{"id":30450,"date":"2025-06-28T17:01:09","date_gmt":"2025-06-28T14:01:09","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=30450"},"modified":"2026-02-14T20:13:23","modified_gmt":"2026-02-14T17:13:23","slug":"biyofilm-yapisi-ve-antibakteriyel-duyarlilik","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2025\/06\/28\/biyofilm-yapisi-ve-antibakteriyel-duyarlilik\/","title":{"rendered":"Hastane K\u00f6kenli Pn\u00f6moni Etkeni <i>Klebsiella<\/i> ve <i>Acinetobacter<\/i> Su\u015flar\u0131nda Biyofilm Olu\u015fumu ve Antibakteriyel Duyarl\u0131l\u0131\u011f\u0131n De\u011ferlendirilmesi"},"content":{"rendered":"<p class=\"p1\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2024\/09\/p_1277Artboard-1.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-29962 alignnone\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2024\/09\/p_1277Artboard-1.png\" alt=\"\" width=\"29\" height=\"29\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2024\/09\/p_1277Artboard-1.png 512w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2024\/09\/p_1277Artboard-1-260x260.png 260w\" sizes=\"auto, (max-width: 29px) 100vw, 29px\" \/> <\/a>Bu makaleye ili\u015fkin\u00a0<span style=\"color: #ff0000;\"><strong><span class=\"s1\"><a href=\"https:\/\/www.klimikdergisi.org\/tr\/2025\/10\/24\/duzeltme-biyofilm-yapisi-ve-antibakteriyel-duyarlilik-2\/\">bir d\u00fczeltme<\/a><\/span><\/strong><\/span> 24 Ekim 2025\u2019de yay\u0131nland\u0131: <a href=\"https:\/\/doi.org\/10.36519\/kd.2025.5422\">https:\/\/doi.org\/10.36519\/kd.2025.5422<\/a><\/p>\n<hr \/>\n<h2 class=\"p1\">G\u0130R\u0130\u015e<\/h2>\n<p class=\"p2\">Mikroorganizmalar serbest formdan farkl\u0131la\u015farak \u00e7ok h\u00fccreli organizmalar\u0131 taklit eden karma\u015f\u0131k biyofilm yap\u0131lar\u0131n\u0131 olu\u015fturmaktad\u0131r (1). Biyofilm tabakas\u0131n\u0131n %85\u2019ini matriks yap\u0131s\u0131 olu\u015fturur. Bu matriks, mikroorganizmalar taraf\u0131ndan \u00fcretilen h\u00fccre d\u0131\u015f\u0131 polimerik maddeler (Extracellular Polymeric Substances, EPSs) ve h\u00fccre d\u0131\u015f\u0131 DNA partik\u00fclleri ile kona\u011fa ait imm\u00fcnglobulin ve p\u0131ht\u0131la\u015fma fakt\u00f6rlerini i\u00e7erir (1-3). Farkl\u0131 \u00e7al\u0131\u015fmalarda; ya\u015f, cinsiyet, altta yatan komorbiditeler, kateterizasyon s\u00fcresi, hastanede yat\u0131\u015f s\u00fcresi, mikroorganizman\u0131n cinsi gibi fakt\u00f6rlerin biyofilm olu\u015fumu ile ili\u015fkisi de\u011ferlendirilmi\u015ftir (4,5). Ent\u00fcbasyon s\u00fcresi ve mikroorganizma cinsinin biyofilm olu\u015fumuna etkisi oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmekle birlikte risk fakt\u00f6rleri hen\u00fcz net olarak tan\u0131mlanmam\u0131\u015ft\u0131r (6-8).<\/p>\n<p class=\"p3\">Biyofilm yap\u0131s\u0131, \u00e7e\u015fitli mekanizmalarla antibiyotik direncine neden olmaktad\u0131r (1). Bu mekanizmalardan ilki biyofilm yap\u0131s\u0131n\u0131n antibiyotik molek\u00fcl\u00fcne kar\u015f\u0131 bir dif\u00fczyon bariyeri olu\u015fturarak antibiyotiklerin mikroorganizmalara ula\u015fmas\u0131n\u0131 engellemesidir (1). \u00c7e\u015fitli antimikrobiyallerin sentetik ve do\u011fal aljinat tabakas\u0131ndan dif\u00fczyonunu inceleyen bir \u00e7al\u0131\u015fmada, betalaktam grubu antibiyotiklerin aminoglikozidlere k\u0131yasla aljinat tabakas\u0131n\u0131 \u00e7ok daha h\u0131zl\u0131 ge\u00e7ti\u011fi saptanm\u0131\u015ft\u0131r (9). Ayr\u0131ca biyofilm yap\u0131s\u0131, mikroorganizmalar\u0131n diren\u00e7 genlerini aktarabilmesi i\u00e7in uygun ortam olu\u015fturur. Biyofilm i\u00e7inde mikroorganizmalar\u0131n farkl\u0131 b\u00fcy\u00fcme paternleri nedeniyle baz\u0131 antibiyotiklere kar\u015f\u0131 minimum inhibit\u00f6r konsantrasyon (M\u0130K) de\u011ferinin 100\u20131000 kat artt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (10,11). Biyofilm i\u00e7erisindeki mikroorganizmalar\u0131n tedavisinde kullan\u0131labilecek standart M\u0130K de\u011feri hen\u00fcz belirlenmemi\u015ftir (12).<\/p>\n<p class=\"p3\">Yo\u011fun bak\u0131mda yatan hastalarda hem invazif giri\u015fimlerin s\u0131k uygulanmas\u0131 hem de hasta ili\u015fkili risk fakt\u00f6rlerinin di\u011fer hastalara k\u0131yasla daha y\u00fcksek olmas\u0131 sa\u011fl\u0131k bak\u0131m\u0131 ili\u015fkili infeksiyon riskini de art\u0131rmaktad\u0131r (13,14). Ventilat\u00f6r ili\u015fkili pn\u00f6moni (V\u0130P), sa\u011fl\u0131k bak\u0131m\u0131 ili\u015fkili olarak en s\u0131k kar\u015f\u0131la\u015f\u0131lan d\u00f6rt infeksiyon t\u00fcr\u00fcnden biridir (15). Avrupa\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada, yo\u011fun bak\u0131mlarda V\u0130P prevalans\u0131 %20.6 olarak bildirilmi\u015ftir (16). Son y\u0131llarda yabanc\u0131 cisim ili\u015fkili infeksiyonlar ve biyofilm yap\u0131s\u0131 \u00fczerine yap\u0131lan ara\u015ft\u0131rmalar sonucu, V\u0130P geli\u015fiminde endotrakeal t\u00fcp y\u00fczeyinde biyofilm varl\u0131\u011f\u0131 en \u00f6nemli fakt\u00f6r olarak de\u011ferlendirilmektedir (10).<\/p>\n<p class=\"p3\">Mikroorganizmalar\u0131n olu\u015fturdu\u011fu biyofilm yap\u0131s\u0131 ilk olarak 1985 y\u0131l\u0131nda g\u00f6sterilmi\u015ftir. Yap\u0131lan \u00e7al\u0131\u015fmada, medikal ekipman ili\u015fkili infeksiyona sebep olan koag\u00fclaz negatif stafilokok su\u015flar\u0131 k\u00fclt\u00fcr pla\u011f\u0131nda \u00e7o\u011falt\u0131larak optik dansite \u00f6l\u00e7\u00fcm\u00fc yap\u0131lm\u0131\u015f; \u00f6l\u00e7\u00fclen optik dansite de\u011ferlerinin ekipman y\u00fczeyindeki bakteriyel biyofilm a\u011f\u0131rl\u0131\u011f\u0131 ile korelasyon g\u00f6sterdi\u011fi saptanm\u0131\u015ft\u0131r (17). Christensen ve arkada\u015flar\u0131 (17) taraf\u0131ndan geli\u015ftirilen doku k\u00fclt\u00fcr plak metodu, biyofilm varl\u0131\u011f\u0131n\u0131 kantitatif olarak de\u011ferlendirebilmesi nedeniyle farkl\u0131 su\u015flarla modifiye edilerek bir\u00e7ok \u00e7al\u0131\u015fmada referans test olarak kullan\u0131lmaktad\u0131r (18-20).