{"id":28005,"date":"2023-12-25T16:34:41","date_gmt":"2023-12-25T13:34:41","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=28005"},"modified":"2024-06-25T14:46:29","modified_gmt":"2024-06-25T11:46:29","slug":"bakteriyemide-prokalsitoninin-rolu","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/12\/25\/bakteriyemide-prokalsitoninin-rolu\/","title":{"rendered":"Acil Servise Ba\u015fvuran Hastalarda Prokalsitonin Y\u00fcksekli\u011fi Bakteriyemi \u0130\u00e7in Do\u011fru Bir Biyobelirte\u00e7 mi?"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

Sepsis, infeksiyona cevap olarak geli\u015fen konak yan\u0131t\u0131n\u0131n hayat\u0131 tehdit eden organ disfonksiyonu olu\u015fturmas\u0131d\u0131r. Y\u00fcksek mortalite ve morbiditeye neden olabilen ciddi bir sa\u011fl\u0131k sorunudur. Sepsisin erken tan\u0131s\u0131 ve uygun y\u00f6netimi ile sa\u011fkal\u0131m artarken yo\u011fun bak\u0131m ihtiyac\u0131 da azal\u0131r (1). Sepsiste, bir infeksiyon oda\u011f\u0131 ile birlikte sistemik inflamasyon belirtilerinin mevcudiyeti ile tan\u0131 konabilir. Tan\u0131 i\u00e7in alt\u0131n standart kan k\u00fclt\u00fcr\u00fcnde etken mikroorganizman\u0131n \u00fcretilmesidir. Ancak k\u00fclt\u00fcrde \u00fcreme i\u00e7in ge\u00e7en s\u00fcrenin uzunlu\u011fu nedeniyle ek tan\u0131 y\u00f6ntemlerine ihtiya\u00e7 duyulmaktad\u0131r (2). G\u00fcn\u00fcm\u00fczde acil servislerde sepsis erken tan\u0131s\u0131 i\u00e7in C-reaktif protein (CRP) ve prokalsitonin (PCT) kullan\u0131labilmektedir. Prokalsitoninin \u00f6zg\u00fcll\u00fc\u011f\u00fc CRP ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda daha y\u00fcksektir (3). <\/b>Prokalsitonin sa\u011fl\u0131kl\u0131 bireylerde tiroid C h\u00fccrelerinde, 11. kromozomda bulunan kalsitonin geni ile ili\u015fkili peptit-1\u2019den (CALC-1) \u00fcretilen bir prohormondur. Tiroid C h\u00fccrelerinde olu\u015fan PCT\u2019nin tamam\u0131 kalsitonine d\u00f6n\u00fc\u015ft\u00fcr\u00fcld\u00fc\u011f\u00fc i\u00e7in kan dola\u015f\u0131m\u0131nda PCT saptanamaz ya da \u00e7ok d\u00fc\u015f\u00fck d\u00fczeyde saptan\u0131r. Ancak ki\u015fide sistemik bir infeksiyon olu\u015ftu\u011fu zaman, iki alternatif yolak ile ek PCT \u00fcretimi ba\u015flar. Bunlardan biri lipopolisakkarit veya mikroorganizmalardan gelen toksik metabolitler taraf\u0131ndan ind\u00fcklenen do\u011frudan yoldur. Di\u011feri ise, infeksiy\u00f6z yolaklar sonucunda \u00fcretilen interl\u00f6kin-6, t\u00fcm\u00f6r nekrozis fakt\u00f6r-\u03b1 gibi mediat\u00f6rler taraf\u0131ndan ind\u00fcklenen dolayl\u0131 yoldur. Bu ek yolaklarla ortaya \u00e7\u0131kan PCT d\u00fczeylerindeki art\u0131\u015f, hastalarda sepsis tan\u0131s\u0131ndan erken \u015f\u00fcphelenmeye ve erken antibiyotik ba\u015flanmas\u0131na yard\u0131mc\u0131 olur (<\/b>1,2,4)<\/p>\n

