Publication: Çocuk Yoğun Bakım Ünitesindeki Hastane Kaynaklı Enfeksiyonların İrdelenmesi ve Risk Faktörlerinin Belirlenmesi
Abstract
Hastane kaynaklı enfeksiyonlar, mortalite ve morbidite artışı, yatış süresinin uzaması ve sağlık giderlerinde artışa sebep olmaları nedeniyle önem arz ederler. Şuana kadar literatürde, çocuk yoğun bakım ünitelerinde (ÇYBÜ) gelişen hastane kaynaklı enfeksiyonlar için birçok risk faktörü rapor edilmiştir. Bunlar içinde en dikkat çekici faktör her ÇYBÜ'nin kendi risk faktörlerini belirlemensin gerekliliğidir. Birçok ülkede hastane kaynaklı enfeksiyonların azaltılması ve oranlarının sabitleştirmesi amacı ile birçok çalışma yapılmıştır. Sağlık sisteminde çalışanların konuya olan dikkatlerinin arttırılması, sistematik surveyans çalışmalarının yapılması ile bu oranların azaltılması mümkündür. Enfeksiyonların önlenmesi ve kontrol edilmesi için alınan tüm tedbirlerin ne kadar benimsendiği de çok önemlidir. Pediatrik hasta grubunda, hastane kaynaklı enfeksiyonlar için risk faktörleri sadece olgunun yaşına, beraberinde bir hastalık taşıyıp taşımadığına ve diğer tüm mevcut hastalıklarının yanında, yüksek riskli ünitelerde sıklıkla kullanılmaları zorunlu olan, invaziv ve invaziv olmayan uygulara da bağlıdır.Çalışmamızın amacı; Samsun Ondokuz Mayıs Üniversitesi ÇYBÜ'de hastane kaynaklı enfeksiyonlar için risk faktörlerini tanımlamak ve bu risk faktörlerini hastane enfeksiyonlu ve enfeksiyon taşımayan iki grup arasında karşılaştırmaktı. Bu bir prospektif vaka-kontrol çalışmasıdır. Nisan 2007 ve Nisan 2008 tarihleri arasında toplam 393 olgu ÇYBÜ'ye kabul edildi. Çalışmaya dahil edilen toplam 162 olgudan, 51 olgu enfeksiyon grubunda, 111 olgu ise kontrol grubunda yer aldılar. Kırküç olgu operasyon sonrası yada travma sonrası ÇYBÜ'ye kabul edildiği için, 188 olgu ise 48 saatten daha az ÇYBÜ'de kaldıkları için çalışma dışında bırakıldılar. Hastane kaynaklı enfeksiyon tanısı ise CDC kriterlerine göre konuldu.Hastane kaynaklı enfeksiyon hızımız; %31.48 iken, kan dolaşımı enfeksiyonu %42.1 oranı ile ÇYBÜ'de hastane kaynaklı enfeksiyonlar arasında ilk sırada yer aldı. Bunu pnömoni ve üriner sistem enfeksiyonları takip ettiler. Alet ilişkili enfeksiyon oranlarımız ise sırasıyla; 27.9/1000 kan dolaşımı enfeksiyonları, 15.6/100 VİP, 10.4/1000 üriner sistem enfeksiyonları olarak şekillendiler. Nörolojik hastalıklar %28 ve kalp hastalıkları %15.2'lik oranları ile anlamlı bir biçimde diğer tüm hastane kaynaklı enfeksiyon ve primer hastalık beraberlikleri arasında öne çıktılar. Gram negatif bakteriler (%56) en sık izole edilen mikroorganizmalardı. Bunların içinde ise Pseudomonas aeruginosa en sıklıkla (%24) üretilen etken patojendi. Hastane kaynaklı enfeksiyonlar ile hastanede kalma süresi, ÇYBÜ'de kalma süresi, entübasyon, santral venöz kateter, üriner kateterizasyon varlığı ve süreleri, PRISM skorları, olgu yaşı, primer hastalık mevcudiyeti, TPB, sedasyon, trakeostomi ile istatistiksel olarak anlamlı bir ilişki vardı. Buna karşın bir ay öncesine kadar antibiyotik kullanmış olmak, inhalasyon tedavisi, H2 Blokör ve diyaliz uygulaması iki grup arasında istatistik olarak anlamlı fark oluşturmamaktaydı.Hastane kaynaklı enfeksiyonlar için enfeksiyon grubunda mortalite oranı %37.2 iken, kontrol grubunda bu oran sadece %12.6 idi (p<0.001). Her bakteri için antibiyotik duyarlılıkları analiz edildi. Pseudomonas aeruginosa için seftazidim direnci %54 iken, bu bakteride %50 oranında çoğul ilaç direnci saptandı.Bu çalışma ile çoğu rutin ÇYBÜ uygulaması ile hastane kaynaklı enfeksiyonlar arasında ileri derecede anlamlı ilişki olduğunun altını çizdik. Enfeksiyon grubu ile risk faktörleri arasında hastane kaynaklı enfeksiyonlar açısından istatistiksel olarak anlamlı ilişkiler tespit ettik. Sonuç olarak; her hastanenin risk faktörlerini, ünitelere spesifik önlemlerini, enfeksiyon ajanları ve duyarlılık paternlerini ayrı ayrı analiz etmelerini önerirken, yeterli ve etkili hastane kaynaklı enfeksiyon korunmasının ancak bu sayede mümkün olabileceğini düşünmekteyiz.Anahtar Kelimeler: hastane enfeksiyonu, çocuk yoğun bakım ünitesi, risk faktörleri, antibiyotik duyarlılıkları
