Çocuk kliniği ve yoğun bakım ünitesinde yatan hastalarda hastane enfeksiyonları: Bir yıllık sürveyans çalışması
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Date
2009
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Uludağ Üniversitesi
Abstract
Hastane enfeksiyonları ciddi boyutlarda mortalite, morbidite ve ekonomik kayıplara neden olan önemli bir problemdir. HE'nın mortalite ve morbidite oranlarının toplum kökenli enfeksiyonlara göre yüksek olması bu konunun önemini gittikçe arttırmaktadır. Sürveyans çalışmaları, HE'nın değerlendirme ve izleminde çok gereklidir. HE'nın sürveyansı ile enfeksiyon sıklıkları, enfeksiyona neden olan faktörler ve etkenlerin dağılımı, antibiyotik duyarlılık sonuçları ile hastalara uygulanacak tedaviler belirlenmektedir. Bu çalışma ile çocuklarda 1 yıl süresince ÇYBÜ ile Büyük çocuk ve Süt çocuğu kliniğinde yatmakta olan hastalar arasında oluşan hastane kaynaklı enfeksiyon tipleri ve yüzdeleri, HE ile ilişkili mortalite oranları, bunların mortaliteye katkısı ve risk faktörleri ile sık karşılaşılan etkenlerin değerlendirilmesi amaçlanmıştır.Çalışma süresince 91 hasta izlendi. Bazı hastalarda birden fazla HE atağı vardı ve toplam 114 HE atağı ile 95 kültür üremesi saptandı (hasta başına epizod oranı: 1.25). genel HE hızı (ÇYBÜ, klinik, yenidoğan ve hematoloji-onkoloji) %20.7 olarak saptandı. 100 hasta yatışına göre HE oranı YBÜ'de 16.3, klinikte 8.4 iken 1000 hasta gününe göre HE oranı ise; YBÜ'de 18.5, klinikte 17.3 olarak bulundu. Tanılar içinde primer kan akımı enfeksiyonları (KAE) %29 (n=36) ile ilk sırada yer alırken, ikinci sırada pnömoni (%24.2, n=30) ve üçüncü sırada üriner sistem enfeksiyonları (%12, n=15) ile peritonit (%12, n=15) yer aldı. Hastalara uygulanan invaziv prosedürler gözönüne alındığında; kateterle ilişkili KAE 8.9/1000 kateter günü, VİP 13.8/1000 mekanik ventilasyon günü, ÜSE 6/1000 üriner kateter günü olarak bulundu. Etken olarak saptanan mikroorganizmalardan gram negatifler %60, gram pozitifler %31.6, funguslar %8 oranında saptandı. KAE'da en sık görülen mikroorganizmalar; gram negatiflerdi (%61.3). İlk sırada K.pneumoniae (%35.5) ardından A.baumannii (%9.7) ve E.coli (%6.5) yer aldı. Hastane kaynaklı pnömonide de gram negatifler (%85) birinci sırada yer aldı. En sık görülen gram negatif mikroorganizmalar sırasıyla; A.baumannii (%50), P.aeruginosa (%15) ve diğer (S.maltophiliae) (%15) olarak sıralandı. Üriner enfeksiyonların %86.6'da etken gram negatiflerdi. E.coli (%33.3), K.pneumoniae (%20) ve proteus mirabilis (%20) en sık görülen gram negatif mikroorganizmalardı. Risk faktörleri incelendiğinde ise; uzamış yatış, uzamış antibiyotik kullanımı, ek hastalık ve kateter varlığı gelen risk faktörleri arasında idi. Sepsis tanısı almış hastalarda en sık görülen risk faktörleri sırasıyla; uzamış yatış ve ek hastalık varlığı (%92.9), uzamış antibiyotik kullanımı (%88), transfüzyon (%71.4), invaziv kateter kullanımı (%61.9) ve son bir ayda hastaneye yatış öyküsü (%59.5) olarak saptandı. Pnömoni tanısı alanlarda uzamış yatış ve kateter kullanımı %93.3 oranla ilk sırada yer aldı. Ardından uzamış antibiyotik kullanımı %86.7, ek hastalık varlığı %73.3, mekanik ventilasyon ve TPN %66.7 oranında saptandı. Üriner enfeksiyonda da benzer şekilde ilk sırada uzamış yatış (%100) yer aldı. Üriner kateter ve transfüzyon %73.3 oranla ikinci, uzamış antibiyotik kullanımı ve ek hastalık varlığı %60'lık oranla üçüncü sırada en sık görülen risk faktörleri olarak belirlendi. Genel mortalite oranı %22.8 (n=26) idi. YBÜ (%43.4) ve klinik (%4.9) arasında mortalite oranları karşılaştırıldığında YBÜ'de 16 kat daha fazla bulundu. Mortaliteyi etkileyen risk faktörleri incelendiğinde; uzamış yatış, TPN, 24 saati geçen bilinç kapalılığı, kateter varlığı ve mekanik ventilasyon tedavisinin mortalite üzerine anlamlı etkisinin olduğu saptandı.Merkezlerin kendi hasta profillerini, hastane florasını oluşturan mikroorganizmaları ve bunların direnç özelliklerini, her bölümdeki HE dağılımını ve sıklığını bilmeleri, doğru enfeksiyon kontrol yaklaşımlarının geliştirilmesini sağlar. Bu durum tesbiti, üniversitemiz hastanesi çocuk hastalarında gelişebilecek HE'lerine karşı doğru önlemlerin alınmasına, doğru tedavi yaklaşımlarının sağlanmasına yardımcı olacaktır.