Bu \u00e7al\u0131\u015fmada, acil servise ba\u015fvuran ve sepsis tan\u0131s\u0131 konulan hastalarda PCT de\u011feri ile k\u00fclt\u00fcr pozitifli\u011fi aras\u0131ndaki ili\u015fkinin incelenmesi ve PCT e\u015fik de\u011ferinin belirlenmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

01 Ocak 2019 – 01 Nisan 2022 tarihleri aras\u0131nda \u00fc\u00e7\u00fcnc\u00fc basamak e\u011fitim ve ara\u015ft\u0131rma hastanesinin acil servisine ate\u015f \u015fikayetiyle ba\u015fvuran ve sepsis tan\u0131s\u0131 konulan eri\u015fkin (>18 ya\u015f) hastalar geriye d\u00f6n\u00fck olarak de\u011ferlendirildi. Antibiyotik ba\u015flanmadan \u00f6nce iki set kan k\u00fclt\u00fcr\u00fc al\u0131nan ve kan say\u0131m\u0131 ile birlikte CRP, PCT ve biyokimyasal tetkikleri yap\u0131lan hastalar \u00e7al\u0131\u015fmaya dahil edildi. Acil servise ate\u015f \u015fik\u00e2yeti ile ba\u015fvuran ancak ate\u015f nedeninin infeksiyon d\u0131\u015f\u0131 bir hastal\u0131\u011fa ba\u011fl\u0131 oldu\u011fu tespit edilen, viral infeksiyon tan\u0131s\u0131 konan ve hastane bilgi sisteminden verilerine tam olarak ula\u015f\u0131lamayan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131nda b\u0131rak\u0131ld\u0131.<\/span><\/p>\n

\u0130stanbul Merkez Laboratuvar\u0131\u2019nda ger\u00e7ekle\u015ftirilen kan k\u00fclt\u00fcr\u00fc \u00e7al\u0131\u015fmalar\u0131nda \u00fcremeyi sinyalle saptayan otomatize BacT\/ALERT\u00ae<\/span> 3D (bioM\u00e9rieux, Marcy l\u2019Etoile, Fransa) sistemi; izole edilen su\u015flar\u0131n tan\u0131mlanmas\u0131 ve antibiyotik duyarl\u0131l\u0131klar\u0131n\u0131n belirlenmesinde ise otomatize VITEK\u00ae<\/span> 2 Compact (bioM\u00e9rieux, Marcy l\u2019Etoile, Fransa) sistemi kullan\u0131lm\u0131\u015ft\u0131r. Antibiyotik duyarl\u0131l\u0131klar\u0131, Avrupa Antimikrobiyal Duyarl\u0131l\u0131k Testi Komitesi (European Committee on Antimicrobial Susceptibility Testing – EUCAST) standartlar\u0131na uygun olarak yorumlanm\u0131\u015ft\u0131r.\u00a0<\/span><\/p>\n

Hastane bilgi kay\u0131t sisteminden geriye d\u00f6n\u00fck olarak; ya\u015f, cinsiyet, hemogram, CRP, kan k\u00fclt\u00fcr\u00fc sonucu ve PCT bilgileri al\u0131nd\u0131. Hastalar, k\u00fclt\u00fcrde \u00fcreme olanlar ve olmayanlar olarak iki gruba ayr\u0131lm\u0131\u015f olup bu iki grup ya\u015f, l\u00f6kosit say\u0131s\u0131, CRP ve PCT de\u011ferleri a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. Ayr\u0131ca bakteriyemiyi saptamada; PCT i\u00e7in duyarl\u0131l\u0131k, \u00f6zg\u00fcll\u00fck, pozitif tahmin de\u011feri (PTD) ve negatif tahmin de\u011feri (NTD) hesapland\u0131. \u00a0<\/span><\/p>\n

