Yenidoğan yoğunbakım ünitesinde izlenen prematüre bebeklerde sepsis gelişimi ile beyaz küre ve trombosit sayılarının ilişkisi.

Abstract

In this study, it is aimed to investigate the identification of extended spectrump-Iactamases (GSBL) of 960 Eseheriehia eoli ve 300 Klebsiella spp whichwere isolated from wound and urine Ispecimens of hospitalized patients andoutpatients, and their resistance to same anti-biotics, by double disc sinergytest and phenotipical confirmatory test. The bacteria were isolated bystandart methods. Antibiotic resistance was tested by disc diffusion method,while, double disc sinergy test and phenotipical confirmatory tests were usedto find the existence of GS BL. All the tests were done according to criteria ofthe National Commit!ee for Clinical Laboratory Standarts(NCCLS). TheFisher's ki-square test was used to show the antibiotic resistance. 162 of 960E. eoli strains (%16,8) and 66 of 300 Klebsiella spp strains (%22) (54 ofwhich K. pneumoniae (%18) and 12 of which was K. oxytoea (%8) werefound to be positive. The resistance of amicasin of the GS BL positive strainshas been found %5,9 in the urine material, while it was %14,5 in the woundmaterial and it was statistically significant (p <0,031 ). Consequently, the discdiffusion test, double disc sinergy test and the phenotipical contirmative testswere found to be compatible and it is determined that there is a necessity tobe careful for the amicasin resistance in the strains isolated from the GSBLposilive wound samples.Keywords: Exlended-speclrum p-Iaclamases, Resistance of antibiolics,Klebsiella spp., E. eoli.değişiklikler değerlendirilmış ve sepsis gelişen ve gelişmeyen bebeklerdenelde edilen ölçümlerin (1., 3., 5., 7. günlerdeki) karşılaştırılması yapılmıştır.Araştırma sonucunda elde edilen veriler SPSS programında analiz edilerekp< 0.05 anlamlılık sınırı olarak kabul edilmiştir. Çalışmaya alınan tümolguların % 14'ünde ilk hafta içinde sepsis gelişmiştir. Sepsis grubu vekontrol grubu arasında gebelik haftası ve doğum ağırlığı açısından farklaranlamlı bulunmuştur. Gruplar arasında cinsiyet dağılımı , doğum şekli ,annelerin yaş ortalaması , gebelik sayısı , hipertansiyon, diyabet, erkenmembran rüptürü ve preeklampsi oranları açısından fark bulunmamıştır. Hem1. ve 5. dakika Apgar skorları hem de resüsitasyon uygulanma oranlarıanlamlı farklılık göstermiştir. Sepsis ve sepsis olmayan gruplar arasındalökosit sayıları açısından fark bulunamazken sepsis ve kontrol grubuarasında 1, 3, 5. ve 7. günlerde bakılan hem trombosit sayıları hem detrombositopeni oranları açısından arasındaki farklar oldukça anlamlıbulunmuştur . Bu çalışma sonucunda, ilk hafta içerisinde alınan ardışık kanörneklerinde sepsis geliştiren bebeklerde yaşamın ilk gününden başlayarakhem ortalama trombosit sayısının daha düşük hem de trombositopenioranlarının anlamlı şekilde yüksek olduğu görülmüştür.Anahtar kelimeler: Trombosit sayısı , lökosit sayısı , sepsis, yenidoğan

The rate of mortality is deereated signifieanııy in prematurity and itsconeomitant problems depending on the improvement in neonatal intensivecare. On the other hand mortalities and morbidities due to sepsis are stilihigh. Humoral and eellular defans meehanisms are poorly developed inneonatal period. It explains high rate of morbidities in premature neonates.While weeks of pregnancies deerease, the rate of infeetions increases.Sepsis whieh represents sings and symptoms within first week usuallyprogresses rapidly and effeets multiple organs. Most of the affeeted neonatesare premature and have low birth weighl. Mieroorganisms eausing infeetionshave maternal origin. And mortality rates are higher than Iate sepsis. Earlydiagnosis and proper management are very important to reduee mortalitiesand for good prognosis. The diagnosis usually depends on clinie of neonates.Howewer sing of sepsis may not be present at the beginning or or otherpathological conditions that mimic sepsis during this period make diagnosisdifficull. A number of screaning tests are available for early diagnosis.Howewer test of choice must be sensitive, can be done easily and shouldgive fast results. By this study we aimed to eveluate the relations betweenhematological parameters that that includes leucocyte count and changes inplatelet numbers and sepsis in premature neonates in neonatal interısivecare units. AIso we aimed to eveluate how those parameters may predietsepsis or help to diagnose sepsis and is there any relation between theduration and the range of changes in parameters and clinical course,prognosis of disease and responsible microorganisms. We included 207premature neonate who are under 37 weeks of gestational age and inneonatal intensive care units into study. Hematological parameters weremeasured eonseeutively at 1, 3, 5. and 7. days. The changes in theparameters within the first week were evaluated. Results of sepsis developedgroup and control groups were compared.for statistical analysis we usedSPSS programs. P values < 0.05 were accepted as a border for statisticalsignifance. The rate of sepsis was 14 % within first week. Gestational ageand birth weight differences were statistically significant in sepsis group andcontrol groups. There were no differences between the groups according tosexes, types of delivery, maternal age, number of pregnancies, history ofhypertantion, diabetes, premature rupture of membrane and preeclamycia.APGAR scores at 1 and 5 minutes and resusoutation rates were significantlydifferent. Leucocyte counts were similar howewer platelet numbers at 1, 3, 5.and 7. days and rate of thrombocytopenia were significanııy different in septicgroups and control groups. As a conclusion, analysis of consecutivehematological parameters showed that the mean platelet numbers is lowerand the rate of thrombocy,t openia is higher in sepsis developed group incomparison with control group.Key words: Platelet count, leucoeytes count, sepsis, newbom