<\/p>\n<p class=\"p3\">Bu \u00e7al\u0131\u015fmada, V\u0130P tan\u0131s\u0131 alm\u0131\u015f hastalardan izole edilen <i>Acinetobacter baumannii<\/i> ve <i>Klebsiella pneumoniae<\/i> su\u015flar\u0131n\u0131n biyofilm \u00fcretimi ve farkl\u0131 y\u00f6ntemlerle meropenem ve amikasine duyarl\u0131l\u0131klar\u0131n\u0131n de\u011ferlendirilmesi ama\u00e7land\u0131. Ayr\u0131ca biyofilm \u00fcretimi ile ili\u015fkili olabilecek risk fakt\u00f6rleri, farkl\u0131 antibiyotik duyarl\u0131l\u0131k test sonu\u00e7lar\u0131 ve biyofilm \u00fcretim test sonu\u00e7lar\u0131 birlikte de\u011ferlendirilerek, biyofilm \u00fcretiminin agar bazl\u0131 antibiyotik duyarl\u0131l\u0131k test sonu\u00e7lar\u0131na etkisinin ortaya konulmas\u0131 hedeflendi.<\/p>\n<h2 class=\"p4\">Y\u00d6NTEMLER<\/h2>\n<p class=\"p2\"><span class=\"s1\">Prospektif g\u00f6zlemsel olarak planlanan \u00e7al\u0131\u015fmaya, Ekim 2019\u2013Haziran 2021 tarihleri aras\u0131nda hastanemizin yo\u011fun bak\u0131m \u00fcnitesinde (YB\u00dc\u2019de) yatmakta iken infeksiyon hastal\u0131klar\u0131 hekiminin rutin vizitlerinde V\u0130P tan\u0131s\u0131 alan ve tedavisi d\u00fczenlenen 18 ya\u015f ve \u00fczerindeki hastalar al\u0131nd\u0131; ventilat\u00f6r ili\u015fkili olay (V\u0130O) saptanan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131nda b\u0131rak\u0131ld\u0131. <\/span><\/p>\n<p class=\"p3\">\u00c7al\u0131\u015fmaya al\u0131nan hastalar, trakeal aspirasyon k\u00fclt\u00fcrlerinde 105 cfu\/ml ve \u00fczerinde <i>A. baumanii<\/i> ve <i>K. pneumoniae <\/i>\u00fcremesi olanlard\u0131. Trakeal aspirasyon d\u0131\u015f\u0131nda solunum yolu \u00f6rne\u011fi al\u0131nan, trakeostomi ile ventile edilen ve de\u011ferlendirme s\u0131ras\u0131nda akci\u011fer d\u0131\u015f\u0131 infeksiyon oda\u011f\u0131 bulunan hastalar ise \u00e7al\u0131\u015fmaya dahil edilmedi.<\/p>\n<p class=\"p3\">\u00c7al\u0131\u015fma i\u00e7in Dokuz Eyl\u00fcl \u00dcniversitesi Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 12 Haziran 2019 tarih ve 2019\/14-41 karar numaras\u0131yla onay al\u0131nd\u0131.<\/p>\n<h3 class=\"p5\">Ventilat\u00f6r \u0130li\u015fkili Pn\u00f6moni Tan\u0131s\u0131<\/h3>\n<p class=\"p2\">Ventilat\u00f6r ili\u015fkili pn\u00f6moni, endotrakeal ent\u00fcbasyondan 48 saat ve sonras\u0131nda geli\u015fen pn\u00f6moni olarak tan\u0131mlanm\u0131\u015f olup etkenin tespit edilmesi i\u00e7in trakeal aspirasyon k\u00fclt\u00fcr\u00fc yap\u0131lmas\u0131 \u00f6nerilmektedir (21). \u00c7al\u0131\u015fmam\u0131z kapsam\u0131nda, endotrakeal ent\u00fcbasyon s\u0131ras\u0131nda pn\u00f6moni klini\u011fi g\u00f6r\u00fclmeyen hastalarda, ent\u00fcbasyondan 48 saat ve sonras\u0131nda geli\u015fen akci\u011fer radyolojik bulgular\u0131 ile birlikte a\u015fa\u011f\u0131daki kriterlerden en az ikisinin olmas\u0131 durumu V\u0130P olarak tan\u0131mland\u0131:<\/p>\n<ul>\n<li class=\"p6\">Ate\u015f y\u00fcksekli\u011fi veya hipotermi,<\/li>\n<li class=\"p6\">L\u00f6kositoz veya l\u00f6kopeni,<\/li>\n<li class=\"p6\">Solunum sekresyonlar\u0131nda art\u0131\u015f,<\/li>\n<li class=\"p6\">Solunum yolu \u00f6rne\u011fi k\u00fclt\u00fcr\u00fcnde klinik olarak anlaml\u0131 \u00fcreme.<\/li>\n<\/ul>\n<h3 class=\"p7\">\u0130zolatlar\u0131n ve Hasta Verilerinin Toplanmas\u0131<\/h3>\n<p class=\"p2\">Ventilat\u00f6r ili\u015fkili pn\u00f6moni etkeni olarak belirlenen <i>A. baumanii<\/i> ve <i>K. pneumoniae<\/i> su\u015flar\u0131 pasajlanarak \u00e7al\u0131\u015fma ba\u015flang\u0131c\u0131na kadar -20\u00b0C\u2019de boncuklu stok besiyeri (Orbak, T\u00fcrkiye) i\u00e7erisinde sakland\u0131. Hastalar\u0131n yedi g\u00fcnl\u00fck V\u0130P epizodu ve 30 g\u00fcnl\u00fck izlemi kaydedildi. Hastalar\u0131n demografik verileri ve risk fakt\u00f6rleri ise hastane kay\u0131t sisteminden elde edildi. Toplanan veriler a\u015fa\u011f\u0131da sunuldu:<\/p>\n<ul>\n<li class=\"p6\">Demografik veriler (ya\u015f ve cinsiyet),<\/li>\n<li class=\"p6\">Risk fakt\u00f6rleri [hastanede yat\u0131\u015f s\u00fcresi, invazif medikal ekipman kullan\u0131m\u0131, cerrahi \u00f6yk\u00fcs\u00fc, travma \u00f6yk\u00fcs\u00fc, reent\u00fcbasyon varl\u0131\u011f\u0131, V\u0130P epizodu s\u0131ras\u0131nda septik \u015fok geli\u015fimi, V\u0130P epizodu s\u0131ras\u0131nda akut solunum stres sendromu (Acute Respiratory Distress Syndrome, ARDS) geli\u015fimi, V\u0130P epizodu s\u0131ras\u0131nda hemodiyaliz ihtiyac\u0131, son 90 g\u00fcn i\u00e7inde antibiyoterapi \u00f6yk\u00fcs\u00fc, altta yatan hastal\u0131klar ve ent\u00fcbasyondan \u00f6rnek al\u0131m\u0131na kadar ge\u00e7en s\u00fcre],<\/li>\n<li class=\"p6\">Ventilat\u00f6r ili\u015fkili pn\u00f6moni epizodu ve 30 g\u00fcnl\u00fck hasta izlemi sonlan\u0131m bilgileri [mortalite, iyile\u015fme, YB\u00dc yat\u0131\u015f s\u00fcresi (g\u00fcn), hastanede yat\u0131\u015f s\u00fcresi (g\u00fcn), ekst\u00fcbasyona kadar ge\u00e7en s\u00fcre (g\u00fcn)].<\/li>\n<\/ul>\n<h3 class=\"p5\">\u0130zolatlar\u0131n Tan\u0131mlanmas\u0131<\/h3>\n<p class=\"p2\">-20\u00b0C\u2019 de saklanan boncuklu stok besiyerlerinden tek boncuk al\u0131narak kanl\u0131 agar (Becton Dickinson, Almanya) y\u00fczeyine ekildi ve 35\u00b0C\u2019de 24 saat ink\u00fcbe edildi. Agar y\u00fczeyinde elde edilen tek koloniler \u201cmatrix-assisted laser desorption ionization-time of flight mass spectrometry\u201d (MALDI-TOF MS) (Biomerieux, Fransa) otomatize sistemiyle tan\u0131mland\u0131. Antimikrobiyal duyarl\u0131l\u0131k testleri i\u00e7in kontrol su\u015fu olarak <i>Escherichia coli<\/i> ATCC25922 (12,20) ve biyofilm kontrol su\u015fu olarak <i>K. pneumoniae<\/i> ATCC700603 (19,20) kullan\u0131ld\u0131.