Značaj hemokultura u dijagnostici i praćenju rezistencije bakterija na antibiotik

master's thesis

• Title (english): Significance of blood culture in diagnostics and bacterial resistance to antibiotics monitoring
• Author: Miljenka Igrec
• Mentor: Milica Katić (mentor)
• Committee member: Ana Budimir (predsjednik povjerenstva)
• Committee member: Zlata Ožvačić Adžić (član povjerenstva)
• Committee member: Milica Katić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Family Medicine); Zagreb
• Defense date and country: 2017-09-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Family Medicine

Abstract

Uvod: Bakterijemija je stanje prisustva bakterija u krvi. Imuni odgovor na prisustvo bakterije može uzrokovati sepsu i septički šok što rezultira visokim mortalitetom. Za odgovarajuće liječenje sepse, iznimno značajnog kliničkog entiteta u kojem treba pravovremeno djelovati odgovarajućom antibiotskom terapijom potrebno je poznavati i najčešće uzročnike.
Hemokultura se smatra zlatnim standardom detekcije i izolacije mikroorganizma iz krvi, a kao mikrobiološki dokaz prisutne bakterijemije.
Za obradu hemokultura, kod sumnje na bakterijemiju Mikrobiološki laboratorij Zavoda za javno zdravstvo Međimurske županije koristi automatizirani sustav za detekciju mikroorganizma u krvi i primarno sterilnim tekućinama BacT/ALERT 3D.
Cilj rada je utvrditi bakterijske uzročnike iz primarno sterilnih uzoraka (hemokultura) te njihovu osjetljivost na antibiotike u vremenskom periodu od 2011. do 2015. godine u Županijskoj bolnici Čakovec.

Materijal i metode
Iz mikrobiološkog laboratorija Zavoda za javno zdravstvo Međimurske županije, koji vrši mikrobiološku obradu svih bioloških uzoraka hospitaliziranih bolesnika u Županijskoj bolnici Čakovec prikupljeni su podaci o učinjenim hemokulturama za razdoblje od 2011. do 2015. godine. U obradi podataka korištene su metode deskriptivne statistike.

Rezultati
Broj obrađenih uzoraka krvi u ŽB Čakovec tijekom pet godina kretao se od 1286 do 1508 parova hemokultura. Udio pozitivnih je bio u rasponu od 14% do 21%, dok je udio kontaminiranih uzoraka iznosio od 4-7%.
Vodeća tri mjesta među izolatima iz hemokultura zauzima E.coli; S.aureus i K.pneumoniae.
Kod E. coli kao najčešćeg bakterijskog izolata iz hemokultura uočava se porast otpornosti na koamoksiklav od 13% u 2011. godini do 30% u 2015. godini. Osjetljivost na 3. generaciju cefalosporina (ceftriakson) je uglavnom ispod 10%. Osjetljivost na gentamicin je u zadnje tri godine vrlo niska.
Nažalost, otpornost na kinolone je u svim godinama, osim 2014. iznad 10%. Na karbapeneme nema zabilježene otpornosti.

Zaključak
Vrlo je važno dobro poznavati očekivane patogene i pratiti njihovu osjetljivost na antibiotike, kako bi se prema tome mogla zasnivati dobra empirijska terapija.
Komunikacija između zdravstvenih radnika na odjelima i osoblja u Mikrobiološkom laboratoriju doprinosi poboljšanju indikatora koji se prate, odnosno smanjuju stope kontaminacija.
Pouzdani rezultati pretrage utječu na pravilan odabir antibiotske terapije, te posljedično na rezistenciju bakterija na antibiotike.

Abstract (english)

Abstract: Bacteremia is the presence of bacteria in the blood. The immune response to the presence of bacteria in the blood can cause sepsis and septic shock which results in a high mortality rate. For an adequate treatment of sepsis, a severe clinical condition which requires a timely intervention with appropriate antibiotic therapy it is of great importance to know the most frequent causes.
Blood culture is considered the best option for the detection and isolation of microorganisms from the blood as well as a microbiological proof of a present bacteremia.
The aim of this study is to ascertain the causative bacterial agents in normally sterile fluids as well as their susceptibility to antibiotics within the period of 2011-2015 in the District Hospital of Čakovec.

Material and Method:
Data on processed blood cultures within the period of 2011 – 2015 were collected form the Microbiological Laboratory Institute for Public Health of the District of Međimurje, which carries out the microbiological analysis of all samples taken from hospitalized patients in the District Hospital of Čakovec. For data interpretation methods of descriptive statistics were used.

Results
The number of processed blood samples in the Distirct Hospital Čakovec is between 1286 and 1508 pairs of blood cultures. The relative share of positive samples is between 14% and 21%, while the relative share of contaminated samples accounts to 4 -7%.
The three most frequent bacteria among the isolates from the blood cultures are E.coli; S.aureus and K.pneumoniae.
With E. coli as the most frequent bacterial isolate from the blood cultures a growing resistance to co-amoxiclav from 13% in 2011 to 30% in 2015 can be perceived. The susceptibility to the third generation of cephalosporine (ceftriaxone) is mainly under 10%. The susceptibility to gentamicin has been very low in the past three years.
Unfortunately, the resistance to quinolone has been above 10% in all years except 2014. To carbapenem no resistance has been registered.

Conclusion
It is very important to learn about the expected pathogens and follow their susceptibility to antibiotics to, hence, be able to develop a good empiric therapy.
The communication between the medical staff of the hospital departments and the staff of the Microbiological Laboratory contributes to the improvement of the followed indicators, respectively to the reduction of the contamination rate.
Reliable study results influence the correct choice of antibiotic therapy as well as, consequently, the resistance of bacteria to antibiotics.

• Keywords: bakteriemija; sepsa; hemokultura; rezistencija bakterija na antibiotik; praćenje pred-analitičkih indikatora; edukacija zdravstvenog osoblja
• Keywords (english): bacteremia; sepsis; hemoculture; antibiotic resistance; follow of pre-analytic indicators; education of health professionals
• Language: croatian
• URN:NBN: urn:nbn:hr:105:455740
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-19 13:50:10