{"id":23841,"date":"2021-12-27T12:15:50","date_gmt":"2021-12-27T09:15:50","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=23841"},"modified":"2021-12-27T13:14:07","modified_gmt":"2021-12-27T10:14:07","slug":"gm-etyolojisinde-bakterilerin-rolu","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/12\/27\/gm-etyolojisinde-bakterilerin-rolu\/","title":{"rendered":"Gran\u00fclomat\u00f6z Mastitlerin Etyolojisinde Rol Alan Aerop ve Anaerop Bakterilerin Da\u011f\u0131l\u0131m\u0131 ve Antimikrobik Maddelere Diren\u00e7 Durumlar\u0131"},"content":{"rendered":"<h2 class=\"p1\">G\u0130R\u0130\u015e<\/h2>\n<p class=\"p2\">Mastitler, memenin inflamasyonu ile seyreden infeksiy\u00f6z ya da noninfeksiy\u00f6z hastal\u0131klar olup genellikle kad\u0131nlar\u0131 etkiler (1). Mastitler; laktasyonel mastit, non-laktasyonel mastit ve meme apsesi olmak \u00fczere \u00fc\u00e7 grupta incelenmektedir. Non-laktasyonel mastit; santral veya subareolar infeksiyon, periferal infeksiyon ve gran\u00fclomat\u00f6z infeksiyon olmak \u00fczere \u00fc\u00e7 gruba ayr\u0131l\u0131r (1). \u0130nfeksiy\u00f6z olmayan mastit (non-laktasyonel mastit), memenin lob\u00fcllerinde geni\u015fleme ile seyreden ve nedeni hen\u00fcz kesin olarak belirlenememi\u015f bir mastit t\u00fcr\u00fcd\u00fcr. \u00d6zellikle GM bu grupta en s\u0131k rastlanan kliniktir. Sarkoidoz, histoplazmoz, Wegener gran\u00fclomatozu, bruselloz ve tifo gibi hastal\u0131klarda GM geli\u015febilmektedir. En s\u0131k rastlanan ve patogenezi belirsiz olan GM tipi idiyopatik GM olup otoimm\u00fcn hastal\u0131klarla beraber g\u00f6r\u00fclebilece\u011fi belirtilmi\u015ftir (2). Toplumumuzda GM\u2019li hastalar; memede a\u011fr\u0131l\u0131 kitle, apse olu\u015fumu, fist\u00fcl, meme ba\u015f\u0131nda \u00e7ekilme gibi \u015fikayetlerle hastaneye ba\u015fvurmaktad\u0131r ve ba\u015flang\u0131\u00e7ta olgular \u00e7o\u011funlukla meme kanseri ile kar\u0131\u015fabilmektedir. GM\u2019li hastalarda, memede geli\u015fen apse odaklar\u0131ndan izole edilen etkenlerin patolojiye sekonder olarak eklendi\u011fi ileri s\u00fcr\u00fclmektedir (1).<\/p>\n<p class=\"p2\"><span class=\"s1\">Non-laktasyonel mastitin en s\u0131k rastlan\u0131lan t\u00fcr\u00fc olan GM\u2019de, etyolojik rol\u00fc olan bakteriler tam olarak bilinmemektedir. Ara\u015ft\u0131rmalarda ba\u015fta <i>Corynebacterium <\/i>t\u00fcrleri olmak \u00fczere, <i>Escherichia coli<\/i>, bifidobakteriler, anaerobik streptokoklar, <i>Clostridium<\/i> t\u00fcrleri etkenler aras\u0131nda g\u00f6sterilmi\u015ftir (3). <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Ayr\u0131ca g\u00fcncel \u00e7al\u0131\u015fmalarda, nikotinin direkt veya indirekt olarak subareolar meme kanallar\u0131na zarar verdi\u011fi ve zarar g\u00f6rm\u00fc\u015f dokular\u0131n aerop ve anaerop bakteri infeksiyonlar\u0131na daha a\u00e7\u0131k oldu\u011fu \u00f6ne s\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Sigaran\u0131n ayn\u0131 zamanda <i>in vivo<\/i> ve <i>in vitro<\/i> olarak Gram pozitif bakteri \u00fcremesini bask\u0131lad\u0131\u011f\u0131 dolay\u0131s\u0131yla GM etyolojisinde rol alan Gram-negatif aerobik ve anaerobik bakterilerin a\u015f\u0131r\u0131 \u00fcremesine neden oldu\u011fu \u00f6ne s\u00fcr\u00fclm\u00fc\u015ft\u00fcr (2, 3). <\/span><\/p>\n<p class=\"p2\">Gran\u00fclomat\u00f6z mastite neden olan bakteriyel etkenlerin tan\u0131s\u0131, hastal\u0131\u011f\u0131n tedavisi ve takibi a\u00e7\u0131s\u0131ndan b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r. Gran\u00fclomat\u00f6z mastit tan\u0131s\u0131 alm\u0131\u015f hastalar\u0131n, apse ve doku \u00f6rneklerinde bakterilerin tan\u0131mlanmas\u0131 i\u00e7in \u00f6ncelikle aerop ve anaerop k\u00fclt\u00fcr y\u00f6ntemleri kullan\u0131lmaktad\u0131r (1). Ancak bir\u00e7ok kaynakta belirtildi\u011fi gibi, etkenlerin konvansiyonel bakteriyolojik tekniklerle izolasyonunda\u00a0her zaman ba\u015far\u0131\u00a0sa\u011flanamad\u0131\u011f\u0131 i\u00e7in, g\u00fcn\u00fcm\u00fczde molek\u00fcler y\u00f6ntemlerden [polimeraz zincir reaksiyonu (PZR), multipleks PZR, ger\u00e7ek zamanl\u0131 PZR] de\u00a0yararlan\u0131lmaktad\u0131r (1, 3, 4).<\/p>\n<p class=\"p2\">Gran\u00fclomat\u00f6z mastit tedavi edilmedi\u011fi takdirde hastalarda meme apseleri ve geni\u015f meme dokusu nekrozlar\u0131 geli\u015febilmektedir. T\u00fcberk\u00fcloz d\u0131\u015f\u0131 bakteriyel mastitli hastalara uygulanan tedaviler, merkezden merkeze de\u011fi\u015febilmekle birlikte genel olarak apse drenaj\u0131 uygulanmakta ve empirik olarak da penisilin, sefalosporinler, beta-laktam inhibit\u00f6rleri ve klindamisin kullan\u0131lmaktad\u0131r (5). Bunun yan\u0131 s\u0131ra, son yap\u0131lan \u00e7al\u0131\u015fmalarda sa\u011fl\u0131kl\u0131 annelerin s\u00fctlerinden izole edilen baz\u0131 <i>Lactobacillus<\/i> t\u00fcrlerinin\u00a0(<i>Lactobacillus salivarus, Lactobacillus gasseri<\/i>) tedavide kullan\u0131ld\u0131\u011f\u0131 ve olumlu yan\u0131tlar al\u0131nd\u0131\u011f\u0131 bildirilmi\u015ftir (5). Ayr\u0131ca etki mekanizmalar\u0131 tam olarak bilinmemekle beraber \u00f6zellikle GM\u2019lerin tedavisinde steroidler de kullan\u0131lmaktad\u0131r (6).<\/p>\n<h2 class=\"p1\">Y\u00d6NTEMLER<\/h2>\n<ul>\n<li class=\"p2\">\u00c7al\u0131\u015fmam\u0131zda \u00f6rnek al\u0131m\u0131ndan, bakteri t\u00fcrlerinin PZR ile tan\u0131mlanmas\u0131na kadar ger\u00e7ekle\u015ftirilen ad\u0131mlar a\u015fa\u011f\u0131da belirtilmi\u015ftir:<\/li>\n<li class=\"p3\">Hastalara ait bilgilerin yer ald\u0131\u011f\u0131 formlar\u0131n doldurulmas\u0131,<\/li>\n<li class=\"p3\">Hastalardan \u00f6rneklerin al\u0131nmas\u0131 ve laboratuvara ta\u015f\u0131nmas\u0131,<\/li>\n<li class=\"p3\">Besiyerlerine ekim yap\u0131lmas\u0131, aerop\/anaerop ortamlar\u0131n sa\u011flanmas\u0131 ve ink\u00fcbasyonu,<\/li>\n<li class=\"p3\">\u00dcretilen bakterilerin tan\u0131mlanmas\u0131,<\/li>\n<li class=\"p3\">K\u00fclt\u00fcrde \u00fcretilen bakterilerin antimikrobik maddelere diren\u00e7lerinin belirlenmesi,<\/li>\n<li class=\"p3\">Gram boyamas\u0131nda bakteri g\u00f6r\u00fcld\u00fc\u011f\u00fc halde k\u00fclt\u00fcrlerde bakteri \u00fcretilemeyen \u00f6rneklerin PZR ile incelenmesi.