Kan Dolaşımı Enfeksiyonlarında Etken Mikroorganizma ile Akut Faz Reaktanları Arasındaki İlişkinin İncelenmesi
Öz
Amaç: Kan dolaşımı enfeksiyonlarında erken tanı ve hedefe yönelik tedavi mortalite üzerinde belirleyici faktörlerdir. Kan kültürleri sonuçlanana
kadar geçen zamanda uygun tedavinin kararında C-reaktif protein (CRP) ve prokalsitonin (PCT) katkı sağlayabilmektedir. Bu çalışmada kan kültüründe
üreyen etkenlerin gram özelliklerine göre CRP ve PCT arasındaki ilişkinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Haziran 2017-Aralık 2019 tarihleri arasında yoğun bakım ünitesinde kan dolaşımı enfeksiyonu tanısıyla takip edilen hastaların kan
kültürü üremeleri ve kültür alımından 24 saat öncesi veya sonrasına ait CRP ve PCT değerleri retrospektif olarak incelendi. Etken mikroorganizmalar
gram özelliklerine göre ayrılarak CRP ve PCT değerleri kıyaslandı.
Bulgular: Çalışmaya dahil edilen 123 hastada 348 kan kültüründe etken mikroorganizma üremesi incelendi. Gram-negatif etkenlerde ortanca CRP
136 mg/L iken Gram-pozitif etkenlerde ortanca CRP 109,5 mg/L olarak saptandı (p=0,024). Yine Gram-negatif etkenlerde ortanca PCT 1,4 ng/mL iken
Gram-pozitif etkenlerde 0,81 ng/mL olarak saptandı (p=0,041).
Sonuç: Çalışmamızda Gram-negatif etkenlerin neden olduğu kan dolaşımı enfeksiyonlarında Gram-pozitif etkenlere kıyasla daha yüksek CRP ve
PCT düzeyleri saptanmıştır. Kültür üremesi sonuçlanana kadar geçen zamanda enflamatuvar belirteçlerle etken mikroorganizmanın öngörülmesi ve
uygun ampirik tedavinin başlanması düşünülebilir.
Anahtar Kelimeler
Etik Beyan
Çalışmamız Sağlık Bilimleri Üniversitesi, Gülhane Tıp Fakültesi Etik Kurulu (2020-19/421) tarafından onaylanmıştır.
Destekleyen Kurum
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Proje Numarası
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Teşekkür
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Kaynakça
- 1. Koizumi Y, Sakanashi D, Ohno T, et al. Plasma procalcitonin levels remain low at the onset of gram-positive bacteremia regardless of severity or the presence of shock: A retrospective analysis of patients with detailed clinical characteristics. J Microbiol Immunol Infect. 2021;54:1028-1037.
- 2. Clos TWD. Function of C-reactive protein. Ann Med. 2000;32:274-278.
- 3. Madhura NS, Shashikala N, Shankar M, et al. Procalcitonin levels versus Microbiological profile in Central line associated bloodstream infections (CLABSI) of patients on Hemodialysis. Asian J Med. 2021;12:34-42.
- 4. Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med. 2000;26:1193-1200.
- 5. Guo SY, Zhou Y, Hu QF, et al. Procalcitonin Is a Marker of Gram-Negative Bacteremia in Patients With Sepsis. Am J Med Sci. 2015;349:499-504.
- 6. Leli C, Ferranti M, Moretti A, et al. Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections. Dis Markers. 2015;2015:701480.
- 7. Oussalah A, Ferrand J, Filhine-Tresarrieu P, et al. Diagnostic Accuracy of Procalcitonin for Predicting Blood Culture Results in Patients With Suspected Bloodstream Infection: An Observational Study of 35,343 Consecutive Patients (A STROBE-Compliant Article). Medicine (Baltimore). 2015;94:e1774.