Verilerin analizinde SPSS (Statistical Package for the Social Sciences) versiyon 15.0 program\u0131 (IBM Corp., Armonk, ABD) kullan\u0131ld\u0131.\u00a0 Tan\u0131mlay\u0131c\u0131 istatistikler i\u00e7in ortalama, standart sapma, medyan, minimum ve maksimum; kategorik de\u011fi\u015fkenler i\u00e7in \u03c7\u00b2 testi; normal da\u011f\u0131l\u0131m g\u00f6steren de\u011fi\u015fkenler i\u00e7in Student t-testi kullan\u0131ld\u0131. Da\u011f\u0131l\u0131m\u0131 normal olmayan s\u00fcrekli varyasyon g\u00f6steren de\u011fi\u015fkenlerde Mann-Whitney U istatistiksel analizleri yap\u0131ld\u0131. \u0130statistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 kabul edildi.<\/p>\n

\u00c7al\u0131\u015fma, Sancaktepe \u015eehit Prof. Dr. \u0130lhan Varank E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Giri\u015fimsel Olmayan Ara\u015ft\u0131rmalar Etik Kurulu taraf\u0131ndan 11 Ocak 2023 tarihinde 2023\/17 karar numaras\u0131yla onaylanm\u0131\u015ft\u0131r.\u00a0<\/span><\/p>\n

BULGULAR<\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> Hastalar\u0131n Klinik ve Laboratuvar \u00d6zellikleri<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Kan K\u00fclt\u00fcr\u00fcnde \u00dcreme Olmas\u0131 ile Ya\u015f ve Laboratuvar Parametreleri Aras\u0131ndaki \u0130li\u015fkinin De\u011ferlendirilmesi<\/p><\/div>\n

Acil servise ate\u015f \u015fikayetiyle ba\u015fvuran 4036 hasta incelendi ve kriterlere uygun olan 174 (%57.8)\u2019\u00fc erkek, 127 (%42.2)\u2019si kad\u0131n olmak \u00fczere toplam 301 hasta \u00e7al\u0131\u015fmaya dahil edildi. Hastalar\u0131n ya\u015flar\u0131 19 ile 95 aras\u0131nda de\u011fi\u015firken, medyan ya\u015f 71 idi. De\u011ferlendirmeye al\u0131nan hastalar\u0131n 245 (%81.4)\u2019inin kan k\u00fclt\u00fcr\u00fcnde \u00fcreme g\u00f6r\u00fclmezken, 56 (%18.6)\u2019s\u0131nda \u00fcreme oldu\u011fu saptand\u0131. \u00c7al\u0131\u015fmaya al\u0131nan hastalarda %76 oran\u0131yla en s\u0131k olarak pn\u00f6moni tan\u0131s\u0131 tespit edildi. Hastalar\u0131n klinik ve laboratuvar \u00f6zellikleri Tablo 1\u2019de verildi. Bakteriyemisi olan ve olmayanlar kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, k\u00fclt\u00fcrde \u00fcreme olan hastalar belirgin olarak daha ya\u015fl\u0131 idi. L\u00f6kosit say\u0131s\u0131, CRP ve PCT de\u011ferleri bakteriyemisi olan grupta istatistiksel a\u00e7\u0131dan belirgin olarak daha y\u00fcksek saptand\u0131 (Tablo 2).<\/p>\n

\"\"<\/a>

Tablo 3.<\/strong> Bakteriyemiyi Saptamada PCT D\u00fczeyinin Duyarl\u0131l\u0131k ve \u00d6zg\u00fcll\u00fck De\u011ferleri<\/p><\/div>\n

\"\"<\/a>

\u015eekil 1.<\/strong> Bakteriyemi ve Prokalsitonin D\u00fczeyine \u0130li\u015fkin ROC E\u011frisi*
* \u201cArea under the ROC curve\u201d (AUC)=0.718.<\/p><\/div>\n