<\/li>\n<\/ul>\n<h3 class=\"p4\">Hasta Formlar\u0131n\u0131n Doldurulmas\u0131<\/h3>\n<p class=\"p2\">\u00c7al\u0131\u015fmam\u0131zda \u0130stanbul \u00dcniversitesi-Cerrahpa\u015fa Giri\u015fimsel Olmayan Klinik Ara\u015ft\u0131rmalar Etik Kurulu Y\u00f6nergesi\u2019ne g\u00f6re hastalar\u0131n yasal temsilcilerinin bilgilendirilmi\u015f onaylar\u0131 al\u0131nd\u0131. Genel Cerrahi Meme Poliklini\u011fi\u2019ne gelen mastitli hastalara ait bilgilerin yer ald\u0131\u011f\u0131 formlar dolduruldu. Bu formlarda, \u00e7al\u0131\u015fmaya dahil edilen hastalar\u0131n; ya\u015f, do\u011furma \u015fekli ve ka\u00e7\u0131nc\u0131 do\u011fumlar\u0131 oldu\u011fu, emzirme s\u00fcreleri, emzirme d\u00f6neminde pompa kullan\u0131l\u0131p kullan\u0131lmad\u0131klar\u0131, mastite ba\u011fl\u0131 s\u00fct miktar\u0131ndaki de\u011fi\u015fim, apsenin ba\u015flang\u0131\u00e7 tarihi, apsenin tahmini nedeni, sigara ve alkol kullan\u0131m\u0131, aile i\u00e7i stres durumlar\u0131, yak\u0131n zamanda ge\u00e7irilmi\u015f ya da var olan \u00f6nemli hastal\u0131klar\u0131, kullanmakta olduklar\u0131 antibiyotik veya di\u011fer ila\u00e7lar, \u00fcriner sistem infeksiyonu ge\u00e7irip ge\u00e7irmedikleri, ailede mastit \u00f6yk\u00fcs\u00fc varl\u0131\u011f\u0131 sorguland\u0131. Hekimin klinik tan\u0131s\u0131na g\u00f6re mastitin (laktasyonel\/non-laktasyonel) tipi kaydedildi.<\/p>\n<h3 class=\"p4\">\u00c7al\u0131\u015fma Grubu ve Materyalin Toplanmas\u0131<\/h3>\n<p class=\"p2\"><span class=\"s2\">Ara\u015ft\u0131rmam\u0131z, Ocak 2015-Ocak 2016 tarihleri aras\u0131nda, \u0130stanbul \u00dcniversitesi-Cerrahpa\u015fa, Cerrahpa\u015fa T\u0131p Fak\u00fcltesi Genel Cerrahi Anabilim Dal\u0131 Meme Poliklini\u011fi ve Acil Cerrahi Servisi\u2019ne ba\u015fvurmu\u015f; klinik muayenelerinde periareolar b\u00f6lgede ciltte eritem, meme ba\u015f\u0131nda \u015fi\u015fkinlik, sertlik, ak\u0131nt\u0131 varl\u0131\u011f\u0131 tespit edilmesi \u00fczerine meme dokular\u0131ndan al\u0131nan \u00f6rneklerin histopatolojik incelemesi sonucuna g\u00f6re GM tan\u0131s\u0131 alm\u0131\u015f, 46 eri\u015fkin hastaya ait \u00f6rnekle ger\u00e7ekle\u015ftirilmi\u015ftir. \u00dc\u00e7\u00fc doku biyopsisi ve 43\u2019\u00fc i\u011fne aspirasyonu ile al\u0131nan cerahat \u00f6rne\u011fi olmak \u00fczere toplam 46 \u00f6rnekle ger\u00e7ekle\u015ftirilen bu ara\u015ft\u0131rmada, her hasta i\u00e7in bir \u00f6rnek incele<\/span>meye dahil edilmi\u015ftir.<\/p>\n<p class=\"p2\">\u00c7al\u0131\u015fmaya dahil olacak hastalar i\u00e7in temel kriterlerimiz; eri\u015fkin olmalar\u0131n\u0131n yan\u0131 s\u0131ra \u00f6rneklerinin histopatolojik incelemesinde yo\u011fun inflamatuar reaksiyon ve hastal\u0131\u011f\u0131n karakteristik \u00f6zelli\u011fi olan non-kazeifiye gran\u00fclomlar\u0131n g\u00f6r\u00fclmesi sonucu GM tan\u0131s\u0131 alm\u0131\u015f olmalar\u0131d\u0131r (1, 6, 7). Laktasyonel mastit, t\u00fcberk\u00fcloz mastit ve meme kanseri tan\u0131s\u0131 alm\u0131\u015f hastalar\u0131n yan\u0131 s\u0131ra son 72 saatte antibiyotik kullananlar \u00e7al\u0131\u015fmam\u0131zdan d\u0131\u015flanm\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">Genel cerrahi meme poliklini\u011fine ba\u015fvuran mastitli hastalardan \u00f6rnekler al\u0131nmadan \u00f6nce, cerrahi hekimleri taraf\u0131ndan \u00f6rnek al\u0131nacak b\u00f6lgenin cilt antisepsisi povidon iyot i\u00e7eren Betadix %7.5 SCRUB (Naturel Medikal, T\u00fcrkiye) ile sa\u011flanm\u0131\u015ft\u0131r. Al\u0131nan cerahat \u00f6rnekleri zaman kaybetmeden laboratuvara getirilmi\u015f; doku biyopsileri ise Cary-Blair ta\u015f\u0131ma besiyerine al\u0131narak laboratuvara ula\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r.<\/p>\n<h3 class=\"p4\">K\u00fclt\u00fcr ve Antimikrobiyal Duyarl\u0131l\u0131klar\u0131n Belirlenmesi<\/h3>\n<p class=\"p2\">Al\u0131nan \u00f6rnekler aerop ve anaerop bakterilerin varl\u0131\u011f\u0131 y\u00f6n\u00fcnden, Gram boyama yap\u0131larak incelenmi\u015ftir. Aerop k\u00fclt\u00fcrler i\u00e7in, kanl\u0131 agar, \u00e7ikolatams\u0131 agar ve MacConkey agar besiyeri; anaerop k\u00fclt\u00fcrler i\u00e7in %5 koyun kan\u0131 ve menadion ile zenginle\u015ftirilmi\u015f Schaedler agar, zenginle\u015ftirilmi\u015f Schaedler agar ile haz\u0131rlanm\u0131\u015f kanamisin-vankomisinli agar besiyeri, fenil-etil alkoll\u00fc agar besiyeri ve sodyum tiyoglikolatl\u0131 s\u0131v\u0131 besiyeri kullan\u0131lm\u0131\u015ft\u0131r. Anaerobik ortam GasPak ile sa\u011flanm\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">Aerop ve anaerop bakterilerin tan\u0131mlanmas\u0131nda standard klinik mikrobiyoloji laboratuvar\u0131 y\u00f6ntemleri kullan\u0131lm\u0131\u015f olup gerek duyulmas\u0131 halinde aerop bakterilerin tan\u0131s\u0131 i\u00e7in BD Phoenix (Becton, Dickinson Company, Maryland, ABD) cihaz\u0131ndan; anaerop bakteriler i\u00e7inse API 20A (bioM\u00e9rieux, Marcy l\u2019Etoile, Fransa) kitinden yararlan\u0131lm\u0131\u015ft\u0131r. \u00dcretilen aerop bakterilerin antibiyotiklere duyarl\u0131l\u0131klar\u0131, cinse spesifik olan antibiyotik diskleri kullan\u0131larak, Mueller-Hinton agar besiyerlerinde Kirby-Bauer disk dif\u00fczyon y\u00f6ntemi ile; anaerop bakterilerin antibiyotiklere duyarl\u0131l\u0131klar\u0131 ise gradyan test ile saptanm\u0131\u015ft\u0131r.<\/p>\n<h3 class=\"p4\">Aerop ve Anaerop Bakterilerin Tan\u0131s\u0131nda Kullan\u0131lan Molek\u00fcler Y\u00f6ntemler<\/h3>\n<p class=\"p2\"><span class=\"s1\">Hasta antibiyotik tedavisi alt\u0131nda olmad\u0131\u011f\u0131 halde \u00f6rneklerden haz\u0131rlanan Gram boyamalarda g\u00f6r\u00fclen bakterilerin \u00fcretilememesi durumunda, ileri ara\u015ft\u0131rmalar i\u00e7in cins ya da t\u00fcr spesifik bakteri primerleri kullan\u0131larak muhtemel patojen bakterilerin belirlenmesine y\u00f6nelik 16S rRNA analizi yap\u0131lm\u0131\u015ft\u0131r. PZR amplifikasyon \u00fcr\u00fcnleri elde edildikten sonra, \u00e7al\u0131\u015fma izolatlar\u0131m\u0131z\u0131n 16S<i> <\/i>gen b\u00f6lgesinin safla\u015ft\u0131r\u0131lmas\u0131 ve baz dizi analizi, 4 farkl\u0131 oligon\u00fckleotit primeri ile ABI 3730XL DNA \u201cAnalyzer\u201d (Applied Biosystems, CA, ABD) cihaz\u0131 ile \u00fcretici firma direktifleri do\u011frultusunda okunmu\u015f ve kromatogramlar\u0131 al\u0131nm\u0131\u015ft\u0131r. ABI format\u0131ndaki kromatogram dosyalar\u0131 FASTA format\u0131na d\u00f6n\u00fc\u015ft\u00fcr\u00fcld\u00fckten sonra \u201cSequencher version 4.10.1 sequence analysis software\u201d (Gene Codes, Ann Harbor, ABD), MEGA 4.1 (<\/span><span class=\"s3\">megasoftware.net<\/span><span class=\"s1\">) program\u0131 ve \u201cFinchTV chromatogram viewer\u201d (Geospize, ABD) kullan\u0131larak kar\u015f\u0131la\u015ft\u0131rmal\u0131 ve manuel olarak d\u00f6rt farkl\u0131 primerden elde edilen diziler birle\u015ftirilmi\u015f ve 16S rRNA dizileri elde edilmi\u015ftir (8). D\u00f6rt farkl\u0131 primer [(27F \u2013 5\u2019 AGAGTTTGATCTGGCTCAG-3\u2019, ba\u011fland\u0131\u011f\u0131 b\u00f6lge 8-27. bazlar); (MG3f- 5\u2019 CAGCAGCCGCGGTAATAC-3\u2019, ba\u011fland\u0131\u011f\u0131 b\u00f6lge 52-536. bazlar); (MG5f- 5\u2019 AAACTCAAAGGAATTGACGG-3\u2019, ba\u011fland\u0131\u011f\u0131 b\u00f6lge 907-926. bazlar); (1525R \u2013 5\u2019AAGGAGGTGWTCCARCC-3\u2019, ba\u011fland\u0131\u011f\u0131 b\u00f6lge 1544-1525. bazlar)] kullan\u0131larak haz\u0131rlanan 1446\u20131515 nt uzunlu\u011fundaki 16S rRNA gen FASTA dizileri analizlerde kullan\u0131lm\u0131\u015ft\u0131r (8). <\/span><\/p>\n<p class=\"p2\">DNA dizilerinin, biyoenformatik programlar taraf\u0131ndan okunmas\u0131 i\u00e7in belli standard formatlar olu\u015fturulmu\u015ftur ve bunlar\u0131n en yayg\u0131n\u0131 FASTA dizileridir (8).