<\/p>\n<h3 class=\"p5\">Doku K\u00fclt\u00fcr Plak Metodu ile Biyofilm \u00dcretiminin Belirlenmesi<\/h3>\n<p class=\"p2\">Biyofilm \u00fcretimi, Christensen ve arkada\u015flar\u0131 (17) taraf\u0131ndan 1985 y\u0131l\u0131nda geli\u015ftirilen ve modifiye edilen y\u00f6ntemle de\u011ferlendirildi. Kanl\u0131 agar y\u00fczeyinde geli\u015fen koloniden al\u0131nan \u00f6rnek %1 glukoz i\u00e7eren 5 ml \u201ctryptic soy broth\u201d besiyerine ekilerek 35\u00b0C\u2019de 24 saat ink\u00fcbe edildi. Ard\u0131ndan taze besiyeri ile 1\/100 oran\u0131nda dil\u00fce edildi. Bu sol\u00fcsyondan otomatik pipet yard\u0131m\u0131 ile mikroplaka kuyucuklar\u0131na 0.2 ml eklenerek 35\u00b0C\u2019de 24 saat ink\u00fcbasyona b\u0131rak\u0131ld\u0131 ve biyofilm olu\u015fumu ind\u00fcklendi. Mikroplaka kuyucuklar\u0131ndaki s\u0131v\u0131 nazik\u00e7e bo\u015falt\u0131larak fosfat tamponlu salin (pH 7.3) ile \u00fc\u00e7 kez y\u0131kand\u0131. Metanol ile yap\u0131lan fiksasyonun ard\u0131ndan kuyucuklara oda \u0131s\u0131s\u0131nda 0.2 ml %0.1 kristal viyole \u00e7\u00f6zeltisi eklenerek 15 dk boyand\u0131. Kuyucuklardaki s\u0131v\u0131 bo\u015falt\u0131larak glacial asetik asit ile fikse edildi.<\/p>\n<p class=\"p3\">ELISA cihaz\u0131nda (Thermo Fisher Scientific, ABD) 570 nm dalga boyunda absorbans \u00f6l\u00e7\u00fcld\u00fc ve her su\u015f i\u00e7in \u00fc\u00e7 kez \u00f6l\u00e7\u00fcm tekrarlanarak optik dansite (OD) de\u011ferlerinin ortalamas\u0131 kaydedildi. Stepanovi\u0107 ve arkada\u015flar\u0131n\u0131n (22) \u00f6nerdi\u011fi form\u00fcle uygun olarak, bakteri inok\u00fclasyonu yap\u0131lmayan negatif kontrol kuyucuklar\u0131n\u0131n OD \u00f6l\u00e7\u00fcm de\u011ferlerinin ortalama de\u011ferine standart sapma de\u011ferinin \u00fc\u00e7 kat\u0131 eklenerek OD \u201ccut-off\u201d (ODc) de\u011feri belirlendi. Her su\u015fun OD \u00f6l\u00e7\u00fcm sonucu ODc ile kar\u015f\u0131la\u015ft\u0131r\u0131larak su\u015fun biyofilm \u00fcretim kapasitesi tespit edildi; OD ortalamas\u0131 ODc de\u011ferinden b\u00fcy\u00fck olan su\u015flar biyofilm \u00fcreticisi olarak tan\u0131mlan\u0131rken, ODc de\u011ferinden k\u00fc\u00e7\u00fck ve ODc de\u011ferine e\u015fit \u00f6l\u00e7\u00fcmler biyofilm negatif olarak s\u0131n\u0131fland\u0131r\u0131ld\u0131. Kullan\u0131lan form\u00fcl a\u015fa\u011f\u0131da sunuldu:<\/p>\n<p class=\"p3\"><span class=\"s2\">ODc = \u00dc\u00e7 negatif kontrol kuyucu\u011funun OD ortalamas\u0131 + (3 \u00d7 standart sapma)<\/span><\/p>\n<h3 class=\"p5\">Antibiyotik Duyarl\u0131l\u0131klar\u0131n\u0131n Belirlenmesi<\/h3>\n<p class=\"p8\"><b><i>Disk Dif\u00fczyon Y\u00f6ntemi<\/i><\/b><\/p>\n<p class=\"p3\">Mueller-Hinton agar (Becton Dickinson, Almanya) y\u00fczeyine 0.5 McFarland yo\u011funlu\u011fundaki bakteri s\u00fcspansiyonlar\u0131 yay\u0131larak 6 mm \u00e7apl\u0131 k\u00e2\u011f\u0131t amikasin ve meropenem diskleri (Becton Dickinson, Almanya) yerle\u015ftirildi. \u0130nhibisyon zonlar\u0131 Avrupa Antimikrobiyal Duyarl\u0131l\u0131k Testi Komitesi (European Committee on Antimicrobial Susceptibility Testing, EUCAST) standartlar\u0131na uygun olarak de\u011ferlendirildi (12,23).<\/p>\n<p class=\"p9\"><b><i>E-test Y\u00f6ntemi<\/i><\/b><\/p>\n<p class=\"p2\">Haz\u0131rlanan 0.5 McFarland yo\u011funluktaki bakteri s\u00fcspansiyonlar\u0131 Mueller-Hinton agar (Becton Dickinson, Almanya) y\u00fczeyine steril bir ek\u00fcvyon yard\u0131m\u0131yla t\u00fcm y\u00fczeyi kaplayacak \u015fekilde yay\u0131ld\u0131. Agar y\u00fczeyine meropenem ve amikasin antibiyotiklerinin belli konsantrasyonlar\u0131n\u0131 i\u00e7eren e-test \u015feritleri (Biom\u00e9rieux, Fransa) yerle\u015ftirilerek 35\u00b0C\u2019de 24 saat ink\u00fcbe edildi. \u015eerit etraf\u0131nda olu\u015fan inhibisyon elipsinin \u015ferit \u00fczerindeki \u00f6l\u00e7ekle kesi\u015fti\u011fi nokta kaydedilerek belirlenen M\u0130K de\u011ferleri EUCAST standartlar\u0131na uygun olarak de\u011ferlendirildi (12,23).<\/p>\n<p class=\"p10\"><b><i>Mikrodil\u00fcsyon Y\u00f6ntemi<\/i><\/b><\/p>\n<p class=\"p2\">S\u0131v\u0131 mikrodil\u00fcsyon y\u00f6ntemiyle el ile 96 kuyucuklu U tabanl\u0131 mikroplaka kullan\u0131larak \u00e7al\u0131\u015f\u0131ld\u0131. \u00dcreticinin \u00f6nerileri do\u011frultusunda meropenem (Biosynth Carbosynth, \u0130ngiltere) ve amikasin (Sigma Aldrich, ABD) etken maddeleri 100 mg tart\u0131larak steril su ile \u00e7\u00f6z\u00fcld\u00fc.<\/p>\n<p class=\"p3\">A\u015fa\u011f\u0131da verilen form\u00fcle uygun olarak test edilecek konsantrasyonun 10 kat\u0131 yo\u011funlukta stok \u00e7\u00f6zeltisi haz\u0131rland\u0131 ve haz\u0131rlanan stok sol\u00fcsyonlar 0.1 ml hacminde ayr\u0131larak steril Eppendorf t\u00fcp\u00fc i\u00e7erisinde -80\u00b0C\u2019de sakland\u0131.<\/p>\n<p class=\"p3\">Suland\u0131r\u0131c\u0131 hacmi (V) = Antibiyotik a\u011f\u0131rl\u0131\u011f\u0131 (w) x Antibiyotik potensi \/ \u0130stenilen konsantrasyon (P\/c)<\/p>\n<p class=\"p3\"><span class=\"s2\">Stok sol\u00fcsyon kullan\u0131larak mikrodil\u00fcsyon plaklar\u0131ndaki Mueller-Hinton buyyonunda seri dil\u00fcsyonlar haz\u0131rland\u0131 (Meropenem i\u00e7in 1\u20131024 \u03bcg\/ml, amikasin i\u00e7in 0.5\u2013512 ug\/ml). \u0130lk kolon, \u00fcreme kontrol kuyucu\u011fu olarak ayr\u0131ld\u0131 ve bu kolona antibiyotik sol\u00fcsyonu eklenmedi. T\u00fcm su\u015flardan 5\u00d7105 cfu\/ml konsantrasyonda bakteri s\u00fcspansiyonu haz\u0131rland\u0131. Haz\u0131rlanan bakteri s\u00fcspansiyonu ilk kolondan ba\u015flanarak inok\u00fcle edildi. Sterilite kontrol kuyucu\u011fu olan 12 numaral\u0131 kolona inok\u00fclasyon yap\u0131lmad\u0131. Mikroplaka 35\u00b0C\u2019de 16 saat ink\u00fcbe edildi. Her sat\u0131rda \u00fcremenin g\u00f6zle g\u00f6r\u00fclebilir \u015fekilde inhibe edildi\u011fi en d\u00fc\u015f\u00fck konsantrasyon M\u0130K de\u011feri olarak belirlendi ve EUCAST standartlar\u0131na uygun olarak de\u011ferlendirildi (12,23).