Hastalar\u0131n l\u00f6kosit de\u011ferleri ile PCT de\u011ferleri aras\u0131nda d\u00fc\u015f\u00fck d\u00fczeyde pozitif korelasyon oldu\u011fu g\u00f6r\u00fcld\u00fc (r=0.373, p<\/i><0.001). Benzer \u015fekilde CRP de\u011ferleri ile PCT de\u011ferleri aras\u0131nda da d\u00fc\u015f\u00fck d\u00fczeyde pozitif korelasyon tespit edildi (r=0.490, p<\/i><0.001). Prokalsitoninin \u00f6zg\u00fcll\u00fc\u011f\u00fc %80 ve NTD %89.5 olarak saptand\u0131 (Tablo 3). Prokalsitonin de\u011feri \u2265<\/b>3.29 ng\/ml olan hastalar\u0131n 33 (%39.8)\u2019\u00fcnde bakteriyemi var iken <3.29 ng\/ml olan hastalar\u0131n sadece 23 (%10.6)\u2019\u00fcnde bakteriyemi oldu\u011fu tespit edildi (p<\/i><0.05). Prokalsitonin sonucu i\u00e7in e\u011fri alt\u0131ndan kalan alan (\u201carea under the ROC curve\u201d – AUC) 0.718 olarak bulunurken, e\u015fik de\u011ferinin 3.29 oldu\u011fu saptand\u0131. Bakteriyemide, PCT tan\u0131 testi i\u00e7in bulunan de\u011ferin orta d\u00fczeyde (%70-%80) ay\u0131rma yetene\u011fi oldu\u011fu belirlendi (\u015eekil 1).\u00a0<\/span><\/p>\n

\u0130RDELEME<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, bakteriyemisi olan hastalarda olmayan gruba g\u00f6re ya\u015f ortalamas\u0131, l\u00f6kosit say\u0131s\u0131, CRP ve PCT de\u011ferinin istatistiksel a\u00e7\u0131dan anlaml\u0131 d\u00fczeyde y\u00fcksek oldu\u011fu saptand\u0131. Ayr\u0131ca bakteriyemiyi saptamada PCT\u2019nin y\u00fcksek \u00f6zg\u00fcll\u00fck ve NTD\u2019ye sahip oldu\u011fu da g\u00f6r\u00fcld\u00fc. Thomas-R\u00fcddel ve arkada\u015flar\u0131n\u0131n (5) sepsis ile PCT aras\u0131ndaki ili\u015fkiyi inceleyen \u00e7al\u0131\u015fmalar\u0131nda, PCT de\u011ferleri Gram-negatif bakteriyemi i\u00e7in 26 ng\/ml (7.7-63.1), Gram-pozitif bakteriyemi i\u00e7in 7.1 ng\/ml (2.0\u201323.3) ve kandidemi i\u00e7in 4.7 ng\/ml (1.9-13.7) olarak hesaplanm\u0131\u015f olup AUC de\u011feri \u00e7al\u0131\u015fmam\u0131za benzer \u015fekilde %72 (%95 GA=0.71-0.74) olarak bildirilmi\u015ftir. \u00dclkemizde \u00fc\u00e7\u00fcnc\u00fc basamak bir hastanenin yo\u011fun bak\u0131m\u0131nda yap\u0131lan benzer bir \u00e7al\u0131\u015fmada, sepsis tan\u0131s\u0131 alan ve kan k\u00fclt\u00fcr\u00fc \u00fcremesi saptanan 410 hastan\u0131n 136\u2019s\u0131nda kan k\u00fclt\u00fcr \u00fcremesi olmu\u015ftur. Bakteriyemi saptanan ve sepsis tan\u0131s\u0131 alan bu hastalar, \u00fcremelerin Gram-negatif ve Gram-pozitif olmas\u0131 y\u00f6n\u00fcnden ara\u015ft\u0131r\u0131lm\u0131\u015f olup PCT d\u00fczeyi Gram-negatif \u00fcremesi olan hastalarda 7.31 ng\/ml iken Gram-pozitif \u00fcremesi olan hastalarda ise 0.46 ng\/ml olarak saptanm\u0131\u015ft\u0131r. PCT i\u00e7in %70.83 duyarl\u0131l\u0131k ve %84.21 \u00f6zg\u00fcll\u00fck ile e\u015fik de\u011fer \u22641.3 ng\/ml olarak belirlenmi\u015ftir. Yine bu \u00e7al\u0131\u015fmada, PCT i\u00e7in AUC de\u011feri 0.80 olarak hesaplanm\u0131\u015ft\u0131r. S\u00f6z konusu \u00e7al\u0131\u015fma kapsam\u0131nda, \u00f6zellikle bakteriyel\/viral infeksiyon ayr\u0131m\u0131nda prokalsitoninin yararl\u0131 oldu\u011fu saptanm\u0131\u015ft\u0131r (6). Toplum k\u00f6kenli pn\u00f6monisi olan hastalarda prokalsitoninin, bakteriyel ve viral pn\u00f6moniyi ay\u0131rt etmede do\u011fruluk oran\u0131 yakla\u015f\u0131k %65-70 oran\u0131nda saptanm\u0131\u015ft\u0131r (7). \u00c7al\u0131\u015fmam\u0131zda, PCT i\u00e7in \u00f6zg\u00fcll\u00fck %80, NTD %89.5 iken PCT sonucu i\u00e7in AUC de\u011feri 0.718 bulundu; PCT duyarl\u0131l\u0131\u011f\u0131 ise %58.9 oran\u0131 ile literat\u00fcr verilerinden daha d\u00fc\u015f\u00fck olarak saptand\u0131.<\/span><\/p>\n

