Filiz YILDIRIM, KADRİYE KART YAŞAR, Gönül ŞENGÖZ, Rahşan YAMANLAR, Fatime NAYMAN, KADİR İDİN

Erişkin yoğun bakım ünitesinde stenotrophomonas maltophilia infeksiyonu ve kontrolü

Bu çalışmanın amacı, yoğun bakım ünitelerinde (YBÜ) giderek artan bir problem olan Stenotrophomonas maltophilia infeksiyonlarına ve bakterinin yayılımını engellemek için alınması gereken önlemlere dikkat çekmektir. Hastanemizde aynı koridor üzerinde bulunan sekiz ve altı yataklı 2 ayrı erişkin YBÜ’de 36 günlük periyotta beş ayrı hastadan alınan kan kültürlerinden S.maltophilia suşu izole edilmesi üzerine; hastane infeksiyonu/salgın şüphesi ile sürveyans çalışması yapılmış ve izolasyon ve kontrole yönelik gerekli önlemlerin yer aldığı bir prosedür izlenmiştir. Üç kadın hasta solunum yetmezliği, travma ve intrakranyal kanama, iki erkek hasta ise aspirasyon pnömonisi tanısı ile yatmaktaydı. Yatıştan sonra, kan kültüründe bakteri üremesinin saptandığı gün ortalaması 36 gündü (19-70). Hastaların biri ölmüş, diğerleri 30-54 günde iyileşmiştir. YBÜ 1 ve 2’nin aynı koridora açılan kapıları olduğu, hastalarına farklı doktor, hemşire ve temizlik personeli tarafından bakım verildiği saptanmıştır. Ancak gece nöbetlerinde bu durumun zaman zaman sağlanamadığı, buna bağlı olarak da iki YBÜ arasında bu bakterinin yayıldığı fikrine varılmıştır. Hastalar arasında yayılımı durdurmak için YBÜ’de izolasyon önlemleri alınmış, personelin el yıkama ve hastane infeksiyonlarının yayılımı konusundaki eğitimleri güncellenmiştir.

Control of stenotrophomonas maltophilia infection in an adult intensive care unit

The aim of this study is to take attention to Stenotrophomonas maltophilia infections, a rising problem in ICU’s, and to necessary precautions in order to control the acquisition and spread of this microorganism. There are total 14 (eight and six) beds in two separate ICU’s in the same corridor in our hospital. Since Şve S.maltophilia strains were isolated from blood cultures taken in 36 days period, we started a surveillance study for a possible hospital infection /outbreak and we followed a procedure containing isolation and infection control precautions.Three female patients were hospitalized with diagnosis of shortness of breath, trauma and intracranial bleeding, and two male patients were hospitalized with diagnosis of aspiration pneumonia. Average day of bacterial growth detection after hospitalization was 36 (19-70) days. One of the patients were lost, others were recovered in 30-54 days. ICU 1 and 2 have doors into the same corridor. Different phycisians, nurses and hospital workers take care of two ICU patients. However, this cannot be provided in night shifts. We concluded that night staff spreaded the agent between two ICU’s. Isolation precautions were taken to prevent spread of the infection between the patients, hospital infection and handwashing trainings were repeated.

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