<\/span><\/p>\n<h3 class=\"p5\">\u0130statistiksel Analizler<\/h3>\n<p class=\"p2\"><span class=\"s2\">\u0130statistiksel analizler, SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 26.0 program\u0131 (IBM Corp., Armonk, NY, ABD) ile ger\u00e7ekle\u015ftirildi. \u00c7al\u0131\u015fma verileri de\u011ferlendirilirken tan\u0131mlay\u0131c\u0131 istatistiksel y\u00f6ntemler (ortalama, standart sapma, medyan, frekans, oran, minimum, maksimum) kullan\u0131ld\u0131. Nicel verilerin normal da\u011f\u0131l\u0131ma uygunluklar\u0131 Kolmogorov-Smirnov testi, Shapiro-Wilk testi ve grafiksel y\u00f6ntemlerle de\u011ferlendirildi. Normal da\u011f\u0131l\u0131m g\u00f6steren nicel verilerin iki grup kar\u015f\u0131la\u015ft\u0131rmalar\u0131nda ba\u011f\u0131ms\u0131z \u00f6rneklem T testi, normal da\u011f\u0131l\u0131m g\u00f6stermeyen verilerin iki grup kar\u015f\u0131la\u015ft\u0131rmalar\u0131nda ise Mann-Whitney U testi uyguland\u0131. Nitel verilerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda ise Pearson \u03c7\u00b2 testi, Fisher Freeman Halton kesin testi ve Fisher kesin test kullan\u0131ld\u0131. T\u00fcm su\u015flar\u0131n disk dif\u00fczyon, e-test ve mikrodil\u00fcsyon y\u00f6ntemleri ile meropenem ve amikasine diren\u00e7 sonu\u00e7lar\u0131 aras\u0131ndaki uyum McNemar testi, McNemar-Bowker testi ve Kappa uyum testi ile de\u011ferlendirildi. Anlaml\u0131l\u0131k d\u00fczeyi <i>p<\/i>&lt;0.05 olarak kabul edildi.<\/span><\/p>\n<h2 class=\"p4\">BULGULAR<\/h2>\n<div id=\"attachment_30497\" style=\"width: 1074px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo1.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-30497\" class=\"size-full wp-image-30497\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo1.png\" alt=\"\" width=\"1064\" height=\"1997\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo1.png 1064w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo1-139x260.png 139w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo1-288x540.png 288w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo1-768x1441.png 768w\" sizes=\"auto, (max-width: 1064px) 100vw, 1064px\" \/><\/a><p id=\"caption-attachment-30497\" class=\"wp-caption-text\"><strong>Tablo 1.<\/strong> Hastalar\u0131n Sosyodemografik ve Klinik \u00d6zellikleri<\/p><\/div>\n<p class=\"p2\">\u00c7al\u0131\u015fmaya al\u0131nan 98 hastan\u0131n 61(%62.2)\u2019i erkek, 37 (%37.8)\u2019si kad\u0131nd\u0131. T\u00fcm hastalar\u0131n ya\u015f ortalamas\u0131 67.5 y\u0131l olarak bulundu. Ventilat\u00f6r ili\u015fkili pn\u00f6moni epizodu \u00f6ncesinde hastalar\u0131n tamam\u0131nda 90 g\u00fcn i\u00e7erisinde antibiyotik kullan\u0131m \u00f6yk\u00fcs\u00fc mevcuttu. Otuz bir hastada cerrahi giri\u015fim \u00f6yk\u00fcs\u00fc, 27 hastada reent\u00fcbasyon, 26 hastada imm\u00fcnsupresyon, yedi hastada travma \u00f6yk\u00fcs\u00fc vard\u0131. Yedi g\u00fcnl\u00fck V\u0130P epizodu s\u0131ras\u0131nda hastalar\u0131n 56\u2019s\u0131 kaybedildi ve 36 hasta iyile\u015fti; \u00fc\u00e7 hastada bakteriyemi, iki hastada plevral ef\u00fczyon, bir hastada pn\u00f6motoraks olmak \u00fczere alt\u0131 hastada ise komplikasyon geli\u015fti. Otuz g\u00fcnl\u00fck hasta izleminin sonunda hastalar\u0131n 65\u2019i kaybedilirken 28 hasta taburcu edildi. Otuz g\u00fcnl\u00fck s\u00fcrenin sonunda be\u015f hastan\u0131n klinik izlemi serviste devam etmekteydi. Hastalar\u0131n demografik verileri, risk fakt\u00f6rleri ve sonlan\u0131m bilgileri Tablo 1\u2019de sunuldu.<\/p>\n<div id=\"attachment_30499\" style=\"width: 2191px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo2.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-30499\" class=\"size-full wp-image-30499\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo2.png\" alt=\"\" width=\"2181\" height=\"651\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo2.png 2181w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo2-390x116.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo2-810x242.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo2-768x229.png 768w\" sizes=\"auto, (max-width: 2181px) 100vw, 2181px\" \/><\/a><p id=\"caption-attachment-30499\" class=\"wp-caption-text\"><strong>Tablo 2.<\/strong> <i>A. baumanii<\/i> ve <i>K. pneumoniae<\/i> Su\u015flar\u0131nda Biyofilm \u00dcretimi ve Antibiyotik Diren\u00e7 Oranlar\u0131<\/p><\/div>\n<p class=\"p3\">\u00c7al\u0131\u015fmaya dahil edilen 98 izolat\u0131n MALDI-TOF y\u00f6ntemiyle 67\u2019si <i>A. baumanii<\/i>, 31\u2019i <i>K. pneumoniae<\/i> olarak tan\u0131mland\u0131. T\u00fcm su\u015flar\u0131n 87 (%88.8)\u2019sinde biyofilm \u00fcretimi saptand\u0131. <i>K. pneumoniae<\/i> olarak tiplendirilen 31 su\u015fun tamam\u0131, <i>A. baumanii<\/i> olarak tiplendirilen 67 su\u015fun ise 56\u2019s\u0131 biyofilm \u00fcreticisi olarak tespit edildi. <i>A. baumanii<\/i> olarak tiplendirilen 11 su\u015fta biyofilm \u00fcretimi saptanmad\u0131. <i>K. pneumoniae<\/i> su\u015flar\u0131nda biyofilm \u00fcretimi anlaml\u0131 olarak daha s\u0131k g\u00f6r\u00fcld\u00fc (<i>p<\/i>=0.015). Mikrodil\u00fcsyon y\u00f6ntemiyle t\u00fcm bakterilerin 95 (%96.9)\u2019inde meropeneme, 88 (%89.8)\u2019inde ise amikasine diren\u00e7 saptand\u0131. Su\u015flar\u0131n biyofilm \u00fcretimi ve antibiyotik duyarl\u0131l\u0131k test sonu\u00e7lar\u0131n\u0131 i\u00e7eren laboratuvar verileri Tablo 2\u2019de sunuldu.<\/p>\n<h3 class=\"p11\">Antibiyotik Duyarl\u0131l\u0131k Test Y\u00f6ntemlerinin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/h3>\n<p class=\"p2\"><span class=\"s2\">\u00c7al\u0131\u015fmaya dahil edilen t\u00fcm su\u015flar\u0131n amikasine ve meropeneme direnci mikrodil\u00fcsyon, e- test ve disk dif\u00fczyon y\u00f6ntemleriyle test edildi. Biyofilm \u00fcretmeyen 11 <i>A. baumanii<\/i>, biyofilm \u00fcreten 56 <i>A. baumanii<\/i> ve biyofilm \u00fcreten 31 <i>K. pneumoniae<\/i> su\u015funun antibiyotik duyarl\u0131l\u0131k test sonu\u00e7lar\u0131 mikrodil\u00fcsyon y\u00f6ntemi ile kar\u015f\u0131la\u015ft\u0131r\u0131larak de\u011ferlendirildi. Y\u00f6ntemler aras\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde fark saptanmad\u0131 (<i>p<\/i>&gt;0.05). Test sonu\u00e7lar\u0131 aras\u0131ndaki uyumu de\u011ferlendirebilmek i\u00e7in kappa \u00adde\u011ferleri hesapland\u0131. <\/span><\/p>\n<p class=\"p3\">Biyofilm \u00fcreticisi olmayan 11 <i>A. baumanii<\/i> su\u015funun tamam\u0131, mikrodil\u00fcsyon ve e-test y\u00f6ntemleriyle meropeneme ve amikasine diren\u00e7li saptand\u0131. Mikrodil\u00fcsyon y\u00f6ntemiyle amikasine diren\u00e7li saptanan bir su\u015f disk dif\u00fczyon y\u00f6ntemiyle amikasine duyarl\u0131 tespit edildi. Mikrodil\u00fcsyon y\u00f6ntemiyle duyarl\u0131 su\u015f say\u0131s\u0131 yetersiz oldu\u011fundan bu grupta kappa de\u011feri hesaplanamad\u0131.