Kistik Fibrozisli Hastalarda Anaerop Bakterilerin Rolünün Araştırılması

Abstract

Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae and Burkholderia cepacia complex are the most frequently isolated microorganisms from respiratory tract samples of the cystic fibrosis patients. However recent studies pointed out the importance of anaerobic bacteria in pulmonary infections seen in cystic fibrosis patients. In these patients the bacterial and cellular residues, accreted with dense viscous mucus cause formation of mucus plugs in the larger airways. Behind these plugs, anaerobic environment develops due to decreased oxygen passage towards the lower airways. In this anoxic environment anaerobic bacteria originated from oral flora become colonized easily and be the part of the resident bacteria inhabiting the lower airways of these patients. The aim of this study was to evaluate the role of anaerobic bacteria in cystic fibrosis patients attending to Hacettepe University, Paediatric Respiratory Diseases Department, by using quantitative culture method for both aerobic and anaerobic bacteria. Anaerobic bacteria were identified by conventional and semi-automated methods. Antibiotic susceptibilities of the anaerobic isolates were performed by agar dilution method. Seventy seven anaerobic bacteria were isolated from 35 (81,4%) of 43 patients. The total count of anaerobes and facultative bacteria (mean 1606,24x104 ) was higher than the total count of aerobes and facultative bacteria (mean 1413,86x104 ). None of the anaerobes was isolated from the patients with very few PMNL’s in direct examination of sputum samples. In patients whose samples yielded intermediate or high numbers of PMNLs, significantly more obligate anaerobic bacteria were isolated (p: 0,046). Age of the viii patients was another factor which was evaluated in this study; patients older than 18 were colonized with higher amount of anaerobic bacteria. Susceptibilities of 72 isolates out of 77, against ampicillin, sulbactam- ampicillin, piperacillin, piperacilin tazobactam, moxifloxacin, metronidazole, imipenem and clindamycin were also evaluated. Clindamycin was found to be the least effective antibiotic among all. None of the isolates was resitant to imipenem.