<\/p>\n<div id=\"attachment_24005\" style=\"width: 966px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-24005\" class=\"size-full wp-image-24005\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil1.png\" alt=\"\" width=\"956\" height=\"414\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil1.png 956w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil1-390x169.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil1-810x351.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil1-768x333.png 768w\" sizes=\"auto, (max-width: 956px) 100vw, 956px\" \/><\/a><p id=\"caption-attachment-24005\" class=\"wp-caption-text\"><strong>\u015eekil 1.<\/strong> <i>Staphylococcus epidermidis<\/i> ATCC 12228 genomu.<\/p><\/div>\n<div id=\"attachment_24008\" style=\"width: 984px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil2.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-24008\" class=\"size-full wp-image-24008\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil2.png\" alt=\"\" width=\"974\" height=\"416\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil2.png 974w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil2-390x167.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil2-810x346.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KLM_3649_Sekil2-768x328.png 768w\" sizes=\"auto, (max-width: 974px) 100vw, 974px\" \/><\/a><p id=\"caption-attachment-24008\" class=\"wp-caption-text\"><strong>\u015eekil 2.<\/strong> <i>Corynebacterium kroppenstedtii<\/i> DSM 44385 genomu.<\/p><\/div>\n<p class=\"p2\">Elde edilen 16S rRNA konsens\u00fcs diziler, MEGA 4.1 program\u0131 kullan\u0131larak Amerika Birle\u015fik Devletleri Ulusal Biyoteknoloji Bilgi Merkezi \u00a0(NCBI- The National Center for Biotechnology Information, U.S. National Library of Medicine) ve Leibniz Enstit\u00fcs\u00fc Alman Mikroorganizmalar ve H\u00fccre K\u00fclt\u00fcrleri Koleksiyonu (DSMZ &#8211; Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH) gibi gen bankalar\u0131nda bulunan referans bakteri FASTA dizileri ile blast analizi yap\u0131larak kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f ve benzerlikleri k\u0131yaslanarak bakteri isimlendirmeleri ger\u00e7ekle\u015ftirilmi\u015ftir (9) (\u015eekil 1-2).<\/p>\n<h3 class=\"p4\">\u0130statistiksel Analiz<\/h3>\n<p class=\"p2\">\u00c7al\u0131\u015fmam\u0131zda tan\u0131mlay\u0131c\u0131 de\u011ferlerin saptanmas\u0131nda \u201cIBM SPSS Statistics for Windows, Version 21.0\u201d (Armonk, NY, ABD) kullan\u0131ld\u0131. Nicel de\u011fi\u015fkenler ortalama standard sapma; kategorik de\u011fi\u015fkenler ise ki\u015fi say\u0131s\u0131 ve % olarak verildi.<\/p>\n<h2 class=\"p1\">BULGULAR<\/h2>\n<div id=\"attachment_24012\" style=\"width: 1077px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-24012\" class=\"size-full wp-image-24012\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo1.png\" alt=\"\" width=\"1067\" height=\"2287\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo1.png 1067w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo1-121x260.png 121w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo1-252x540.png 252w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo1-768x1646.png 768w\" sizes=\"auto, (max-width: 1067px) 100vw, 1067px\" \/><\/a><p id=\"caption-attachment-24012\" class=\"wp-caption-text\"><strong>Tablo 1.<\/strong> GM\u2019li Hastalara ait Sosyodemografik \u00d6zelliklerin Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131za dahil etti\u011fimiz GM\u2019li hastalar\u0131n ya\u015f aral\u0131\u011f\u0131 23 ile 55 aras\u0131nda ve ortalamas\u0131 34.5 olup sosyodemografik \u00f6zelliklerinin da\u011f\u0131l\u0131m\u0131 Tablo 1\u2019de verilmi\u015ftir.<\/p>\n<div id=\"attachment_24014\" style=\"width: 1078px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo2.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-24014\" class=\"size-full wp-image-24014\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo2.png\" alt=\"\" width=\"1068\" height=\"1434\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo2.png 1068w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo2-194x260.png 194w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo2-402x540.png 402w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo2-768x1031.png 768w\" sizes=\"auto, (max-width: 1068px) 100vw, 1068px\" \/><\/a><p id=\"caption-attachment-24014\" class=\"wp-caption-text\"><strong>Tablo 2.<\/strong> GM Hastalar\u0131na ait \u00d6rneklerde \u00dcreyen Aerop ve<br \/>Anaerop Bakterilerin Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n<p class=\"p2\">Hastalar\u0131n k\u00fclt\u00fcr sonu\u00e7lar\u0131 de\u011ferlendirildi\u011finde 20 (%43.7)\u2019sinde \u00fcreme g\u00f6r\u00fcl\u00fcrken 26 (%56.5)\u2019s\u0131nda \u00fcreme saptanmam\u0131\u015ft\u0131r. Gram pozitif \u00e7omaklardan <i>Corynebacterium<\/i> t\u00fcrlerinin, 46 hastan\u0131n 12 (%26.1)\u2019sinde \u00fcremesi dikkati \u00e7ekmi\u015ftir. Hastalar\u0131n 7 (%15.2)\u2019sinde <i>Corynebacterium kroppenstedtii<\/i>, 3 (%6.5)\u2019\u00fcnde <i>C. urealyticum<\/i>, 2 (%4.3)\u2019 sinde <i>C. amycolatum<\/i> \u00fcremi\u015ftir. Gram pozitif diplokoklardan <i>Staphylococcus aureus\u2019<\/i>un hastalardan 2 (%4.3)\u2019sinde; <i>Staphylococcus saprophyticus, Streptococcus pyogenes <\/i>ve<i> <\/i>non-hemolitik streptokok t\u00fcrlerinin ayr\u0131 ayr\u0131<span class=\"Apple-converted-space\">\u00a0 <\/span>yaln\u0131zca 1\u2019er hastada; ve Gram negatif \u00e7omaklardan <i>Klebsiella<\/i> spp. ve <i>Proteus<\/i> spp.\u2019 nin de<span class=\"Apple-converted-space\">\u00a0 <\/span>yine 1\u2019er hastada \u00fcredi\u011fi saptanm\u0131\u015ft\u0131r (Tablo 2). Hastalar\u0131m\u0131zda \u00fcreyen anaerop bakterilerin da\u011f\u0131l\u0131m\u0131n\u0131 inceledi\u011fimizde 3 (%6.5) \u00f6rnekle en fazla <i>Peptostreptococcus <\/i>spp. \u00fcredi\u011fi dikkati \u00e7ekmi\u015ftir. Ayr\u0131ca 2 (%4.3) hastada <i>Bacteroides fragilis<\/i>, 1 hastada <i>Clostridium <\/i>spp. \u00fcremi\u015ftir. (Tablo 2).