<\/p>\n<p class=\"p3\">Biyofilm \u00fcretmeyen 56 <i>A. baumanii<\/i> su\u015flar\u0131n\u0131n tamam\u0131 mikrodil\u00fcsyon y\u00f6ntemiyle meropeneme diren\u00e7li saptan\u0131rken, e-test ve disk dif\u00fczyon y\u00f6ntemleriyle 55 su\u015f diren\u00e7li bulundu. Meropeneme duyarl\u0131 su\u015f say\u0131s\u0131 yetersiz oldu\u011fu i\u00e7in bu grupta meropenem i\u00e7in kappa de\u011feri hesaplanamad\u0131. Ayn\u0131 grupta mikrodil\u00fcsyon y\u00f6ntemiyle 54 su\u015f, disk dif\u00fczyon y\u00f6ntemiyle 52 su\u015f, e-test y\u00f6ntemiyle 53 su\u015f amikasine diren\u00e7li saptand\u0131. Mikrodil\u00fcsyon y\u00f6ntemi ile disk dif\u00fczyon ve e-test y\u00f6ntemleri aras\u0131nda amikasin i\u00e7in anlaml\u0131 uyum oldu\u011fu belirlendi (<i>p<\/i>=0.687; <i>p<\/i>=1.000). Biyofilm \u00fcreticisi <i>A. baumanii<\/i> su\u015flar\u0131nda amikasin i\u00e7in kappa de\u011ferleri e-test y\u00f6ntemi i\u00e7in 0.79 (<i>p<\/i>=0.001), disk dif\u00fczyon y\u00f6ntemi i\u00e7in -0.05 (<i>p<\/i>=0.690) olarak hesapland\u0131.<\/p>\n<p class=\"p3\">Biyofilm \u00fcreticisi olan 31 <i>K. pneumoniae<\/i> su\u015funun mikrodil\u00fcsyon y\u00f6ntemiyle 28\u2019i meropeneme diren\u00e7li bulundu. Meropeneme diren\u00e7li olarak belirlenen 28 su\u015fun 26\u2019s\u0131 disk dif\u00fczyon y\u00f6ntemiyle, 27\u2019si ise e-test y\u00f6ntemiyle diren\u00e7li olarak saptand\u0131. T\u00fcm test y\u00f6ntemlerinde \u00fc\u00e7 su\u015f meropeneme duyarl\u0131 bulundu. Bu grupta mikrodil\u00fcsyon y\u00f6ntemi ile disk dif\u00fczyon ve e-test y\u00f6ntemleri aras\u0131nda meropenem i\u00e7in anlaml\u0131 uyum oldu\u011fu belirlendi (<i>p<\/i>=0.500; <i>p<\/i>=1.000). Mikrodil\u00fcsyon y\u00f6ntemi ile disk dif\u00fczyon y\u00f6ntemi aras\u0131ndaki uyum d\u00fczeyi 0.716 (<i>p<\/i>=0.001), mikrodil\u00fcsyon ile e-test y\u00f6ntemi aras\u0131ndaki uyum d\u00fczeyi ise 0.839 (<i>p<\/i>=0.001) olarak saptand\u0131.<\/p>\n<div id=\"attachment_30501\" style=\"width: 2195px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo3.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-30501\" class=\"size-full wp-image-30501\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo3.png\" alt=\"\" width=\"2185\" height=\"818\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo3.png 2185w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo3-390x146.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo3-810x303.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo3-768x288.png 768w\" sizes=\"auto, (max-width: 2185px) 100vw, 2185px\" \/><\/a><p id=\"caption-attachment-30501\" class=\"wp-caption-text\"><strong>Tablo 3.<\/strong> Su\u015flar\u0131n Amikasin ve Meropeneme Duyarl\u0131l\u0131k Test Sonu\u00e7lar\u0131n\u0131n Mikrodil\u00fcsyon Y\u00f6ntemiyle Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n<div id=\"attachment_30503\" style=\"width: 2195px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo4.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-30503\" class=\"size-full wp-image-30503\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo4.png\" alt=\"\" width=\"2185\" height=\"634\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo4.png 2185w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo4-390x113.png 390w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo4-810x235.png 810w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo4-768x223.png 768w\" sizes=\"auto, (max-width: 2185px) 100vw, 2185px\" \/><\/a><p id=\"caption-attachment-30503\" class=\"wp-caption-text\"><strong>Tablo 4.<\/strong> Disk Dif\u00fczyon ve E-test Y\u00f6ntemlerin Mikrodil\u00fcsyon Y\u00f6ntemi ile Uyumlulu\u011fu<\/p><\/div>\n<p class=\"p3\">Biyofilm \u00fcreticisi olan 31 <i>K. pneumoniae<\/i> su\u015funda mikrodil\u00fcsyon y\u00f6ntemiyle amikasine diren\u00e7li saptanan 23 su\u015fun 17\u2019si e-test, 15\u2019i disk dif\u00fczyon y\u00f6ntemiyle diren\u00e7li; alt\u0131s\u0131 e-test, sekizi disk dif\u00fczyon y\u00f6ntemiyle duyarl\u0131 olarak belirlendi. Mikrodil\u00fcsyon y\u00f6ntemi ile amikasine duyarl\u0131 olarak saptanan sekiz su\u015fun \u00fc\u00e7\u00fc e-test, ikisi disk dif\u00fczyon y\u00f6ntemiyle amikasine diren\u00e7li bulundu. Mikrodil\u00fcsyon y\u00f6ntemi ile disk dif\u00fczyon ve e-test y\u00f6ntemleri aras\u0131nda amikasin i\u00e7in anlaml\u0131 uyum mevcuttu (<i>p<\/i>=0.109, <i>p<\/i>=0.508). Bu grupta amikasin i\u00e7in mikrodil\u00fcsyon ve disk dif\u00fczyon y\u00f6ntemleri aras\u0131ndaki uyum d\u00fczeyi 0.323 (<i>p<\/i>=0.049); e-test aras\u0131ndaki uyum d\u00fczeyi ise 0.324 (<i>p<\/i>=0.048) olarak belirlendi. Test y\u00f6ntemlerinden elde edilen sonu\u00e7lar ve y\u00f6ntemler aras\u0131ndaki uyum Tablo 3 ve Tablo 4\u2019te sunuldu.<\/p>\n<p class=\"p3\">Biyofilm \u00fcretimi ile demografik veriler, \u00e7e\u015fitli risk fakt\u00f6rleri, hasta sonlan\u0131mlar\u0131 ve mikrodil\u00fcsyon y\u00f6ntemiyle saptanan meropenem ve amikasin diren\u00e7 verilerinin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 i\u00e7in iki farkl\u0131 gruplama yap\u0131ld\u0131:<\/p>\n<p class=\"p12\"><i>A. baumanii <\/i>olarak tan\u0131mlanan 67 su\u015f: 56 biyofilm pozitif su\u015f ve 11 biyofilm negatif su\u015f,<\/p>\n<p class=\"p12\">Biyofilm \u00fcreticisi olarak belirlenen 87 su\u015f: 56 <i>A. baumanii <\/i>su\u015fu <i>ve<\/i> 31 <i>K. pneumoniae<\/i> su\u015fu.<\/p>\n<h3 class=\"p5\">Analiz I.