Nosocomial Infections (NI) that cause mortality, morbidity and economic loss constitute a serious problem. Since the ratio of NI is higher than the community originated infections, importance of the issue increases. Surveillance studies are crucial in evaluation and follow up of NI. The surveillance of NI helps to determine the frequency of infections, the distribution of factors that cause infection, antibiotic sensitivity results and the medical treatments.The aim of the current study is to evaluate the NI types and proportions, mortality rates related to NI, contribution of NI to mortality and risk factors and frequently encountered microorganisms, among patients who were hospitalized in Pediatric Intensive Care Unit (PICU) and pediatric ward throughout 1 year.Ninety one patiens were followed throughout the study. Some patients had more than one NI episodes, and a total of 114 NI episodes and 95 organisms were isoleted (mean episode ratio for each patient was 1.25). The incidence of NI (PICU, pediatric ward, Neonatal Intensive Care Unit (NICU) and hematology-oncology ward) was 20.7%. For 100 admitted patients in PICU, NI ratio was 16.3 and in pediatric ward it was 8.4; on the other hand according to 1000 patient days, NI ratio was 18.5 in PICU, and it was 17.3 in pediatric ward. Primary bloodstream infection (BSI) was the first among diagnoses with 29% (n=36) ratio, pneumonia was the second with 24.2% ratio (n=30), and urinary tract infections (UTI) with 12% (n=15) shared the third place with peritonitis (12%, n=15). Considering the invasive procedures, central line associated BSI, ventilator associated pneumonia (VAP) and UTI were found as 8.9, 13.8 and 6/1000 catheter days, respectively. The proportions of microorganisms that were determined as the cause of NI were gram negative bacteria, gram positive bacteria and fungi; 60%, 31.6% and 8.4% respectively. Gram negative bacteria were the most common microorganism in BSI (61.3%). K.pneumoniae was the most common agent in gram negatives (35.5%), followed by A.baumannii (9.7%) and E.coli (6.5%). Gram negatives were most frequently encountered cause of hospital related pneumonia (85%). The most common microorganisms in hospital related pneumonia was A.baumannii (50%), followed by P.aeruginosa (15%) and S.maltophiliae (15%). The most common cause of UTI was gram negatives by 86.6%. The most commonly isolated microorganisms were E.coli (33.3%), K.pneumoniae (20%) and proteus mirabilis (20%). When the risk factors were examined, prolonged hospitalization, prolonged antibiotics use, existence of comorbid disease and cathater usage.The most common risk factors among the patients with BSI were; prolonged hospitalization (92.9%), existence of comorbid disease (92.9%), prolonged antibiotic usage (88%), transfusion (71.4%), invasive procedures (61.9%) and history of hospitalization in last month (59.5%). Among the ones diagnosed with pneumonia, prolonged hospitalization and catheter usage shared the first place among the risk factors (93.3%), followed by prolonged antibiotics usage (86.7%), existence of comorbid disease (73.3%), mechanic ventilation and total parenteral nutrition (TPN) (66.7%). Similarly in UTI, prolonged hospitalization was the most common risk factor (100%), followed by urinary catheter and transfusion (73.3%), prolonged antibiotics usage and existence of comorbid disease (60%). The mean mortality rate was 22.8% (n=26). When mortality rates were compared in PICU (43.4%) and pediatric ward (4.9%), it was 16 times more in PICU. When factors that affect mortality were examined, prolonged hospitalization, TPN, unconscious state beyond 24 hours, existence of invasive catheter and mechanic ventilation were found to be most effective ones.By knowing their patient profiles, microorganisms that make up the hospital flora, the resistance status of the microorganisms and NI prevalance and frequency in each clinic; hospitals can develop proper control methods. Determination of the situation through the current study, will be helpful in taking precautions and in providing the proper treatments, in case of possible NI in pediatric patients.