Nosocomial infections (NI) are always an important public health problem associated with considerable morbidity and mortality, prolonged hospital stays, and increased health care costs in pediatric intensive care units(PICU). So far, many of the risk factors associated with the development of NI in pediatric intensive care units have been published in literature. One the most important concern is that all PICU should know their risk factors in order to prevent life-threat conditions. There have been various attempts in many countries to control NI, with the aim of reducing and stabilising the rates. This has required heightened awareness on the part of health care professionals, systematic surveillance of the incidence of infections, as well as the adoption of measures to control and prevent infection. The risk of NI in paediatric patients depends not only on their age, primary disease and associated comorbidities, but also on the invasive and non-invasive procedures commonly used in high-risk units.The aim of this study is to describe the risk factors of NI in pediatric intensive care unit in a tertiary care university hospital in Samsun and to assess the comparison of these risk factors amongst two groups of patient with infection and non-infection. This is a prospective case-control cohort study. During the study period, between April 2007 and April 2008, total of 398 subjects was admitted to the PICU, of which 162 subjects were included. Of these 51 and 111 subjects were in the infection group and control group, respectively. Exclusions included; 43 postoperative subjects and injuries, 188 subjects who admitted less than 48 hours in PICU. The diagnosis of hospital infection was made according to the criteria of the `Centers for Disease Control and Prevention? (CDC).The incidence rate of NI was 31.48 infections per 100 admissions in the PICU. Bacteraemia (42.1%) was the most frequent episode of NI in PICU, followed by pneumonia and urinary tract infections. Device associated infection rates were 27.9/1000, 15,6/100, 10,4/1000 via blood stream infections, ventilator associated pneumonia(VAP) and urinary catheter, respectively. Neurologic diseases (28%) and cardiac diseases (15.2%) were significantly higher amongst the primary diseases which related with NI. The most common microorganisms isolated were Gram-negative bacteria (56%). Of these 24% was Pseudomonas aeruginosa which was the most frequent microorganism. While the factors associated with NI in the PICU as follows: length of hospital stay, PICU stay, duration of the intubation, central venous catheterisation, urinary catheterisation, PRISM scores, patient age, presence of primer disease, with regards to non-invasive treatments; TPN, sedation, and regarding the invasive procedures; central venous catheter, intubation, urinary catheter, tracheotomy were revealed statically significant relationship between infection and control group; previous antibiotic usage, inhale treatment, H2 blockers and dialysis were not significant predisposing factors between two groups.Mortality rates in patients who developed nosocomial infection was 37,2% whereas in control group was only 12,6% (p <0.001). The resistance patterns of drugs for each microorganism were also performed. Ceftazidime resistance and multiple drug resistance for Pseudomonas aeruginosa was 54% and 50%, respectively.This study has highlighted a significant degree of association between most of the routine PICU procedures and infection. Within the two groups of patients, we have seen significant correlation between the risk factors and infection group. We suggest that risk factors, specific precautions, infectious agents and resistance patterns in each hospital should be analyzed and recorded separately. It would provide proper hospital specific infection controls.Keywords: nosocomial infection, pediatric intensive care unit, risk factors, resistans patterns of drugs.