<\/p>\n<div id=\"attachment_24016\" style=\"width: 1078px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo3.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-24016\" class=\"size-full wp-image-24016\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo3.png\" alt=\"\" width=\"1068\" height=\"665\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo3.png 1068w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo3-390x243.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo3-810x504.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo3-768x478.png 768w\" sizes=\"auto, (max-width: 1068px) 100vw, 1068px\" \/><\/a><p id=\"caption-attachment-24016\" class=\"wp-caption-text\"><strong>Tablo 3.<\/strong> GM Hastalar\u0131na ait \u00d6rneklerde Saptanan Bakteri<br \/>Birliktelikleri<\/p><\/div>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131zda, \u00fcreme saptad\u0131\u011f\u0131m\u0131z 20<span class=\"Apple-converted-space\">\u00a0 <\/span>GM\u2019li hasta \u00f6rne\u011finin 6 (%30)\u2019s\u0131nda farkl\u0131 bakteri t\u00fcrleri birlikte \u00fcremi\u015ftir (Tablo 3).<\/p>\n<p class=\"p2\">Bakteri \u00fcremesi g\u00f6r\u00fclmeyen 26 hasta \u00f6rne\u011finin 19 (%73)\u2019unda direkt Gram boyamada polimorf n\u00fcveli l\u00f6kositlerle birlikte bakteriler g\u00f6r\u00fcld\u00fc\u011f\u00fcnden, \u00f6rnekler molek\u00fcler y\u00f6ntemlerle ileri incelemeye al\u0131nm\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">GM\u2019li hastalarda \u00fcreyen aerop bakterilerin antibiyotiklere diren\u00e7 durumlar\u0131n\u0131 belirlemek i\u00e7in yapt\u0131\u011f\u0131m\u0131z disk dif\u00fczyon y\u00f6ntemi sonu\u00e7lar\u0131, EUCAST 2016 dok\u00fcman\u0131na g\u00f6re de\u011ferlendirilmi\u015ftir (10). Buna g\u00f6re Gram pozitif diplokoklardan, metisiline duyarl\u0131 <i>Staphylococcus aureus <\/i>(MSSA) su\u015flar\u0131nda eritromisin direnci 2 su\u015fta, klindamisin ve linezolid direnci 1\u2019er su\u015fta saptanm\u0131\u015ft\u0131r. Metisiline duyarl\u0131 <i>Staphylococcus saprophyticus<\/i> su\u015fu ise klindamisine ve eritromisine diren\u00e7li olarak bulunmu\u015ftur. \u0130zole edilen 1 non-hemolitik streptokok su\u015fu; penisiline, amoksisilin\/klavulonik aside, klindamisine, eritromisine ve trimetoprim<i>\/<\/i>s\u00fclfametoksazola diren\u00e7li olarak tespit edilmi\u015ftir. Di\u011fer bir streptokok t\u00fcr\u00fc olan <i>Streptococcus pyogenes <\/i>su\u015funda, eritromisin direnci saptanm\u0131\u015ft\u0131r. \u0130zole edilen <i>Proteus<\/i> spp. su\u015funda; ampisilin, seftriakson ve trimetoprim<i>\/<\/i>s\u00fclfametoksazol direnci g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. \u0130zole edilen 1 <i>Klebsiella<\/i> spp. su\u015fu ise trimetoprim<i>\/<\/i>s\u00fclfametoksazol ve siprofloksasine diren\u00e7li olarak bulunmu\u015ftur. Aerop Gram pozitif \u00e7omaklardan \u00fcretebildi\u011fimiz tek t\u00fcr olan <i>Corynebacterium<\/i> spp. su\u015flar\u0131nda, siprofloksasin direncine 5 su\u015fta, klindamisin direncine 3 su\u015fta rastlanm\u0131\u015f; buna kar\u015f\u0131n penisilin, gentamisin, vankomisin ve linezolid direnci hi\u00e7bir su\u015fta saptanmam\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">\u00c7al\u0131\u015fmam\u0131zda, GM\u2019li hastalarda \u00fcreyen anaerop bakterilere kar\u015f\u0131, antibiyotiklerin M\u0130K de\u011ferlerini belirlemek i\u00e7in yapt\u0131\u011f\u0131m\u0131z gradyan test sonu\u00e7lar\u0131 da EUCAST 2016 dok\u00fcman\u0131na g\u00f6re de\u011ferlendirilmi\u015ftir (10). Buna g\u00f6re izole edilen <i>Peptostreptococcus<\/i> spp. su\u015flar\u0131ndan t\u00fcm\u00fcn\u00fcn amoksisilin\/klavulonik asit, imipenem ve klindamisine duyarl\u0131 oldu\u011fu; 1\u2019inin penisiline, 1\u2019inin metronidazola ve 1\u2019inin sefoksitine diren\u00e7li su\u015flar oldu\u011fu saptanm\u0131\u015ft\u0131r. \u0130zole edilen 2 <i>Bacteroides fragilis <\/i>su\u015fu, amoksisilin\/klavulonik asit, imipenem, klindamisin ve metronidazole duyarl\u0131; penisiline ve sefoksitine diren\u00e7li bulunmu\u015ftur. Benzer \u015fekilde, izole edilen di\u011fer bir anaerop Gram pozitif \u00e7omak olan 1 <i>Clostridium <\/i>spp. su\u015fu da penisiline, amoksisilin\/klavulonik asit, imipenem, klindamisin, metronidazol ve sefoksitine duyarl\u0131 bulunmu\u015ftur.<\/p>\n<div id=\"attachment_24018\" style=\"width: 1077px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo4.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-24018\" class=\"size-full wp-image-24018\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo4.png\" alt=\"\" width=\"1067\" height=\"1517\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo4.png 1067w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo4-183x260.png 183w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo4-380x540.png 380w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2021\/12\/KD.C34.S3_3649_Tablo4-768x1092.png 768w\" sizes=\"auto, (max-width: 1067px) 100vw, 1067px\" \/><\/a><p id=\"caption-attachment-24018\" class=\"wp-caption-text\"><strong>Tablo 4.<\/strong> BI 3730XL Cihaz\u0131nda Kromatogramlardan Elde Edilen FASTA Dizilerinin NCBI ve DSMZ Veri Bankalar\u0131 Kontrol\u00fc Sonras\u0131 Olu\u015fturulmu\u015f Sonu\u00e7lar\u0131<\/p><\/div>\n<p class=\"p2\">GM\u2019li 46 hastam\u0131z\u0131n 19\u2019unda direkt Gram boyamada bakteri g\u00f6r\u00fcld\u00fc\u011f\u00fc halde, yap\u0131lan k\u00fclt\u00fcrlerde bakteri \u00fcremesine rastlanmam\u0131\u015ft\u0131r. K\u00fclt\u00fcrlerde bakterilerin \u00fcretilemedi\u011fi 19 cerahat \u00f6rne\u011finden yap\u0131lan 16S rRNA\u2019n\u0131n PZR amplifikasyonu sonucunda elde edilen bakteri DNA\u2019lar\u0131<span class=\"s1\">n\u0131n FASTA dizilerine g\u00f6re 2 \u00f6rnekte <i>Staphyloccoccus aureus<\/i>, 3 \u00f6rnekte <i>Staphyloccoccus epidermidis<\/i>, 3 \u00f6rnekte<i> Corynebacterium kroppenstedtii <\/i>ve 1\u2019er \u00f6rnekte <i>Staphyloccoccus capitis, Streptococcus <\/i>spp.,<i> Streptococcus mitis<\/i>, <i>Lactococcus lactis<\/i>, <i>Klebsiella pneumoniae, Corynebacterium pseudotuberculosis<\/i> ve <i>Corynebacterium urealyticum<\/i> izole edilmi\u015ftir. Anaerop bakterilerden ise 1\u2019er \u00f6rnekte <i>Peptostreptococcaceae bacterium<\/i> <i>Cutibacterium<\/i> spp<i>.