COVID-19 Hastalarında Ventilatörle İlişkili Pnömoni Risk Faktörleri ve Patojenlerin Değerlendirilmesi: Retrospektif Bir Çalışma

Amaç: COVID-19 Pandemisi esnasında yoğun bakımlarda takip edilen hastaların çoğunda mekanik ventilasyon gerekliliği ortaya çıkmıştır. Bu çalışmada yoğun bakım ünitelerindeki COVID-19 hastalarında ventilatör ilişkili pnömonilerin risk faktörlerinin, sıklığının ve etkenlerinin incelenmesi amaçlanmıştır. Yöntemler: Bu çalışma retrospektif bir tasarıma sahiptir ve bir eğitim araştırma hastanesinin 3. Basamak yoğun bakımlarında takip edilen COVID-19 hastaları arasında yapılmıştır. Çalışmaya Mart 2020 ile 1 Ocak 2021 arasında 3. Basamak yoğun bakımlarda entübe olarak takip edilen on sekiz yaşından büyük COVID-19 hastaları dahil edildi. Hasta dosyalarından endotrakeal aspirat kültürlerindeki üremeler, enfeksiyöz mikroorganizmalar ve antibiyotik duyarlılıkları gibi mikrobiyolojik veriler toplandı. Ventilatör ilişkili pnömonide etkili olan risk faktörlerini belirlemek için tek değişkenli ve çok değişkenli ikili Lojistik Regresyon analizi kullanıldı. Bulgular: Hastaların %52.9 (108)’unda ventilatör ilişkili pnömoni görüldü ve endotrakeal aspirat kültürlerindeki üreme ile doğrulandı. Kültürde üreme görülen hastaların hastane yatış (17.56±14.09)(gün) ve entübe takip süreleri (14.55±11.66)(gün) üreme görülmeyen hastaların hastane yatış (9.74±6.01) ve entübe takip (7.12±4.32) sürelerinden anlamlı yüksek idi (sırasıyla, P<0.001, P<0.001). Sonuç: Sonuç olarak, COVID-19 pandemisinde entübe yoğun bakım hastalarında ventilatör ilişkili pnömonilerin irdelendiği bu çalışmada en önemli prediktif faktörün mekanik ventilasyon süresi olduğu bulundu. Çalışmada en sık etkenin Acinetobacter baumannii olduğu tespit edildi.

Anahtar Kelimeler:

COVID-19, SARS-CoV-2, hastane enfeksiyonları, ventilatör ilişkili pnömoni, yoğun bakım.

Evaluation of Ventilator-Associated Pneumonia Risk Factors and Pathogens in COVID-19 Patients: A Retrospective Study

Objective: Many patients followed in intensive care units during the COVID-19 pandemic required mechanical ventilation. In the present study, the purpose was to examine the risk factors, frequency, and causative pathogens of ventilator-associated pneumonia in COVID-19 patients in intensive care units. Material and Method: The study had a retrospective study design and was conducted among COVID-19 patients followed in the tertiary intensive care units of a training and research hospital. COVID-19 patients, who were older than eighteen years, and intubated in the tertiary intensive care units between March 2020 and January 1, 2021, were included in the present study. Microbiological data such as reproductions in endotracheal aspirate cultures, infectious microorganisms, and antibiotic susceptibility were collected from the patient files. Univariate and Multivariate Binary Logistic Regression analysis were used to determine the risk factors effective in ventilator-associated pneumonia. Results: Ventilator-associated pneumonia was observed in 52.9% (108) of patients, which was confirmed by growth in endotracheal aspirate cultures. The hospitalization (17.56±14.09) and intubated follow-up times (14.55±11.66)(day) of the patients who had culture growth were significantly higher than the hospitalization (9.74±6.01) and intubated follow-up (7.12±4.32)(day) times of the patients without growth (P<0.001, P<0.001, respectively). Conclusions: In conclusion, in the present study, where ventilator-associated pneumonia evaluations were made in intensive care patients intubated during the COVID-19 pandemic, it was found that the most important predictive factor was the duration of mechanical ventilation. Acinetobacter baumannii was detected to be the most common causative pathogen in the study.

Keywords:

COVID-19, SARS-CoV-2, Nosocomial infections, Ventilator-associated pneumonia, Critical care.,

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