Acil servise ate\u015f y\u00fcksekli\u011fi ile ba\u015fvuran hastalarda, sepsis tan\u0131s\u0131n\u0131 h\u0131zla koyup \u015f\u00fcphe olu\u015fur olu\u015fmaz antibiyoterapiye ba\u015flanmas\u0131 mortaliteyi azaltmaktad\u0131r (8). Sepsisin erken tan\u0131s\u0131 i\u00e7in PCT, CRP ve interl\u00f6kin-6 gibi biyobelirte\u00e7ler de\u011ferlendirilmi\u015f ancak duyarl\u0131l\u0131klar\u0131 ve \u00f6zg\u00fcll\u00fckleri s\u0131n\u0131rl\u0131 bulunmu\u015ftur. Prokalsitonin i\u00e7in yap\u0131lan bir \u00e7al\u0131\u015fmada intraven\u00f6z endotoksin enjekte edilmi\u015f ve enjeksiyondan 3-4 saat sonra PCT art\u0131\u015f\u0131 g\u00f6zlenmi\u015f ve PCT dola\u015f\u0131mda 24 saat y\u00fcksek saptanm\u0131\u015ft\u0131r (1).\u00a0<\/span><\/p>\n

Sepsis olgular\u0131nda PCT\u2019nin tan\u0131sal de\u011ferinin incelendi\u011fi bir \u00e7al\u0131\u015fmada, PCT e\u015fik de\u011feri sepsis i\u00e7in 0.57 ng\/ml (AUC=0.99) ve bakteriyemi i\u00e7in 4.68 ng\/ml (AUC=0.94) olarak tespit edilmi\u015ftir (9). Bizim \u00e7al\u0131\u015fmam\u0131zda da benzer bir \u015fekilde bakteriyemi i\u00e7in PCT e\u015fik de\u011feri 3.29 ng\/ml olarak saptand\u0131.\u00a0<\/span><\/p>\n