- 8. Bilgili B, Haliloğlu M, Süzer Aslan M, et al. Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis. Turk J Anaesthesiol Reanim. 2018;46:38-43.
- 9. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309-332.
- 10. Erdem H, Dizbay M, Karabey S, ve ark. Withdrawal of Staphylococcus aureus from intensive care units in Turkey. Am J Infect Control. 2013;41:1053-1058.
- 11. Baykara N ,Akalın H, Arslantaş MK, ve ark. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study. Critical Care. 2018;22:93.
- 12. Wu D, Zhou S, Hu S, et al. Inflammatory responses and histopathological changes in a mouse model of Staphylococcus aureus-induced bloodstream infections. J Infect Dev Ctries. 2017;11:294-305.
- 13. Cortegiani A, Misseri G, Ippolito M, et al. Procalcitonin levels in candidemia versus bacteremia: a systematic review. Critical Care. 2019;23:190-197.
- 14. Thomas-Rüddel DO, Poidinger B, Kott M, et al. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. Crit Care. 2018;22:128-138.
- 15. Feezor RJ, Oberholzer C, Baker HV, et al. Molecular characterization of the acute inflammatory response to infections with gram-negative versus gram-positive bacteria. Infect Immun. 2003;71:5803-5813.
- 16. Demirdal T, Sen P, Nemli SA. Diagnostic Value of Procalcitonin in Predicting Bacteremia in Intensive Care Unit. Indian J Crit Care Med. 2018;22:78-84.
- 17. Charles PE, Ladoire S, Aho S, et al. Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either gram negative or gram positive bacteria. BMC Infect Dis. 2008;8:38.
- 18. Yan ST, Sun LC, Jia HB, et al. Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria. Am J Emerg Med. 2017;35:579-583.
- 19. Tien BYQ, Goh HMS, Chong KKL, et al. Enterococcus faecalis Promotes Innate Immune Suppression and Polymicrobial Catheter-Associated Urinary Tract Infection. Infect Immun. 2017;85:e00378-17.
- 20. Fournier B, Philpott DJ. Recognition of Staphylococcus aureus by the innate immune system. Clin Microbiol Rev. 2005;18:521-540.
- 21. Fieber C, Janos M, Koestler T, et al. Innate Immune Response to Streptococcus pyogenes Depends on the Combined Activation of TLR13 and TLR2. PLoS One. 2015;10:e0119727.
Investigation of the Relationship Between Acute Phase Reactants and Causative Microorganisms in Blood Stream Infections
Öz
Objectives: Early diagnosis and targeted therapy are the determinants of mortality in bloodstream infections. In the time until the blood cultures
are finalized, C-reactive protein (CRP) and procalcitonin (PCT) can contribute to the decision of the appropriate treatment. In this study, it was aimed
to evaluate the relationship between CRP and PCT according to gram characteristics of factors grown in blood culture.
Materials and Methods: Blood culture results, CRP and PCT values of the patients who were followed up with the diagnosis of bloodstream
infection in the intensive care unit between June 2017 and December 2019, 24 hours before or after the culture collection, were retrospectively
analyzed. Causative microorganisms were separated according to their gram characteristics and their CRP and PCT values were compared.
Results: Causative microorganisms in 348 blood cultures of 123 patients included in the study were examined. While the median CRP was 136 mg/L
in Gram-negative agents, the median CRP was found as 109.5 mg/L in Gram-positive agents (p=0.024). While the median PCT was 1.4 ng/mL in
Gram-negative agents, it was found to be 0.81 ng/mL in Gram-positive agents (p=0.041).
Conclusion: Higher CRP and PCT levels were found in bloodstream infections caused by Gram-negative agents compared to Gram-positive agents
in our study. Prediction of the causative microorganism with inflammatory markers and initiation of appropriate empirical treatment may be
considered in the period until the culture results is completed.