<\/i>, <i>Cutibacterium acnes<\/i> ve <i>Bifidobacterium breve <\/i>izole edilmi\u015ftir. Molek\u00fcler y\u00f6ntemlerle yap\u0131lan \u00e7al\u0131\u015fmalara dahil edilen her bir \u00f6rnekte yaln\u0131zca bir t\u00fcr saptanabilmi\u015ftir (Tablo 4). 16S rRNA\u2019n\u0131n PZR amplifikasyonu sonucunda elde edilen bakteri DNA\u2019lar\u0131n\u0131n FASTA dizilerine g\u00f6re bakteri t\u00fcrlerinin saptanmas\u0131nda kullan\u0131lan bakteri genomlar\u0131ndan; <i>Staphylococcus epidermidis<\/i> ATCC 12228 genomu ve <i>Corynebacterium kroppenstedtii<\/i> DSM 44385 genomu \u015eekil 1 ve 2\u2019de yer g\u00f6sterilmi\u015ftir.<\/span><\/p>\n<h2 class=\"p1\">TARTI\u015eMA<\/h2>\n<p class=\"p2\">\u00dclkemizde GM\u2019li hastalar\u0131n klini\u011fine y\u00f6nelik olduk\u00e7a fazla ara\u015ft\u0131rma olmas\u0131na ra\u011fmen infeksiyona neden olan mikroorganizmalar\u0131n oran\u0131na ve t\u00fcr da\u011f\u0131l\u0131m\u0131na y\u00f6nelik ara\u015ft\u0131rma yok denecek kadar azd\u0131r<\/p>\n<p class=\"p2\">\u00dclkemizin bulundu\u011fu co\u011frafi konumun yan\u0131 s\u0131ra, beslenme al\u0131\u015fkanl\u0131klar\u0131, kad\u0131nlar\u0131n do\u011fum yapma say\u0131s\u0131, kad\u0131n\u0131n aile i\u00e7indeki ve \u00e7al\u0131\u015fan kad\u0131n olarak toplumdaki yeri g\u00f6z \u00f6n\u00fcnde bulunduruldu\u011funda, GM tan\u0131s\u0131 alm\u0131\u015f hastalar\u0131n ya\u015f ortalamalar\u0131n\u0131n bilinmesi, toplumumuzda mastitli hastalar\u0131n ya\u015f ortalamalar\u0131nda g\u00f6r\u00fclebilecek de\u011fi\u015fimlerin izlenebilmesi a\u00e7\u0131s\u0131ndan \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n<p class=\"p2\"><span class=\"s1\">Ara\u015ft\u0131rmam\u0131za dahil edilen GM\u2019li 46 hastan\u0131n ya\u015f ortalamas\u0131 34.5\u2019tur. Bulgular\u0131m\u0131za benzer \u015fekilde Kok ve arkada\u015flar\u0131 (11), 2010 y\u0131l\u0131nda yay\u0131nlad\u0131klar\u0131 ara\u015ft\u0131rmalar\u0131nda 43 GM tan\u0131s\u0131 alm\u0131\u015f hastada ya\u015f ortalamas\u0131n\u0131 34 olarak bildirmi\u015ftir. \u00dclkemizde, Akbulut ve arkada\u015flar\u0131 (12), 2011 y\u0131l\u0131nda GM\u2019li hastalar ile yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada ya\u015f ortalamas\u0131n\u0131 33.2 olarak saptarken Parlakg\u00fcm\u00fc\u015f ve arkada\u015flar\u0131 (13) 2012 y\u0131l\u0131nda 36 olarak saptam\u0131\u015ft\u0131r. <\/span><\/p>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131zda, GM\u2019li hastalar\u0131n 28 (%60.8)\u2019inde \u00f6nceden ge\u00e7irilmi\u015f mastit \u00f6yk\u00fcs\u00fc tespit edilmi\u015ftir. Ammari ve arkada\u015flar\u0131 (14), 2002 y\u0131l\u0131nda ger\u00e7ekle\u015ftirdikleri \u00e7al\u0131\u015fmada, 29 GM\u2019li hastadan 4 (%11)\u2019\u00fcn\u00fcn \u00f6nceden ge\u00e7irilmi\u015f mastit \u00f6yk\u00fcs\u00fc bulundu\u011funu bildirmi\u015ftir. Bu sonu\u00e7lara g\u00f6re ara\u015ft\u0131rmam\u0131za dahil olan mastitli hastalarda di\u011fer uluslararas\u0131 verilere g\u00f6re daha y\u00fcksek oranda \u00f6nceden ge\u00e7irilmi\u015f bir mastit \u00f6yk\u00fcs\u00fc oldu\u011fu dikkati \u00e7ekmektedir. Bu durumun; \u00fclkemizde ger\u00e7ekle\u015fen do\u011fum say\u0131s\u0131, tedavideki aksamalar ve buna ba\u011fl\u0131 geli\u015fen n\u00fckslerle ili\u015fkili olabilece\u011fi g\u00f6r\u00fc\u015f\u00fcndeyiz.<\/p>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131za dahil edilen hastalar\u0131n sigara kullan\u0131m\u0131n\u0131n %60.8 olarak olduk\u00e7a y\u00fcksek bir oranda oldu\u011fu tespit edilmi\u015ftir. \u00dclkemizde ger\u00e7ekle\u015ftirilen \u00fc\u00e7 farkl\u0131 \u00e7al\u0131\u015fmada ise bu oran %37.5, %19 ve %35 olarak bildirilmi\u015ftir (13, 15, 16). \u00c7al\u0131\u015fmam\u0131zda saptanan y\u00fcksek sigara kullan\u0131m oran\u0131, kaynaklarda bildirilen oranlar\u0131n olduk\u00e7a \u00fcst\u00fcndedir.<\/p>\n<p class=\"p2\">GM\u2019li hastalar\u0131m\u0131z\u0131n \u00f6rneklerinde en s\u0131k \u00fcretilen aerop bakterinin <i>Corynebacterium <\/i>t\u00fcrleri oldu\u011fu dikkati \u00e7ekmektedir. Bunu <i>Staphylococcus aureus <\/i>ve <i>Enterobacteriaceae <\/i>ailesinden <i>Proteus mirabilis <\/i>ve <i>Klebsiella pneumoniae <\/i>takip etmektedir. Yine ara\u015ft\u0131rma sonu\u00e7lar\u0131m\u0131za g\u00f6re hasta grubumuzda en s\u0131k \u00fcretilen anaerop bakteri <i>Peptostreptococcus <\/i>spp. olup bunu <i>Bacteroides fragilis<\/i> izlemektedir. Ayr\u0131ca, <i>Clostridium <\/i>spp.\u2019nin de etkenler aras\u0131nda bulundu\u011fu g\u00f6sterilmi\u015ftir.<\/p>\n<p class=\"p2\">G<span class=\"s4\">M etyolojisinde bakterilerin rol\u00fcn\u00fc ara\u015ft\u0131ran kaynaklarda, mastitli b\u00f6lgeden al\u0131nan doku veya cerahat \u00f6rneklerinin gerek konvansiyonel y\u00f6ntemlerle gerekse molek\u00fcler y\u00f6ntemlerle, <i>Corynebacterium<\/i> t\u00fcrlerinin ve \u00f6zellikle <i>C. kroppenstedii<\/i>\u2019nin<i> <\/i>di\u011fer bakterilere g\u00f6re \u00e7ok daha y\u00fcksek s\u0131kl\u0131kta izole edilmesi dikkat \u00e7ekmi\u015ftir. Deri mikrobiyotas\u0131 \u00fcyeleri aras\u0131nda bulunan bu bakterilerin etken mi yoksa kontaminant m\u0131 oldu\u011fu tart\u0131\u015f\u0131l\u0131rken; bu bakterinin etyolojideki rol\u00fc incelenmeye de\u011fer bulundu\u011fu i\u00e7in pek \u00e7ok \u00e7al\u0131\u015fma GM ile <i>Corynebacterium<\/i> spp. ili\u015fkisine yer vermi\u015ftir. \u00d6zellikle, \u00f6rne\u011fin al\u0131nma \u015fekli y\u00fczeyel ak\u0131nt\u0131dan \u201cswap\u201d ile de\u011fil de doku biyopsisi veya i\u011fne aspirasyonu oldu\u011funda, Gram boyamada polimorf n\u00fcveli l\u00f6kositlele birlikte g\u00f6r\u00fclen bakterilerin k\u00fclt\u00fcrde \u00fcretilmesi halinde bunlar\u0131n etken olma olas\u0131l\u0131\u011f\u0131n\u0131n \u00e7ok daha y\u00fcksek oldu\u011funa de\u011finilmi\u015ftir. <i>S. epidermidis<\/i> ve <i>S. aureus\u2019<\/i>un yan\u0131 s\u0131ra ba\u015fta <i>C. striatum<\/i> olmak \u00fczere baz\u0131 <i>Corynebacterium<\/i> t\u00fcrlerinin biyofilm olu\u015fturdu\u011fu belirlendikten sonra lipofilik bir doku i\u00e7inde bu bakterilerin davran\u0131\u015flar\u0131 da ayr\u0131ca merak konusu olmu\u015ftur (17, 18). <\/span><\/p>\n<p class=\"p2\"><i>Corynebacterium<\/i> t\u00fcrlerinin GM\u2019li olgulardaki varl\u0131\u011f\u0131 bir\u00e7ok ara\u015ft\u0131rmac\u0131n\u0131n dikkatini \u00e7ekmi\u015f ancak \u00fcretimde ba\u015far\u0131 sa\u011flanamad\u0131\u011f\u0131 bildirilmi\u015ftir (19-24). Fl\u00e8che-Mat\u00e9os ve arkada\u015flar\u0131 (19), GM\u2019li bir olguda direkt Gram boyamada bakteri g\u00f6r\u00fclmedi\u011fi halde <i>Corynebacterium kropenstedii<\/i>\u2019nin \u00fcredi\u011fini belirtmi\u015ftir. Paviour ve arkada\u015flar\u0131 (20), 15 mastitli hastadan \u00fcretilen 19 <i>Corynebacterium <\/i>t\u00fcr\u00fcn\u00fc bildirmi\u015f ve bunlar\u0131n 14\u2019\u00fcn\u00fcn <i>Corynebacterium kropenstedii, <\/i>2\u2019sinin <i>C. tuberculostearicum <\/i>ve 3 \u00fcn\u00fcn <i>C. amycolatum <\/i>oldu\u011funu belirtmi\u015ftir.