\u00dclkemizde bir e\u011fitim ara\u015ft\u0131rma hastanesi acil servisine ba\u015fvuran hastalar\u0131n tam kan say\u0131m\u0131ndaki trombosit, k\u0131rm\u0131z\u0131 kan h\u00fccresi da\u011f\u0131l\u0131m geni\u015fli\u011fi, ortalama trombosit hacmi, trombosit da\u011f\u0131l\u0131m geni\u015fli\u011fi, n\u00f6trofil lenfosit oran\u0131, trombosit lenfosit oran\u0131 ve PCT de\u011ferleri ile kan k\u00fclt\u00fcr \u00fcremelerinin de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, test edilen belirte\u00e7ler aras\u0131nda PCT\u2019nin, Gram-negatif bakteriyemi i\u00e7in en iyi tan\u0131sal performansa sahip oldu\u011fu bildirilmi\u015ftir (10). Yine \u00fclkemizde yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada, yatakl\u0131 servisler ile yo\u011fun bak\u0131mlarda yatan ve sepsis tan\u0131s\u0131 alan hastalar incelenmi\u015f olup PCT, CRP, interl\u00f6kin-6 ve 8 ile endoksin kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. S\u00f6z konusu \u00e7al\u0131\u015fmada, sepsisli hasta grubu ile kontrol grubu kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f ve sepsisli hasta grubunda PCT\u2019nin en g\u00fcvenilir infeksiyon belirteci oldu\u011fu bildirilmi\u015ftir (11). Castelli ve arkada\u015flar\u0131 taraf\u0131ndan sepsis ve \u00e7oklu organ disfonksiyonu olan hastalarda yap\u0131lan bir \u00e7al\u0131\u015fmada, CRP ve PCT ciddi sepsis ve organ disfonksiyonu ile ili\u015fkili bulunmakla birlikte her iki testin duyarl\u0131l\u0131\u011f\u0131 ve kineti\u011finin farkl\u0131 oldu\u011fu bildirilmi\u015ftir (12). Bizim \u00e7al\u0131\u015fmam\u0131zda ise CRP ve PCT\u2019nin bakteriyemisi olan hastalarda anlaml\u0131 d\u00fczeyde y\u00fcksek bulunmas\u0131na kar\u015f\u0131n her iki test aras\u0131nda d\u00fc\u015f\u00fck d\u00fczeyde korelasyon tespit edildi (r=0.490, p<\/i><0.001).<\/p>\n

\u00dclkemizde yap\u0131lan \u00e7al\u0131\u015fmalara bak\u0131ld\u0131\u011f\u0131nda, acil serviste bak\u0131lan PCT de\u011ferindeki art\u0131\u015f ile bakteriyel infeksiyon veya sepsisten \u015f\u00fcphelenilmesi i\u00e7in bir e\u015fik de\u011fer bulunamad\u0131. \u0130spanya\u2019da ger\u00e7ekle\u015ftirilen bir kohort \u00e7al\u0131\u015fmada, 653 hasta de\u011ferlendirilmi\u015f ve 2.54 ng\/ml de\u011ferinde bir e\u015fik de\u011fer saptanm\u0131\u015ft\u0131r. S\u00f6z konusu e\u015fik de\u011ferin \u00f6zg\u00fcll\u00fc\u011f\u00fc ve duyarl\u0131l\u0131\u011f\u0131n\u0131n CRP ile laktattan \u00e7ok daha y\u00fcksek oldu\u011fu ve ilk ba\u015fvuruda >32.5 ng\/ml gibi a\u015f\u0131r\u0131 y\u00fcksek olan PCT de\u011ferinin mortalite i\u00e7in ba\u011f\u0131ms\u0131z bir g\u00f6sterge oldu\u011fu bildirilmi\u015ftir.\u00a0 <\/span>\u00c7al\u0131\u015fmada, PCT de\u011ferinin di\u011fer belirte\u00e7lere k\u0131yasla daha erken artmas\u0131, infektif ve infektif olmayan inflamasyon nedenlerini daha iyi ay\u0131rt etmesi ve sepsis \u015fiddeti ile daha yak\u0131ndan ili\u015fkili olmas\u0131 nedeniyle PCT de\u011ferinin, CRP\u2019ye k\u0131yasla daha \u00fcst\u00fcn bir sepsis biyobelirteci oldu\u011fu sonucuna ula\u015f\u0131lm\u0131\u015ft\u0131r (13). Bizim \u00e7al\u0131\u015fmam\u0131zda da kan k\u00fclt\u00fcrlerinde \u00fcreme g\u00f6r\u00fclen hastalar\u0131n ya\u015f ve laboratuvar parametreleri dahil olmak \u00fczere t\u00fcm de\u011ferleri, \u00fcreme olmayan gruba g\u00f6re daha y\u00fcksek saptand\u0131. Kan k\u00fclt\u00fcr\u00fc \u00fcremesi i\u00e7in PCT e\u015fik de\u011feri 3.29 olarak belirlendi ve PCT\u2019nin bakteriyemiyi ay\u0131rt etme yetene\u011finin orta d\u00fczeyde oldu\u011fu (%70-%80) tespit edildi. E\u015f zamanl\u0131 antibiyotik kullan\u0131m\u0131, yava\u015f \u00fcreyen veya k\u00fclt\u00fcrde \u00fcremeye uygun olmayan patojenlerin varl\u0131\u011f\u0131 gibi nedenlerle sepsis hastalar\u0131n\u0131n %30\u2019unda kan k\u00fclt\u00fcr\u00fcn\u00fcn negatif olarak sonu\u00e7lanabilece\u011fi bildirilmi\u015ftir (6). \u00c7al\u0131\u015fmam\u0131zda da PCT de\u011feri \u00e7ok y\u00fcksek oldu\u011fu halde kan k\u00fclt\u00fcrlerinde \u00fcreme olmayan hastalar mevcuttu. S\u00f6z konusu hastalara acil servise ba\u015fvurular\u0131 s\u0131ras\u0131nda kan k\u00fclt\u00fcr\u00fc al\u0131nmadan ampirik antibiyotik verildi\u011fi ya da daha \u00f6nceki sa\u011fl\u0131k kurulu\u015fu ba\u015fvurusunda oral antibiyoterapi ba\u015fland\u0131\u011f\u0131 tespit edildi.\u00a0<\/span><\/p>\n

