunt infection. Materials and Methods: This study was conducted between January 2014 and November 2016 in the Dicle University, Faculty of Medicine, Department of Pediatrics, Pediatric Infectious Diseases Department. Eighty-one patients with VPS infections aged between 1 and 18 years were included irrespective of gender in this retrospective study. Results: Of the patients, 76.5% had VPS catheter at the age of 0-1 month, and the most frequent reason for shunt catheter was hydrocephalus. Post-treatment CSF protein levels of patients were statistically significantly lower than that of CSF protein levels on admission (p=0.028). The CSF protein levels of the patients on the fifth day was significantly lower than that of first day CSF protein levels (p = 0.001), and the post-treatment level of CSF protein was also significantly lower than the levels of CSF protein on the fifth day (p < 0.001). The fifth day CSF glucose level, however, was statistically significantly higher than the first day (p=0.007) and post- treatment (p<0.001) CSF glucose levels. Of the patients, 64.1% had gram positive and 35.9% had gram negative microorganism in CSF culture. The most common gram positive microorganism was coagulase-negative staphylococci, whereas the most common gram negative microorganism was acinetobacter spp. For the gram positive bacteria, antibiotics with the highest resistance were ceftriaxone, cefotaxime and tazobactam, respectively; and, the most effective antibiotics were vancomycin, teicoplanin and linezolid. For the gram negative bacteria, antibiotics with the highest resistance were clindamycin, ceftriaxone and cefotaxime, respectively, whereas the most effective antibiotics were colimycin, amikacin and ceftazidime. Of the patients studied, 21% was exitus. Conclusion: VPS infections are associated with severe mortality and morbidity, especially if they cannot be treated properly in childhood. Therefore, first the measures should be taken to prevent the development of shunt infections, and proper and correct antibiotic regimes should be preferred in order to avoid increased antibiotic resistance, long-term hospitalization rates and high treatment costs. Keywords: antibiotics; resistance; infection; mortality; ventriculoperitoneal shunt
Açıklama
Anahtar Kelimeler
Antibiyotik, Direnç, Enfeksiyon, Mortalite, Ventriküloperitoneal şant, Antibiotics, Resistance, Infection, Mortality, Ventriculoperitoneal shunt