<\/p>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131zda en s\u0131k \u00fcreyen bakterinin <i>Corynebacterium <\/i>spp. oldu\u011fu belirlenmi\u015ftir. PZR ile yap\u0131lan ara\u015ft\u0131rmalar\u0131m\u0131z sonucunda da hastalarda, 5 <i>Corynebacterium <\/i>DNA\u2019s\u0131 saptanm\u0131\u015f olup hasta grubumuzun 17 (%36.9)\u2019sinde <i>Corynebacterium<\/i> tespit edilmi\u015ftir. Taylor ve arkada\u015flar\u0131n\u0131n (21), gen sekanslama y\u00f6ntemi ile ger\u00e7ekle\u015ftirdikleri \u00e7al\u0131\u015fmada, 34 GM\u2019li hasta \u00f6rne\u011finin 24 (%70.6)\u2019\u00fcnde lipofilik <i>Corynebacterium <\/i>spp. izole ettikleri bildirilmi\u015ftir. GM\u2019li hastalar\u0131m\u0131zda, saptanan <i>Corynebacterium <\/i>t\u00fcrleri aras\u0131nda <i>C. pseudotuberculosis<\/i>, <i>C. kroppenstedtii <\/i>ve <i>C. urealyticum<\/i>\u2019un yer ald\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Taylor ve arkada\u015flar\u0131 (21) \u00e7al\u0131\u015fmalar\u0131nda, GM\u2019li hastalarda <i>C. kropenstedii<\/i> oran\u0131n\u0131 %41 olarak tespit etmi\u015ftir. Ang ve arkada\u015flar\u0131 (22), \u00e7al\u0131\u015fmalar\u0131nda <i>C. accolens <\/i>t\u00fcr\u00fcn\u00fc bir GM\u2019li hastadan izole ettiklerini bildirmi\u015ftir. Bizim ara\u015ft\u0131rmam\u0131zda ise gerek k\u00fclt\u00fcrle gerekse PZR ile saptayabildi\u011fimiz <i>Corynebacterium <\/i>t\u00fcrleri aras\u0131nda <i>C. accolens <\/i>t\u00fcr\u00fcne rastlanmam\u0131\u015ft\u0131r. \u00dclkemizde GM\u2019li olgulardan al\u0131nan cerahatlerde <i>Corynebacterium <\/i>varl\u0131\u011f\u0131n\u0131 g\u00f6steren iki ara\u015ft\u0131rma bulunmaktad\u0131r. Parlakg\u00fcm\u00fc\u015f ve arkada\u015flar\u0131 (13), 28 gran\u00fclomat\u00f6z mastit tan\u0131s\u0131 alm\u0131\u015f hastadan al\u0131nan \u00f6rneklerden \u00fcretilen su\u015flardan 1\u2019inin difteroid basil oldu\u011funu belirtmi\u015f ancak t\u00fcr tan\u0131m\u0131na gidememi\u015ftir (13). \u00d6zayd\u0131n ve arkada\u015flar\u0131 (23) ise, GM\u2019li 1 olguda <i>Corynebacterium amycolatum <\/i>\u00fcretmi\u015ftir.<\/p>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131zda, GM\u2019li olgularda ikinci s\u0131kl\u0131kta \u00fcretilen bakteri <i>Staphylococcus aureus <\/i>olup bunu streptokoklar izlemektedir. Oran ve arkada\u015flar\u0131 (16), 11 GM\u2019li hastadan ald\u0131klar\u0131 cerahat \u00f6rneklerinin 5 (%45)\u2019inde <i>S. aureus<\/i>\u2019u, 3 (%27)\u2019\u00fcnde <i>Streptococcus <\/i>spp\u2019yi izole ettiklerini belirtmi\u015ftir. Olgular\u0131m\u0131zda <i>S. aureus <\/i>d\u0131\u015f\u0131nda, k\u00fclt\u00fcrle <i>S. epidermidis <\/i>saptamam\u0131za ra\u011fmen PZR y\u00f6ntemiyle 3 \u00f6rnekte <i>S. epidermidis <\/i>varl\u0131\u011f\u0131n\u0131 belirledik. Bu oran, <i>S. aureus <\/i>oran\u0131m\u0131z gibi Sandhu ve arkada\u015flar\u0131n\u0131n (13) %25 ve Parlakg\u00fcm\u00fc\u015f ve arkada\u015flar\u0131n\u0131n (25) %14.3 olan <i>S. epidermidis <\/i>oran\u0131ndan d\u00fc\u015f\u00fckt\u00fcr.<\/p>\n<p class=\"p2\"><span class=\"s4\"><i>S. saprophyticus,<\/i> insanda \u00f6zellikle idrar yolu epiteline tutunabilme \u00f6zelli\u011fi ile bilinen bir bakteridir ve idrar yolu infeksiyonlar\u0131na neden oldu\u011fu bildirilmi\u015ftir (26). <i>S. saprophyticus <\/i>saptad\u0131\u011f\u0131m\u0131z 1 hastam\u0131z\u0131n mastit s\u0131ras\u0131nda \u00fcriner sistem infeksiyonu ge\u00e7iriyor olmas\u0131 bizim i\u00e7in olduk\u00e7a ilgin\u00e7 ve bulgumuzu destekleyici bir veri olmu\u015ftur. Ara\u015ft\u0131rmam\u0131zda, cerrahi hekimlerin \u00f6rnek al\u0131nacak b\u00f6lgenin cilt antisepsisi i\u00e7in povidon iyot i\u00e7eren Betadix %7.5 SCRUM (Naturel Medikal, T\u00fcrkiye) kullanarak deri dezenfeksiyonuna \u00f6zen g\u00f6sterdi\u011fi ve b\u00f6ylece flora bakterilerinin \u00f6rne\u011fe kontaminasyonunun titizlikle \u00f6nlendi\u011fini bildi\u011fimizden; \u00fcreyen bakterilerin deriden kontamine olma olas\u0131l\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmemi\u015ftir. Hasta grubumuzda, 1 <i>S. saprophyticus <\/i>su\u015fu \u00fcretilmi\u015f ve 1 <i>S. capitis <\/i>DNA\u2019s\u0131 PZR ile saptanm\u0131\u015ft\u0131r. Ayr\u0131ca k\u00fclt\u00fcrle 1 <i>S. pyogenes <\/i>su\u015fu \u00fcretilmi\u015f ve PZR ile 1 <i>S. mitis <\/i>DNA\u2019s\u0131 ve t\u00fcr\u00fc kesin olarak tan\u0131mlanamayan bir <i>Streptococcus <\/i>spp. DNA\u2019s\u0131 saptanm\u0131\u015ft\u0131r. <\/span><\/p>\n<p class=\"p2\">Hasta grubumuzda saptad\u0131\u011f\u0131m\u0131z di\u011fer bakteriler <i>Enterobacteriaceae <\/i>ailesinde yer alan <i>Klebsiella <\/i>ve <i>Proteus<\/i>\u2019tur. GM\u2019li olgularda bu bakterilerin varl\u0131\u011f\u0131na s\u0131k olmamakla birlikte de\u011finilmi\u015ftir (25, 27).<\/p>\n<p class=\"p2\">Hasta \u00f6rnekleri ile ger\u00e7ekle\u015ftirdi\u011fimiz anaerop k\u00fclt\u00fcrler sonucunda; anaerop Gram pozitif diplokoklardan <i>Peptostreptococcus <\/i>spp., anaerop Gram negatif \u00e7omaklardan <i>Bacteroides fragilis <\/i>ve anaerop Gram pozitif \u00e7omaklardan <i>Clostridium <\/i>spp. izole edilmi\u015ftir. Hastalar\u0131m\u0131zda (3 olgu), anaerop k\u00fclt\u00fcr ile en s\u0131k \u00fcretebildi\u011fimiz bakteri <i>Peptostreptococcus <\/i>spp.\u2019dir. Bunu %4.3 oran\u0131nda saptad\u0131\u011f\u0131m\u0131z <i>Bacteroides fragilis<\/i> izlemektedir. Paviour ve arkada\u015flar\u0131n\u0131n (14) yan\u0131 s\u0131ra Ammari ve arkada\u015flar\u0131 (20), GM\u2019li hastalarda benzer \u015fekilde s\u0131kl\u0131kla <i>Peptostreptococcus <\/i>spp. izole ettiklerini ve bunu <i>B. fragilisin<\/i> izledi\u011fini g\u00f6stermi\u015ftir.<\/p>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131zda, ger\u00e7ekle\u015ftirdi\u011fimiz aerop ve anaerop k\u00fclt\u00fcrlerin sonucunda; yaln\u0131zca bir bakteri t\u00fcr\u00fc \u00fcreyen \u00f6rneklerin yan\u0131 s\u0131ra birden fazla bakteri t\u00fcr\u00fcn\u00fcn bir arada \u00fcredi\u011fini g\u00f6zledi\u011fimiz \u00f6rneklere de rastlad\u0131k. En s\u0131k rastlad\u0131\u011f\u0131m\u0131z bakteri birlikteli\u011fi hasta \u00f6rneklerinin \u00fc\u00e7\u00fcnde saptad\u0131\u011f\u0131m\u0131z <i>Corynebacterium <\/i>spp. ve <i>Peptostreptococcus <\/i>spp. birlikteli\u011fidir. Mastitli olgular\u0131n sunuldu\u011fu di\u011fer uluslararas\u0131 \u00e7al\u0131\u015fmalarda da bakteri birlikteli\u011fi bizim bulgular\u0131m\u0131za benzer \u015fekilde g\u00f6sterilmi\u015ftir (20, 21, 25). Bu nedenle, saptad\u0131\u011f\u0131m\u0131z bu bakteri birlikteliklerinin, tedavide uygulanacak antibiyotiklerin d\u00fczenlenmesi i\u00e7in \u00f6nemli bir veri olaca\u011f\u0131 kanaatindeyiz.