Toplum kaynakl\u0131 pn\u00f6moninin incelendi\u011fi \u00e7al\u0131\u015fmalarda, bakteriyemi oran\u0131 %12-42 aras\u0131nda de\u011fi\u015fmektedir (14,15). Bizim \u00e7al\u0131\u015fmam\u0131zda olgular\u0131n %76\u2019s\u0131nda pn\u00f6moni olmas\u0131 sebebi ile bakteriyemi oran\u0131 (%19) d\u00fc\u015f\u00fck saptand\u0131. Ayr\u0131ca olgular\u0131n %14\u2019\u00fcnde \u00fcriner sistem infeksiyonu oldu\u011fu ve bakteriyemisi olan olgular\u0131n %23\u2019\u00fcnde Escherichia coli<\/i> \u00fcredi\u011fi tespit edildi.\u00a0<\/span><\/p>\n

Hastalar\u0131n prognozu ve mortalitesi hakk\u0131nda veri toplanamam\u0131\u015f olmas\u0131 \u00e7al\u0131\u015fmam\u0131z\u0131n en \u00f6nemli k\u0131s\u0131tl\u0131l\u0131\u011f\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Sepsis, infeksiyona cevap olarak geli\u015fen konak yan\u0131t\u0131n\u0131n hayat\u0131 tehdit eden organ disfonksiyonu olu\u015fturmas\u0131d\u0131r. Y\u00fcksek mortalite ve morbiditeye neden olabilen ciddi bir sa\u011fl\u0131k sorunudur. Sepsisin erken tan\u0131s\u0131 ve uygun y\u00f6netimi ile sa\u011fkal\u0131m artarken yo\u011fun bak\u0131m ihtiyac\u0131 da azal\u0131r (1). Sepsiste, bir infeksiyon oda\u011f\u0131 ile birlikte sistemik inflamasyon belirtilerinin mevcudiyeti ile tan\u0131 konabilir. Tan\u0131 i\u00e7in alt\u0131n […]<\/p>\n","protected":false},"author":6,"featured_media":28236,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[2726,3369,5198],"class_list":["post-28005","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-bakteriyemi","tag-prokalsitonin","tag-sepsis-2"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28005","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\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=28005"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28005\/revisions"}],"predecessor-version":[{"id":28771,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/28005\/revisions\/28771"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/28236"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=28005"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=28005"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=28005"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}