Anahtar Kelimeler
Etik Beyan
-
Destekleyen Kurum
-
Proje Numarası
-
Teşekkür
-
Kaynakça
- 1. Koizumi Y, Sakanashi D, Ohno T, et al. Plasma procalcitonin levels remain low at the onset of gram-positive bacteremia regardless of severity or the presence of shock: A retrospective analysis of patients with detailed clinical characteristics. J Microbiol Immunol Infect. 2021;54:1028-1037.
- 2. Clos TWD. Function of C-reactive protein. Ann Med. 2000;32:274-278.
- 3. Madhura NS, Shashikala N, Shankar M, et al. Procalcitonin levels versus Microbiological profile in Central line associated bloodstream infections (CLABSI) of patients on Hemodialysis. Asian J Med. 2021;12:34-42.
- 4. Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med. 2000;26:1193-1200.
- 5. Guo SY, Zhou Y, Hu QF, et al. Procalcitonin Is a Marker of Gram-Negative Bacteremia in Patients With Sepsis. Am J Med Sci. 2015;349:499-504.
- 6. Leli C, Ferranti M, Moretti A, et al. Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections. Dis Markers. 2015;2015:701480.
- 7. Oussalah A, Ferrand J, Filhine-Tresarrieu P, et al. Diagnostic Accuracy of Procalcitonin for Predicting Blood Culture Results in Patients With Suspected Bloodstream Infection: An Observational Study of 35,343 Consecutive Patients (A STROBE-Compliant Article). Medicine (Baltimore). 2015;94:e1774.
- 8. Bilgili B, Haliloğlu M, Süzer Aslan M, et al. Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis. Turk J Anaesthesiol Reanim. 2018;46:38-43.
- 9. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309-332.
- 10. Erdem H, Dizbay M, Karabey S, ve ark. Withdrawal of Staphylococcus aureus from intensive care units in Turkey. Am J Infect Control. 2013;41:1053-1058.
- 11. Baykara N ,Akalın H, Arslantaş MK, ve ark. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study. Critical Care. 2018;22:93.
- 12. Wu D, Zhou S, Hu S, et al. Inflammatory responses and histopathological changes in a mouse model of Staphylococcus aureus-induced bloodstream infections. J Infect Dev Ctries. 2017;11:294-305.
- 13. Cortegiani A, Misseri G, Ippolito M, et al. Procalcitonin levels in candidemia versus bacteremia: a systematic review. Critical Care. 2019;23:190-197.
- 14. Thomas-Rüddel DO, Poidinger B, Kott M, et al. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. Crit Care. 2018;22:128-138.
- 15. Feezor RJ, Oberholzer C, Baker HV, et al. Molecular characterization of the acute inflammatory response to infections with gram-negative versus gram-positive bacteria. Infect Immun. 2003;71:5803-5813.
- 16. Demirdal T, Sen P, Nemli SA. Diagnostic Value of Procalcitonin in Predicting Bacteremia in Intensive Care Unit. Indian J Crit Care Med. 2018;22:78-84.
- 17. Charles PE, Ladoire S, Aho S, et al. Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either gram negative or gram positive bacteria. BMC Infect Dis. 2008;8:38.
- 18. Yan ST, Sun LC, Jia HB, et al. Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria. Am J Emerg Med. 2017;35:579-583.
- 19. Tien BYQ, Goh HMS, Chong KKL, et al. Enterococcus faecalis Promotes Innate Immune Suppression and Polymicrobial Catheter-Associated Urinary Tract Infection. Infect Immun. 2017;85:e00378-17.
- 20. Fournier B, Philpott DJ. Recognition of Staphylococcus aureus by the innate immune system. Clin Microbiol Rev. 2005;18:521-540.
- 21. Fieber C, Janos M, Koestler T, et al. Innate Immune Response to Streptococcus pyogenes Depends on the Combined Activation of TLR13 and TLR2. PLoS One. 2015;10:e0119727.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Makaleler |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 30 Haziran 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 75 Sayı: 2 |