Nosocomial Infections (NI) that cause mortality, morbidity and economic loss constitute a serious problem. Since the ratio of NI is higher than the community originated infections, importance of the issue increases. Surveillance studies are crucial in evaluation and follow up of NI. The surveillance of NI helps to determine the frequency of infections, the distribution of factors that cause infection, antibiotic sensitivity results and the medical treatments.The aim of the current study is to evaluate the NI types and proportions, mortality rates related to NI, contribution of NI to mortality and risk factors and frequently encountered microorganisms, among patients who were hospitalized in Pediatric Intensive Care Unit (PICU) and pediatric ward throughout 1 year.Ninety one patiens were followed throughout the study. Some patients had more than one NI episodes, and a total of 114 NI episodes and 95 organisms were isoleted (mean episode ratio for each patient was 1.25). The incidence of NI (PICU, pediatric ward, Neonatal Intensive Care Unit (NICU) and hematology-oncology ward) was 20.7%. For 100 admitted patients in PICU, NI ratio was 16.3 and in pediatric ward it was 8.4; on the other hand according to 1000 patient days, NI ratio was 18.5 in PICU, and it was 17.3 in pediatric ward. Primary bloodstream infection (BSI) was the first among diagnoses with 29% (n=36) ratio, pneumonia was the second with 24.2% ratio (n=30), and urinary tract infections (UTI) with 12% (n=15) shared the third place with peritonitis (12%, n=15). Considering the invasive procedures, central line associated BSI, ventilator associated pneumonia (VAP) and UTI were found as 8.9, 13.8 and 6/1000 catheter days, respectively. The proportions of microorganisms that were determined as the cause of NI were gram negative bacteria, gram positive bacteria and fungi; 60%, 31.6% and 8.4% respectively. Gram negative bacteria were the most common microorganism in BSI (61.3%). K.pneumoniae was the most common agent in gram negatives (35.5%), followed by A.baumannii (9.7%) and E.coli (6.5%). Gram negatives were most frequently encountered cause of hospital related pneumonia (85%). The most common microorganisms in hospital related pneumonia was A.baumannii (50%), followed by P.aeruginosa (15%) and S.maltophiliae (15%). The most common cause of UTI was gram negatives by 86.6%. The most commonly isolated microorganisms were E.coli (33.3%), K.pneumoniae (20%) and proteus mirabilis (20%). When the risk factors were examined, prolonged hospitalization, prolonged antibiotics use, existence of comorbid disease and cathater usage.The most common risk factors among the patients with BSI were; prolonged hospitalization (92.9%), existence of comorbid disease (92.9%), prolonged antibiotic usage (88%), transfusion (71.4%), invasive procedures (61.9%) and history of hospitalization in last month (59.5%). Among the ones diagnosed with pneumonia, prolonged hospitalization and catheter usage shared the first place among the risk factors (93.3%), followed by prolonged antibiotics usage (86.7%), existence of comorbid disease (73.3%), mechanic ventilation and total parenteral nutrition (TPN) (66.7%). Similarly in UTI, prolonged hospitalization was the most common risk factor (100%), followed by urinary catheter and transfusion (73.3%), prolonged antibiotics usage and existence of comorbid disease (60%). The mean mortality rate was 22.8% (n=26). When mortality rates were compared in PICU (43.4%) and pediatric ward (4.9%), it was 16 times more in PICU. When factors that affect mortality were examined, prolonged hospitalization, TPN, unconscious state beyond 24 hours, existence of invasive catheter and mechanic ventilation were found to be most effective ones.By knowing their patient profiles, microorganisms that make up the hospital flora, the resistance status of the microorganisms and NI prevalance and frequency in each clinic; hospitals can develop proper control methods. Determination of the situation through the current study, will be helpful in taking precautions and in providing the proper treatments, in case of possible NI in pediatric patients.
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Keywords
Hastane enfeksiyonları, Çocukluk çağı, Risk faktörleri, Mortalite, Epidemiyoloji, Nosocomial infections, Childhood, Risk factors, Mortality, Epidemiology
Citation
Tuncer, E. (2009). Çocuk kliniği ve yoğun bakım ünitesinde yatan hastalarda hastane enfeksiyonları: Bir yıllık sürveyans çalışması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.