<\/h3>\n<div id=\"attachment_30505\" style=\"width: 2198px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo5.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-30505\" class=\"size-full wp-image-30505\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo5.png\" alt=\"\" width=\"2188\" height=\"2026\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo5.png 2188w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo5-281x260.png 281w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo5-583x540.png 583w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo5-768x711.png 768w\" sizes=\"auto, (max-width: 2188px) 100vw, 2188px\" \/><\/a><p id=\"caption-attachment-30505\" class=\"wp-caption-text\"><strong>Tablo 5.<\/strong> Biyofilm \u00dcreticisi Olan ve Biyofilm \u00dcreticisi Olmayan <i>A. Baumanii<\/i> Su\u015flar\u0131n\u0131n Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n<p class=\"p3\"><span class=\"s1\"><i>A. baumannii<\/i> su\u015flar\u0131 yukar\u0131da verilen say\u0131larda biyofilm pozitif ve biyofilm negatif olmak \u00fczere iki gruba ayr\u0131ld\u0131. Gruplar aras\u0131nda ya\u015f a\u00e7\u0131s\u0131ndan anlaml\u0131 fark bulunmad\u0131. Toplam 26 kad\u0131n hastadan al\u0131nan \u00f6rneklerin 25 (%96.1)\u2019inde ve toplam 41 erkek hastadan al\u0131nan \u00f6rneklerin ise 31 (%75.6)\u2019inde biyofilm \u00fcretimi saptand\u0131. Kad\u0131n hastalardan al\u0131nan \u00f6rneklerde biyofilm \u00fcretim oran\u0131 daha y\u00fcksekti (<i>p<\/i>=0.040; <i>p<\/i>&lt;0.05). \u0130ncelenen risk fakt\u00f6rleri ve hasta sonlan\u0131mlar\u0131 a\u00e7\u0131s\u0131ndan biyofilm \u00fcreten ve biyofilm \u00fcretimi yapmayan <i>A. baumanii<\/i> su\u015flar\u0131 aras\u0131nda anlaml\u0131 farkl\u0131l\u0131k saptanmad\u0131 (<i>p<\/i>&gt;0.05). T\u00fcm su\u015flarda meropeneme diren\u00e7 saptand\u0131\u011f\u0131 i\u00e7in gruplar aras\u0131nda istatistiksel analiz yap\u0131lmad\u0131. Mikrodil\u00fcsyon y\u00f6ntemi ile amikasine diren\u00e7 a\u00e7\u0131s\u0131ndan da anlaml\u0131 fark bulunmad\u0131 (<i>p<\/i>=1.000; <i>p<\/i>&gt;0.05) (Tablo 5). <\/span><\/p>\n<h3 class=\"p5\">Analiz II.<\/h3>\n<div id=\"attachment_30507\" style=\"width: 2196px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo6.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-30507\" class=\"size-full wp-image-30507\" src=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo6.png\" alt=\"\" width=\"2186\" height=\"2159\" srcset=\"https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo6.png 2186w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo6-263x260.png 263w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo6-547x540.png 547w, https:\/\/www.klimikdergisi.org\/wp-content\/uploads\/2025\/06\/KLM.C38.S1_5108_Tablo6-768x759.png 768w\" sizes=\"auto, (max-width: 2186px) 100vw, 2186px\" \/><\/a><p id=\"caption-attachment-30507\" class=\"wp-caption-text\"><strong>Tablo 6.<\/strong> Biyofilm \u00dcreticisi <i>A. baumanii<\/i> ve <i>K. pneumoniae<\/i> Su\u015flar\u0131n\u0131n Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n<p class=\"p2\"><span class=\"s1\">Biyofilm \u00fcreticisi olarak belirlenen 56 <i>A. baumanii <\/i>su\u015fu ve 31 <i>K. pneumoniae<\/i> su\u015fu aras\u0131nda ya\u015f, cinsiyet ve risk fakt\u00f6rleri a\u00e7\u0131s\u0131ndan anlaml\u0131 d\u00fczeyde farkl\u0131l\u0131k saptanmad\u0131 (<i>p<\/i>&gt;0.05). Hastalar\u0131n V\u0130P epizodlar\u0131ndaki ve 30 g\u00fcnl\u00fck izlem s\u00fcre\u00e7lerindeki mortalite ve iyile\u015fme oranlar\u0131, hastanede ve yo\u011fun bak\u0131mda yat\u0131\u015f s\u00fcreleri ve ekst\u00fcbasyona kadar ge\u00e7en s\u00fcreler benzerdi (<i>p<\/i>&gt;0.05). Mikrodil\u00fcsyon y\u00f6ntemi ile saptanan meropenem ve amikasin diren\u00e7 oranlar\u0131 <i>A. baumannii <\/i>grubunda <i>K. pneumoniae<\/i> grubuna k\u0131yasla anlaml\u0131 derecede daha y\u00fcksek bulundu (<i>p<\/i>1=0.003; <i>p<\/i>2=0.042) (Tablo 6). <\/span><\/p>\n<h2 class=\"p4\">\u0130RDELEME<\/h2>\n<p class=\"p2\">\u00c7al\u0131\u015fmam\u0131zda yo\u011fun bak\u0131m yat\u0131\u015f\u0131 s\u0131ras\u0131nda V\u0130P tan\u0131s\u0131 konulan 96 hasta ve hastalar\u0131n trakeal aspirasyon \u00f6rneklerinden izole edilen 67 <i>A. baumanii<\/i> su\u015fu ve 31 <i>K. pneumoniae<\/i> su\u015fu de\u011ferlendirildi. Hastalar\u0131n %62.2\u2019si erkek, %37.8\u2019i kad\u0131nd\u0131 ve ya\u015f ortalamalar\u0131 67.5 y\u0131ld\u0131. Wang ve arkada\u015flar\u0131n\u0131n (24) \u00c7in\u2019de nozokomial infeksiyon geli\u015fen 3223 hastay\u0131 de\u011ferlendirdikleri \u00e7al\u0131\u015fmada, nozokomial infeksiyonlar\u0131n erkeklerde ve ileri ya\u015f grubunda (&gt;60 ya\u015f) daha s\u0131k saptanmas\u0131 \u00e7al\u0131\u015fmam\u0131zla benzerlik g\u00f6stermektedir. T\u00fcrkiye\u2019den sa\u011fl\u0131k bak\u0131m\u0131 ili\u015fkili infeksiyonlar\u0131n de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, pn\u00f6moni en s\u0131k g\u00f6r\u00fclen \u00fc\u00e7 nozokomial infeksiyon aras\u0131nda yer almakta olup yo\u011fun bak\u0131mda yatan hastalarda s\u0131kl\u0131\u011f\u0131n\u0131n artt\u0131\u011f\u0131 saptanm\u0131\u015ft\u0131r (25).