Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Primer Silier Diskinezi Hastalarının Klinik Bulgularının Değerlendirilmesi, Balgam ve Bronkoalveoler Lavaj Mikrobiyolojik Sonuçlarının Karşılaştırılması: Tanımlayıcı Retrospektif Araştırma
Evaluation of Clinical Findings of Primary Ciliary Dyskinesia Patients, Comparison of Sputum and Bronchoalveolar Lavage Microbiological Results: Descriptive Retrospective Research
Gökçen Dilşa TUĞCUa, Sanem ERYILMAZ POLATa, Şule Selin AKYAN SOYDAŞa, Ece OCAKa, Murat Yasin GENÇOĞLUa, Satı ÖZKAN TABAKÇIa, Salih UYTUNa, Güzin CİNELa
aAnkara Şehir Hastanesi, Çocuk Hastanesi, Çocuk Göğüs Hastalıkları Kliniği, Ankara, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2021;30(3):192-8
doi: 10.5336/pediatr.2021-84334
Article Language: TR
Full Text
ÖZET
 Amaç: Primer silier diskinezi (PSD) hastalarında balgam kültürü, basit ve noninvaziv olması nedeniyle en sık tercih edilen havayolu mikrobiyolojisi örneklemesidir. Bronkoalveoler lavaj (BAL) kültürü, alt solunum yolu mikrobiyolojisinin gösterilmesinde en güvenilir yöntem olmasına rağmen genel anestezi gerektirmesi ve invaziv olması nedeniyle rutinde tercih edilmemektedir. Bu çalışmanın amacı, PSD hastalarının klinik, radyolojik ve bronkoskopik verilerinin incelenmesi; bu hastalarda alt solunum yolu mikrobiyolojisinin balgam ve BAL örneklerinde korelasyonunun araştırılmasıdır. Gereç ve Yöntemler: Araştırma, retrospektif tanımlayıcı çalışma olarak planlanmıştır. Ocak 2013 ile Aralık 2020 tarihleri arasında PSD tanısı alan; 0-18 yaş arası hastaların demografik, klinik ve radyolojik verileri incelenmiştir. PSD nedeniyle izlemde iken tanısal fleksibl bronkoskopi (FB) yapılıp, BAL ve FB tarihi ile en fazla 3 ay arasında alınmış ise balgam kültürü örnekleri karşılaştırılmıştır. Bulgular: Otuz üç hastanın yaş ortancası 7,64 (minimum 3,5-maksimum 16 yaş) idi. On dört (%42,4) hasta erkek, 19 (%57,6) hasta ise kız idi. İki (%6,06) hastanın balgam kültüründe Streptococcus pneumoniae üremesi raporlandı, diğer hastaların balgam kültüründe üreme olmadı. BAL mikrobiyolojisinde 18 (%54,55) örnekte üreme görüldü. Balgam ve BAL örneklerinin mikrobiyolojik sonuçları karşılaştırıldığında, BAL örneklerinde bakteri üremesinin istatistiksel olarak çok daha yüksek olduğu görüldü (p<0,001). Hastaların yaşları ile solunum yolu mikrobiyolojisi (balgam ya da BAL) arasında; spirometri verileri (birinci saniyedeki zorlu ekspiratuar volüm ve zorlu vital kapasite yüzdeleri) ile solunum yolu mikrobiyolojisi (balgam ya da BAL) arasında korelasyon görülmedi. Sonuç: Balgam kültürü örneklerinin alt solunum yolu mikrobiyolojisini yansıtma oranı, BAL örneklerine göre belirgin düşüktür. Bu nedenle tedavi yanıtsızlığı hâlinde BAL örneğinin muhtemel patojeni saptayarak tedaviye yön verebileceği bilinmelidir.

Anahtar Kelimeler: Primer silier diskinezi; balgam; bronkoalveoler lavaj; fleksibl bronkoskopi
ABSTRACT
 Objective: Sputum culture is the most preferred sampling of airway microbiology in patients with primary ciliary dyskinesia (PCD) due to its simple and noninvasive nature. Although bronchoalveolar lavage (BAL) culture is the most reliable method for demonstrating lower respiratory tract microbiology; it is not routinely preferred by virtue of flexible bronchoscopy with general anesthesia recruitment. The aim of this study is to investigate clinical, radiological and bronchoscopic data of PCD patients and to explore the correlation of lower respiratory tract microbiology in sputum and BAL samples. Material and Methods: This study is made to be a retrospective and descriptive one. Demographic, clinical and radiological data of patients diagnosed with PCD aged 0-18 years between January 2013-December 2020 were analyzed. If diagnostic flexible bronchoscopy (FB) was performed during follow-up due to PSD, and if a sputum culture was taken from a maximum of 3 months with the date of BAL, results were studied. Results: The median age of 33 patients was 7.64 (minimum 3.5-maximum 16 years). Fourteen (42.4%) patients were male, 19 (57.6%) patients were female. Streptococcus pneumoniae growth was reported in the sputum cultures of 2 (6.06%) patients, and there was no growth in the sputum cultures of the other patients. BAL microbiology showed growth in 18 (54.55%) samples. Bacterial overgrowth in BAL samples was found to be statistically significantly higher than sputum samples (p<0.001). There was no correlation between spirometry data (forced expiratory volume in 1 second and forced vital capacity percentages) and respiratory tract microbiology (sputum or BAL); and no correlation between age and respiratory tract microbiology (sputum or BAL). Conclusion: Sputum culture samples reflect lower respiratory tract microbiology significantly lower than BAL samples. For this reason, it should be known that in case of treatment failure, the BAL sample can determine the possible pathogen and guide the treatment.

Keywords: Primary ciliary dyskinesia; sputum; bronchoalveolar lavage; flexible bronchoscopy
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