<\/p>\n<p class=\"p2\">Gran\u00fclomat\u00f6z mastitli hastalardan al\u0131nan \u00f6rneklerde \u00fcreyen bakterilerin b\u00fcy\u00fck b\u00f6l\u00fcm\u00fcn\u00fcn cilt mikrobiyotas\u0131 bakterileri aras\u0131nda olmas\u0131, izole edilen bakterilerin etken olup olmad\u0131\u011f\u0131 konusunda tart\u0131\u015fmalara neden olmu\u015ftur. Bir\u00e7ok kaynakta \u00f6rnek al\u0131m\u0131n\u0131n, rehberlerde belirtilen \u015fekle uygun olarak deri dezenfeksiyonu sa\u011fland\u0131ktan sonra, doku biyopsisi veya i\u011fne aspirasyonu \u015feklinde yap\u0131ld\u0131\u011f\u0131 belirtilmekte ve \u00fcretilen bakterilerin cilt mikrobiyotas\u0131na ait bakteriler olmas\u0131 halinde dahi hen\u00fcz bu bakterilerin etyolojideki rol\u00fc kesin olarak a\u00e7\u0131klanamad\u0131\u011f\u0131ndan, klinikte antibiyotik tedavisine gidilmektedir (28-32).<\/p>\n<p class=\"p2\">G\u00fcn\u00fcm\u00fczde, laktasyonel mastitlerin etyolojisinde rol\u00fc olan bakterilerin bilinmesine ve tedavide \u00e7o\u011funlukla ba\u015far\u0131 sa\u011flanmas\u0131na kar\u015f\u0131n; non-laktasyonel mastitlerin \u00f6nemli bir b\u00f6l\u00fcm\u00fcn\u00fc te\u015fkil eden GM\u2019lerin patogenezi ve etyolojisi kesin olarak bilinmemektedir. Tedavi yan\u0131t\u0131nda ya\u015fanan g\u00fc\u00e7l\u00fckler ve s\u0131k\u00e7a kar\u015f\u0131la\u015f\u0131lan n\u00fcksler nedeni ile bu hasta grubunda elde edilen her verinin \u00fcst\u00fcnde durulmaya de\u011fer oldu\u011fu belirtilmektedir. Bakterilerin, GM etyolojisinde birincil rol\u00fc oldu\u011funu g\u00f6steren \u00e7al\u0131\u015fmalar\u0131n yan\u0131 s\u0131ra, bu bakterilerin sekonder olarak klinik tabloya eklendi\u011fini belirten \u00e7al\u0131\u015fmalar\u0131n da bulunmas\u0131, primer neden d\u00fczelmedik\u00e7e antibakteriyel tedavi ile kal\u0131c\u0131 ba\u015far\u0131 sa\u011flanamayaca\u011f\u0131n\u0131 ve n\u00fckslerle kar\u015f\u0131la\u015f\u0131laca\u011f\u0131n\u0131 g\u00f6stermektedir. Di\u011fer yandan son y\u0131llarda yap\u0131lan \u00e7al\u0131\u015fmalarda; \u00f6zellikle gran\u00fcloma i\u00e7inde bulunan lipid vakuollerinde, <i>Corynebacterium <\/i>spp.\u2019nin dikkat \u00e7ekici oranlarda bulunmas\u0131 sonucunda daha iyi bir antibiyotik penetrasyonu sa\u011flanmas\u0131 ve iyi bir doku konsantrasyonuna ula\u015f\u0131lmas\u0131 amac\u0131yla lipofilik antibiyotiklerle uzun s\u00fcreli tedaviler \u00f6nerilmektedir (30, 31). Tedavi protokollerinin hen\u00fcz tart\u0131\u015fmal\u0131 olmas\u0131 tedavi yan\u0131t\u0131nda g\u00fc\u00e7l\u00fcklere neden olan di\u011fer \u00f6nemli bir fakt\u00f6r olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r (33-35).<\/p>\n<p class=\"p2\">Mastit tedavisinde kesin \u00e7\u00f6z\u00fcme ula\u015fmak ya da n\u00fckslerin \u00f6n\u00fcne ge\u00e7ebilmek i\u00e7in dikkat edilecek \u00f6nemli noktalardan biri etkene y\u00f6nelik antibiyotik kullan\u0131m\u0131n\u0131 tercih etmektir. Diren\u00e7li su\u015flar\u0131n ortaya \u00e7\u0131kmas\u0131nda uygulanan antibiyotik politikalar\u0131n\u0131n rol\u00fcn\u00fcn b\u00fcy\u00fck oldu\u011fu d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde; etkenlerin saptanmas\u0131 ve antimikrobiyal duyarl\u0131l\u0131klar\u0131n\u0131n belirlenmesi, a\u015f\u0131r\u0131 ve kontrols\u00fcz antibiyotik kullan\u0131m\u0131n\u0131n \u00f6nlenmesi a\u00e7\u0131s\u0131ndan \u00f6nem ta\u015f\u0131maktad\u0131r (33-36). Mastit tedavisinde, geni\u015f spektrumlu antibiyotiklerin yayg\u0131n kullan\u0131m\u0131n\u0131n, infeksiyona neden olan etkenlerde antibiyotik diren\u00e7 oranlar\u0131n\u0131n art\u0131\u015f\u0131na neden oldu\u011fu ve amoksisilin\/klavulonik asit gibi kombine antibiyotik kullan\u0131mlar\u0131ndan olabildi\u011fince ka\u00e7\u0131n\u0131lmas\u0131 gerekti\u011fi \u00f6nerilmi\u015ftir (24, 25).<\/p>\n<p class=\"p2\">Hasta \u00f6rneklerinden izole etti\u011fimiz; 2 MRSA su\u015funda penisilin, seftriakson ve amoksisilin\/klavulonik asit direncine, <i>Staphylococcus saprophyticus<\/i> su\u015funda klindamisin ve eritromisin direncine, <i>Streptococcus pyogenes <\/i>su\u015funda eritromisin direncine ve <i>Corynebacterium<\/i> spp. su\u015flar\u0131nda siprofloksasin direncine rastlanm\u0131\u015ft\u0131r. \u0130zole edilen 1 non-hemolitik streptokok su\u015fu, penisilin, amoksisilin\/klavulonik asit, klindamisin, eritromisin ve<i> <\/i>trimetoprim<i>\/<\/i>s\u00fclfametoksazole; <i>Proteus mirabilis <\/i>su\u015fu, ampisilin, seftriakson, trimetoprim<i>\/<\/i>s\u00fclfametoksazole; ve izole edilen <i>Klebsiella<\/i> spp. su\u015fu ise trimetoprim<i>\/<\/i>s\u00fclfametoksazol ve siprofloksasine diren\u00e7li olarak saptanm\u0131\u015ft\u0131r. Bulgular\u0131m\u0131z ulusal ve uluslararas\u0131 \u00e7al\u0131\u015fmalarda belirtilen diren\u00e7 oranlar\u0131 ile \u00f6rt\u00fc\u015fmektedir (16, 19, 22, 26, 36).<\/p>\n<p class=\"p2\">\u00d6rneklerimizden \u00fcretti\u011fimiz <i>Peptostreptococcus<\/i> spp. su\u015flar\u0131ndan t\u00fcm\u00fcn\u00fcn amoksisilin\/klavulonik asit, imipenem ve klindamisine duyarl\u0131 oldu\u011fu, 1\u2019inin penisiline, 1\u2019inin metronidazol ve 1\u2019inin sefoksitine diren\u00e7li su\u015flar oldu\u011fu saptanm\u0131\u015ft\u0131r. Anaerop bakterilerde, antimikrobiyal direncin h\u0131zla artt\u0131\u011f\u0131 pek \u00e7ok \u00e7al\u0131\u015fmada belirtilmektedir (37-40). \u00d6zellikle penisilin direncindeki art\u0131\u015f\u0131n penisilinaz ve beta-laktamaz olu\u015fturan anaeroplarda korkutucu d\u00fczeyde artt\u0131\u011f\u0131 \u00f6ne s\u00fcr\u00fclmektedir (38). <i>Peptostreptococcus <\/i>spp.\u2019de penisilin M\u0130K de\u011ferlerinin 8 mg\/L\u2019ye ula\u015ft\u0131\u011f\u0131n\u0131 belirten \u00e7al\u0131\u015fmalar bulunmaktad\u0131r (37). Bu durum bir beta-laktam antibiyotik olan sefoksitini de kapsamaktad\u0131r. <i>Peptostreptococcus <\/i>spp. i\u00e7in uluslararas\u0131 \u00e7al\u0131\u015fmalarda klindamisin direncinin %10\u2019a kadar ula\u015ft\u0131\u011f\u0131 bildirilmi\u015ftir (38). \u00dclkemizde ise peptostreptokoklar\u0131n antimikrobiyal direncine de\u011finen g\u00fcncel bir ara\u015ft\u0131rma bulunmamaktad\u0131r. Kornea apselerinden izole edilen <i>Peptostreptococcus anaerobius <\/i>su\u015flar\u0131nda %13.3 oran\u0131nda klindamisin direnci saptand\u0131\u011f\u0131n\u0131 belirten ulusal bir yay\u0131nla bizim ara\u015ft\u0131rmam\u0131zda saptad\u0131\u011f\u0131m\u0131z %11.1\u2019lik diren\u00e7 uyu\u015fmaktad\u0131r (39).