<\/p>\n<p class=\"p3\">Su\u015flar\u0131n biyofilm \u00fcretim kapasitesini etkileyen risk fakt\u00f6rlerini de\u011ferlendiren \u00e7al\u0131\u015fmalar olmakla birlikte, bu risk fakt\u00f6rleri hen\u00fcz net olarak tan\u0131mlanmam\u0131\u015ft\u0131r (4,5,7). \u00c7al\u0131\u015fmam\u0131zda <i>K. pneumoniae<\/i> su\u015flar\u0131n\u0131n tamam\u0131nda, <i>A. baumanii<\/i> su\u015flar\u0131n\u0131n ise %83.6\u2019s\u0131nda biyofilm \u00fcretimi saptand\u0131. \u00dclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada <i>A. baumanii<\/i> su\u015flar\u0131nda biyofilm \u00fcretiminin %99\u2019a ula\u015fabildi\u011fi bildirilmi\u015f olsa da \u00e7al\u0131\u015fmam\u0131zda bu oran daha d\u00fc\u015f\u00fck bulundu (26). Gunardi ve arkada\u015flar\u0131n\u0131n (4) biyofilm \u00fcretimine etki eden risk fakt\u00f6rlerini inceledi\u011fi \u00e7al\u0131\u015fmas\u0131nda biyofilm yap\u0131s\u0131 i\u00e7erisinde <i>K. pneumoniae<\/i> su\u015flar\u0131n\u0131n <i>A. baumanii<\/i> su\u015flar\u0131ndan daha s\u0131k yer ald\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Bu veri \u00e7al\u0131\u015fmam\u0131zdaki bulgular\u0131 desteklemektedir. <i>K. pneumoniae<\/i> su\u015flar\u0131n\u0131n kaps\u00fcl, membran proteinleri gibi vir\u00fclans fakt\u00f6rleri sayesinde biyofilm \u00fcreterek konak imm\u00fcn yan\u0131t\u0131ndan korundu\u011fu bilinmektedir (27). \u00c7al\u0131\u015fmam\u0131zda biyofilm \u00fcretiminin <i>K. pneumoniae<\/i> su\u015flar\u0131nda anlaml\u0131 olarak daha s\u0131k saptanmas\u0131n\u0131n kaps\u00fcl yap\u0131s\u0131n\u0131n biyofilm \u00fcretimini kolayla\u015ft\u0131rmas\u0131ndan kaynakland\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n<p class=\"p3\"><span class=\"s1\">Mikrodil\u00fcsyon y\u00f6ntemiyle t\u00fcm \u00f6rneklerin %96.9\u2019s\u0131nda meropeneme, %89.8\u2019inde ise amikasine diren\u00e7 saptand\u0131. \u00c7al\u0131\u015fmam\u0131zda su\u015flar\u0131n diren\u00e7 oranlar\u0131 benzer hasta gruplar\u0131nda yap\u0131lan di\u011fer \u00e7al\u0131\u015fmalardan daha y\u00fcksek saptand\u0131 (28,29). \u00c7al\u0131\u015fmaya dahil edilen hastalar\u0131n tamam\u0131nda son 90 g\u00fcn i\u00e7erisinde antibiyotik kullan\u0131m \u00f6yk\u00fcs\u00fcn\u00fcn olmas\u0131n\u0131n \u00e7al\u0131\u015fmam\u0131zda diren\u00e7 oranlar\u0131n\u0131n y\u00fcksek olmas\u0131na sebep oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Raman ve arkada\u015flar\u0131n\u0131n (30) antibiyotik direncine neden olan risk fakt\u00f6rlerini belirlemek i\u00e7in yapt\u0131klar\u0131 meta-analizde antibiyotik diren\u00e7 geli\u015fimine etki eden en \u00f6nemli fakt\u00f6r hastan\u0131n antibiyotik kullan\u0131m \u00f6yk\u00fcs\u00fc olarak bildirilmi\u015ftir. Liu ve arkada\u015flar\u0131n\u0131n (31) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, karbapenem direncine sebep oldu\u011fu belirtilen 16 risk fakt\u00f6r\u00fcnden biri hastan\u0131n antibiyotik kullan\u0131m \u00f6yk\u00fcs\u00fc olarak bildirilmi\u015ftir.<\/span><\/p>\n<p class=\"p3\">Biyofilm \u00fcreticisi 56 <i>A. baumannii<\/i> su\u015fu ile biyofilm \u00fcretmeyen 11 <i>A. baumannii<\/i> su\u015fu ve bu su\u015flar\u0131n izole edildi\u011fi hastalar incelendi\u011finde, hastalar\u0131n ya\u015flar\u0131 aras\u0131nda anlaml\u0131 bir fark saptanmad\u0131. Ancak kad\u0131n hastalardan al\u0131nan \u00f6rneklerde biyofilm \u00fcretim oran\u0131, erkek hastalardan al\u0131nan \u00f6rneklere k\u0131yasla anlaml\u0131 d\u00fczeyde daha y\u00fcksek bulundu. Gunardi ve arkada\u015flar\u0131n\u0131n (4) biyofilm \u00fcretimini etkileyen risk fakt\u00f6rlerini inceledi\u011fi \u00e7al\u0131\u015fmada, \u00e7al\u0131\u015fmam\u0131zla benzer \u015fekilde kad\u0131n cinsiyette biyofilm olu\u015fumu erkek cinsiyetten daha s\u0131k g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Ayn\u0131 \u00e7al\u0131\u015fmada, kateterizasyon s\u00fcresi be\u015f g\u00fcn ve \u00fczeri olan hastalarda biyofilm olu\u015fumu ile anlaml\u0131 bir ili\u015fki saptanm\u0131\u015fken, bizim \u00e7al\u0131\u015fmam\u0131zda kateterizasyon s\u00fcresi ile biyofilm olu\u015fumu aras\u0131nda benzer bir ili\u015fki g\u00f6sterilemedi.<\/p>\n<p class=\"p3\">\u00c7al\u0131\u015fmam\u0131zda, biyofilm \u00fcreticisi olmayan su\u015f say\u0131s\u0131n\u0131n yetersiz olmas\u0131 nedeniyle, biyofilm \u00fcretimi ile meropeneme ve amikasine diren\u00e7 aras\u0131ndaki ili\u015fki de\u011ferlendirilemedi. Biyofilm yap\u0131s\u0131n\u0131n \u00e7e\u015fitli mekanizmalar arac\u0131l\u0131\u011f\u0131yla antibiyotik direncine sebep oldu\u011fu ve biyofilm ili\u015fkili infeksiyonlar\u0131n, hastanede ve yo\u011fun bak\u0131mda yat\u0131\u015f s\u00fcresini uzatarak mortalite oran\u0131n\u0131 art\u0131rd\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (6,32). \u00dclkemizde yap\u0131lan \u00e7al\u0131\u015fmalarda, biyofilm \u00fcreten su\u015flarda antibiyotik diren\u00e7 oranlar\u0131n\u0131n y\u00fcksek oldu\u011fu g\u00f6r\u00fclmektedir (33,34).<\/p>\n<p class=\"p3\">Biyofilm olu\u015fumunun ent\u00fcbasyondan k\u0131sa s\u00fcre sonra ba\u015flad\u0131\u011f\u0131 ve medikal ekipman kullan\u0131m\u0131 s\u00fcrd\u00fck\u00e7e biyofilm mat\u00fcrasyonunun devam etti\u011fi g\u00f6sterilmi\u015ftir (10). \u00c7al\u0131\u015fmam\u0131zda biyofilm \u00fcretimi ile ent\u00fcbasyon s\u00fcresi aras\u0131nda anlaml\u0131 ili\u015fki saptanmad\u0131; benzer \u015fekilde ent\u00fcbasyon s\u00fcresi ile biyofilm olu\u015fumu aras\u0131nda ili\u015fki g\u00f6sterilemeyen \u00e7al\u0131\u015fmalar da bulunmaktad\u0131r (5,7). Bununla birlikte yabanc\u0131 cisim varl\u0131\u011f\u0131 biyofilm olu\u015fumunu kolayla\u015ft\u0131r\u0131r. Ayr\u0131ca biyofilm ili\u015fkili infeksiyonlar\u0131n tedavisinin di\u011fer infeksiyonlara k\u0131yasla daha zor olmas\u0131 nedeniyle infeksiyon klini\u011fi bulunmasa bile t\u00fcm hastalar i\u00e7in medikal ekipman kullan\u0131m\u0131 d\u00fczenli olarak de\u011ferlendirilmelidir. Klinik endikasyonu olmayan ekipmanlar\u0131n uygun zamanda \u00e7\u0131kar\u0131lmas\u0131 gereklidir.