Nosocomial infections (NI) are always an important public health problem associated with considerable morbidity and mortality, prolonged hospital stays, and increased health care costs in pediatric intensive care units(PICU). So far, many of the risk factors associated with the development of NI in pediatric intensive care units have been published in literature. One the most important concern is that all PICU should know their risk factors in order to prevent life-threat conditions. There have been various attempts in many countries to control NI, with the aim of reducing and stabilising the rates. This has required heightened awareness on the part of health care professionals, systematic surveillance of the incidence of infections, as well as the adoption of measures to control and prevent infection. The risk of NI in paediatric patients depends not only on their age, primary disease and associated comorbidities, but also on the invasive and non-invasive procedures commonly used in high-risk units.The aim of this study is to describe the risk factors of NI in pediatric intensive care unit in a tertiary care university hospital in Samsun and to assess the comparison of these risk factors amongst two groups of patient with infection and non-infection. This is a prospective case-control cohort study. During the study period, between April 2007 and April 2008, total of 398 subjects was admitted to the PICU, of which 162 subjects were included. Of these 51 and 111 subjects were in the infection group and control group, respectively. Exclusions included; 43 postoperative subjects and injuries, 188 subjects who admitted less than 48 hours in PICU. The diagnosis of hospital infection was made according to the criteria of the `Centers for Disease Control and Prevention? (CDC).The incidence rate of NI was 31.48 infections per 100 admissions in the PICU. Bacteraemia (42.1%) was the most frequent episode of NI in PICU, followed by pneumonia and urinary tract infections. Device associated infection rates were 27.9/1000, 15,6/100, 10,4/1000 via blood stream infections, ventilator associated pneumonia(VAP) and urinary catheter, respectively. Neurologic diseases (28%) and cardiac diseases (15.2%) were significantly higher amongst the primary diseases which related with NI. The most common microorganisms isolated were Gram-negative bacteria (56%). Of these 24% was Pseudomonas aeruginosa which was the most frequent microorganism. While the factors associated with NI in the PICU as follows: length of hospital stay, PICU stay, duration of the intubation, central venous catheterisation, urinary catheterisation, PRISM scores, patient age, presence of primer disease, with regards to non-invasive treatments; TPN, sedation, and regarding the invasive procedures; central venous catheter, intubation, urinary catheter, tracheotomy were revealed statically significant relationship between infection and control group; previous antibiotic usage, inhale treatment, H2 blockers and dialysis were not significant predisposing factors between two groups.Mortality rates in patients who developed nosocomial infection was 37,2% whereas in control group was only 12,6% (p <0.001). The resistance patterns of drugs for each microorganism were also performed. Ceftazidime resistance and multiple drug resistance for Pseudomonas aeruginosa was 54% and 50%, respectively.This study has highlighted a significant degree of association between most of the routine PICU procedures and infection. Within the two groups of patients, we have seen significant correlation between the risk factors and infection group. We suggest that risk factors, specific precautions, infectious agents and resistance patterns in each hospital should be analyzed and recorded separately. It would provide proper hospital specific infection controls.Keywords: nosocomial infection, pediatric intensive care unit, risk factors, resistans patterns of drugs.
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