<\/p>\n<p class=\"p2\"><i>Bacteroides fragilis <\/i>grubu bakteriler, beta-laktamaz yapan ve klinik kullan\u0131mdaki antibiyotiklere y\u00fcksek oranda diren\u00e7 geli\u015ftiren bakteriler olarak bilinmektedir. Ara\u015ft\u0131rmam\u0131zda \u00fcretti\u011fimiz 2 <i>B. fragilis <\/i>su\u015funun, penisilin ve sefoksitine diren\u00e7li oldu\u011fu belirlenmi\u015ftir. Brook ve arkada\u015flar\u0131 (38) ara\u015ft\u0131rmalar\u0131nda, sefoksitin diren\u00e7li <i>Bacteroides fragilis <\/i>k\u00f6kenlerinde M\u0130K de\u011ferinin 64 mg\/L\u2019nin \u00fczerinde oldu\u011funa ve %4 &#8211; %25 aras\u0131nda de\u011fi\u015fen bir sefoksitin direncine i\u015faret etmi\u015ftir. \u00dclkemizde, <i>Bacteroides fragilis <\/i>k\u00f6kenlerinin g\u00fcncel sefoksitin direncine de\u011finen bir ara\u015ft\u0131rma bulunmamaktad\u0131r. Ancak penisilin diren\u00e7li <i>B. fragilis<\/i>\u2019lerde<i> <\/i>M\u0130K de\u011ferinin 256 mg\/L\u2019ye kadar ula\u015ft\u0131\u011f\u0131 belirtilmektedir (40).<\/p>\n<p class=\"p2\">Ara\u015ft\u0131rmam\u0131z s\u00fcresince GM\u2019li 19 hastan\u0131n \u00f6rne\u011finde Gram boyamas\u0131nda bakteriler g\u00f6r\u00fcld\u00fc\u011f\u00fc halde k\u00fclt\u00fcrde \u00fcreme olmad\u0131\u011f\u0131 saptanm\u0131\u015ft\u0131r. GM\u2019li hastalarda k\u00fclt\u00fcrde \u00fcremelerin olmad\u0131\u011f\u0131 bir\u00e7ok \u00e7al\u0131\u015fmada belirtilmi\u015ftir (20-22). Bu nedenle son y\u0131llarda, molek\u00fcler y\u00f6ntemleri kullanan ara\u015ft\u0131rmalar dikkati \u00e7ekmektedir. Taylor ve arkada\u015flar\u0131 (21), 16S rRNA gen analizi ile GM\u2019li olgular\u0131n 14\u2019\u00fcnde Corynebacterium <i>kroppenstedtii <\/i>saptam\u0131\u015ft\u0131r. Paviour ve arkada\u015flar\u0131 (20) ise k\u00fclt\u00fcrde \u00fcrettikleri 19 <i>Corynebacterium<\/i> izolat\u0131n\u0131n t\u00fcr tan\u0131m\u0131n\u0131 16S rRNA gen analizi ile ger\u00e7ekle\u015ftirmi\u015f;14\u2019\u00fcn\u00fcn <i>Corynebacterium kroppenstedtii<\/i>, 2\u2019sinin <i>Corynebacterium tuberculostearicum<\/i> ve 3\u2019\u00fcn\u00fcn <i>Corynebacterium amycolatum <\/i>oldu\u011funu tespit etmi\u015ftir (20). \u00c7al\u0131\u015fmam\u0131zda da, direkt Gram boyamada Gram pozitif \u00e7omak saptad\u0131\u011f\u0131m\u0131z ancak k\u00fclt\u00fcrde bakteri \u00fcretemedi\u011fimiz 5 \u00f6rne\u011fin 3\u2019\u00fcnde <i>Corynebacterium kroppenstedtii, <\/i>1\u2019inde <i>Corynebacterium uralyticum <\/i>ve di\u011fer 1\u2019inde <i>Corynebacterium pseudotuberculosis\u2019<\/i>i 16S rRNA gen analizi ile saptad\u0131k. Ayr\u0131ca,16S rRNA\u2019n\u0131n PZR amplifikasyonu sonucunda elde edilen bakteri DNA\u2019lar\u0131n\u0131n FASTA dizilerine g\u00f6re 1 \u00f6rnekte <i>Lactococcus lactis <\/i>izole edilmi\u015ftir. Uluslararas\u0131 literat\u00fcrde insandan izole edildi\u011fini belirten bir kayna\u011fa rastlanmam\u0131\u015ft\u0131r. Hayvan mastitlerinde ise gittik\u00e7e \u00f6nemi artan yayg\u0131n patojen olarak bildirilmi\u015ftir (41). \u00dclkemizde non-laktasyonel mastitli olgularda PZR ile bakteri saptayan herhangi bir \u00e7al\u0131\u015fmaya rastlamad\u0131\u011f\u0131m\u0131z gibi; mastitli olgularda, <i>Bifidobacterium brevi <\/i>varl\u0131\u011f\u0131n\u0131 g\u00f6steren ulusal ya da uluslararas\u0131 hi\u00e7bir \u00e7al\u0131\u015fmaya da rastlamad\u0131k.<\/p>\n<p class=\"p2\">Gran\u00fclomat\u00f6z mastitin bir alt grubu olarak bilinen ve s\u0131kl\u0131kla g\u00f6r\u00fclen t\u00fcberk\u00fcloz mastitli hastalar\u0131n \u00e7al\u0131\u015fma grubumuzdan d\u0131\u015flanmas\u0131, nadir de olsa GM\u2019li hastalarda etken olarak rastlanabilen vir\u00fcs ve mantarlar\u0131n ara\u015ft\u0131rmam\u0131za dahil edilmemesi ve az say\u0131da hasta ile \u00e7al\u0131\u015f\u0131lmas\u0131 nedeniyle s\u0131n\u0131rl\u0131 veri elde edilmi\u015f olmas\u0131 bu ara\u015ft\u0131rman\u0131n en \u00f6nemli k\u0131s\u0131tl\u0131l\u0131klar\u0131 olarak belirlenmi\u015ftir.<\/p>\n<p class=\"p2\">Sonu\u00e7 olarak, infeksiyona neden olan bakterilerde diren\u00e7 geli\u015fimine yol a\u00e7abilecek geni\u015f spektrumlu antibiyotikleri i\u00e7eren empirik tedavi protokollerinin uygulanmas\u0131ndan ziyade aerop\/anaerop etkenlerin belirlenerek etkene spesifik tedavi uygulanmas\u0131n\u0131n anlaml\u0131 olaca\u011f\u0131 kan\u0131s\u0131nday\u0131z.<span class=\"Apple-converted-space\">\u00a0 <\/span>\u00d6zellikle etkenlerin \u00fcretilmesinde g\u00fc\u00e7l\u00fckler ya\u015fanan GM\u2019li olgularda, Gram pozitif \u00e7omaklara (<i>Corynebacterium <\/i>t\u00fcrlerine) etkili penisilin, vankomisin ve linezolid gibi ya\u011f dokuya penetrasyonu g\u00fc\u00e7l\u00fc olan antibiyotiklerin tedaviye eklenmesi yararl\u0131 olacakt\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>G\u0130R\u0130\u015e Mastitler, memenin inflamasyonu ile seyreden infeksiy\u00f6z ya da noninfeksiy\u00f6z hastal\u0131klar olup genellikle kad\u0131nlar\u0131 etkiler (1). Mastitler; laktasyonel mastit, non-laktasyonel mastit ve meme apsesi olmak \u00fczere \u00fc\u00e7 grupta incelenmektedir. Non-laktasyonel mastit; santral veya subareolar infeksiyon, periferal infeksiyon ve gran\u00fclomat\u00f6z infeksiyon olmak \u00fczere \u00fc\u00e7 gruba ayr\u0131l\u0131r (1). \u0130nfeksiy\u00f6z olmayan mastit (non-laktasyonel mastit), memenin lob\u00fcllerinde geni\u015fleme ile [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":24127,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5330,5331,5329,4750],"class_list":["post-23841","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-aerop-ve-anaerop-bakteriler","tag-anti-bakteriyel-ajanlar","tag-granulomatoz-mastit","tag-polimeraz-zincir-reaksiyonu"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23841","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=23841"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23841\/revisions"}],"predecessor-version":[{"id":24007,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23841\/revisions\/24007"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/24127"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=23841"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=23841"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=23841"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}