<\/p>\n<p class=\"p3\">\u00c7al\u0131\u015fmam\u0131zda biyofilm \u00fcreten <i>A. baumanii<\/i> ve <i>K. pneumoniae<\/i> su\u015flar\u0131n\u0131n izole edildi\u011fi hastalar aras\u0131nda risk fakt\u00f6rleri ve hasta sonlan\u0131mlar\u0131 a\u00e7\u0131s\u0131ndan anlaml\u0131 fark saptanmad\u0131. Bununla birlikte, amikasine ve meropeneme diren\u00e7 oranlar\u0131 <i>A. baumanii<\/i> grubunda istatistiksel olarak anlaml\u0131 d\u00fczeyde <i>K. pneumoniae<\/i> grubundan daha y\u00fcksekti. Bu su\u015flar aras\u0131nda diren\u00e7 paterni farkl\u0131l\u0131\u011f\u0131n\u0131n, biyofilm d\u0131\u015f\u0131 antimikrobiyal diren\u00e7 mekanizmalar\u0131ndan kaynakland\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n<p class=\"p3\"><span class=\"s1\">\u00c7al\u0131\u015fmaya dahil edilen t\u00fcm su\u015flar\u0131n meropeneme ve amikasine direnci \u00fc\u00e7 farkl\u0131 y\u00f6ntemle test edildi. Biyofilm olu\u015fturan <i>K. pneumoniae<\/i> su\u015flar\u0131nda test sonu\u00e7lar\u0131 aras\u0131ndaki uyumun, meropenem i\u00e7in amikasine g\u00f6re daha y\u00fcksek oldu\u011fu belirlendi. Bu durumun, amikasinin hidrofilik yap\u0131s\u0131ndan kaynakland\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir. Biyofilm tabakas\u0131 i\u00e7erisindeki EPS yap\u0131s\u0131n\u0131n, dif\u00fczyon bariyeri olu\u015fturarak antibiyotiklerin mikroorganizmalara ula\u015fmas\u0131n\u0131 engelledi\u011fi bilinmektedir (3,11). <i>P. aeruginosa<\/i> su\u015flar\u0131nda yap\u0131lan bir \u00e7al\u0131\u015fmada, aminoglikozitlerin dif\u00fczyon bariyerinden karbapenemlere k\u0131yasla daha zor ge\u00e7ti\u011fi, ortama alginat liyaz eklenerek biyofilm yap\u0131s\u0131n\u0131n bozulmas\u0131 sonras\u0131 ge\u00e7i\u015fin h\u0131zland\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (35). Mueller-Hinton agar y\u00fczeyinde \u00fcreyen bakteri kolonileri aras\u0131nda da benzer dif\u00fczyon bariyerinin geli\u015fti\u011fi ve bu nedenle amikasin i\u00e7in disk dif\u00fczyon ve e-test y\u00f6ntemleriyle saptanan M\u0130K de\u011ferinin mikrodil\u00fcsyon y\u00f6ntemine k\u0131yasla daha y\u00fcksek \u00f6l\u00e7\u00fcld\u00fc\u011f\u00fc d\u00fc\u015f\u00fcn\u00fclmektedir. \u00dclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada, farkl\u0131 antibiyotik duyarl\u0131l\u0131k test y\u00f6ntemleri kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f ve sonu\u00e7lar aras\u0131nda de\u011fi\u015fkenlik oldu\u011fu g\u00f6sterilmi\u015ftir (36). Bu nedenle, biyofilm \u00fcreten su\u015flarda, klinik uyumlu ideal antibiyotik duyarl\u0131l\u0131k testinin se\u00e7imi i\u00e7in daha fazla \u00e7al\u0131\u015fmaya ihtiya\u00e7 vard\u0131r. <\/span><\/p>\n<p class=\"p3\">Biyofilm ili\u015fkili infeksiyon d\u00fc\u015f\u00fcn\u00fclen hastalar\u0131n klinik ve laboratuvar verilerinin birlikte de\u011ferlendirilmesi a\u00e7\u0131s\u0131ndan \u00f6nemli olan \u00e7al\u0131\u015fmam\u0131zda, hastalar\u0131n altta yatan \u00e7e\u015fitli risk fakt\u00f6rleri, V\u0130P epizodlar\u0131 ve 30 g\u00fcnl\u00fck izlem sonlan\u0131mlar\u0131, biyofilm \u00fcretimi ve farkl\u0131 y\u00f6ntemlerin antibiyotik duyarl\u0131l\u0131k test sonu\u00e7lar\u0131 ile birlikte de\u011ferlendirildi.<\/p>\n<p class=\"p3\">Bu \u00e7al\u0131\u015fma bir tez projesi olarak planland\u0131 ve \u00f6rnek al\u0131m\u0131 COVID-19 pandemisi d\u00f6neminde ger\u00e7ekle\u015ftirildi. Pandemi s\u00fcreci nedeniyle yeterli say\u0131da hasta dahil edilememesi \u00e7al\u0131\u015fman\u0131n en \u00f6nemli k\u0131s\u0131tl\u0131l\u0131\u011f\u0131d\u0131r. Ayr\u0131ca, biyofilm \u00fcretimi yapmayan su\u015f say\u0131s\u0131n\u0131n yetersiz olmas\u0131, istatistiksel olarak anlaml\u0131 kar\u015f\u0131la\u015ft\u0131rmalar\u0131n yap\u0131lmas\u0131n\u0131 engelledi.<\/p>\n<p class=\"p3\">\u00c7al\u0131\u015fmada yer alan hastalar\u0131n \u00e7o\u011funun yo\u011fun bak\u0131m \u00fcnitesinde takip edilmesi ve \u00f6nceki antibiyotik kullan\u0131m \u00f6yk\u00fclerinin bulunmas\u0131, antibiyotik diren\u00e7 oranlar\u0131n\u0131n y\u00fcksek saptanmas\u0131nda etkili oldu. Bununla \u00adbirlikte, biyofilm \u00fcretimi yapmayan ve antibiyotik duyarl\u0131 su\u015f say\u0131lar\u0131n\u0131n da yetersiz olmas\u0131 nedeniyle gruplar aras\u0131nda anlaml\u0131 analizler yap\u0131lamad\u0131. Gruplar aras\u0131nda istatistiksel olarak anlaml\u0131 farklar\u0131n ortaya konulabilmesi i\u00e7in hasta ve \u00f6rnek say\u0131s\u0131n\u0131n art\u0131r\u0131lmas\u0131 gerekti\u011fini d\u00fc\u015f\u00fcn\u00fcyoruz. Sonu\u00e7 olarak; biyofilm yap\u0131s\u0131n\u0131n antibiyoterapiye diren\u00e7 geli\u015fimine ve tedavi ba\u015far\u0131s\u0131zl\u0131\u011f\u0131na neden oldu\u011fu bilinmektedir. Bu nedenle biyofilm \u00fcreten su\u015flarda antibiyotik duyarl\u0131l\u0131k testlerinin standardizasyonu konusunda daha fazla \u00e7al\u0131\u015fma yap\u0131lmas\u0131na ihtiya\u00e7 vard\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Bu makaleye ili\u015fkin\u00a0bir d\u00fczeltme 24 Ekim 2025\u2019de yay\u0131nland\u0131: https:\/\/doi.org\/10.36519\/kd.2025.5422 G\u0130R\u0130\u015e Mikroorganizmalar serbest formdan farkl\u0131la\u015farak \u00e7ok h\u00fccreli organizmalar\u0131 taklit eden karma\u015f\u0131k biyofilm yap\u0131lar\u0131n\u0131 olu\u015fturmaktad\u0131r (1). Biyofilm tabakas\u0131n\u0131n %85\u2019ini matriks yap\u0131s\u0131 olu\u015fturur. Bu matriks, mikroorganizmalar taraf\u0131ndan \u00fcretilen h\u00fccre d\u0131\u015f\u0131 polimerik maddeler (Extracellular Polymeric Substances, EPSs) ve h\u00fccre d\u0131\u015f\u0131 DNA partik\u00fclleri ile kona\u011fa ait imm\u00fcnglobulin ve p\u0131ht\u0131la\u015fma fakt\u00f6rlerini [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[4090,3868,6013,6134,6133],"class_list":["post-30450","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-antibiyotik-duyarlilik-testi","tag-biyofilm","tag-disk-difuzyon","tag-e-test-2","tag-mikrodilusyon"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30450","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\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=30450"}],"version-history":[{"count":7,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30450\/revisions"}],"predecessor-version":[{"id":31474,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30450\/revisions\/31474"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=30450"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=30450"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=30450"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}