Sertaç ARSLAN, Emre DEMİR, Ayhanım TÜMTÜRK, Özlem ERÇEN DIKEN

GÖĞÜS HASTALIKLARI HASTANESİNDE SAĞLIK BAKIMI İLİŞKİLİ PNÖMONİ HASTALARININ DEĞERLENDİRİLMESİ

Amaç: Sağlık Bakımı ile İlişkili Pnömoniler (SBİP), sağlık hizmetlerinin yaygınlaşması ile önemi gittikçe artan, yüksek mortalite ve morbiditeye sahip hasta grubudur. Çalışmamızın amacı, göğüs hastanesinde SBİP tanısı ile tedavi edilmiş ve solunum örneklerinde etken üretilebilmiş hastaların yaş, cinsiyet, etken spektrumu, yatış süresi, yoğun bakım gereksinimi, tedaviye yanıt ve ölüm oranları yönünden SBIP kriterlerleri de gözönüne alınarak değerlendirilmesidir.Gereç ve Yöntemler: Ocak 2013-Temmuz 2014 tarihleri arasında Çorum Göğüs Hastalıkları Hastanesi'nde yatarak tedavi edilen Sağlık Bakımı İlişkili Pnömoni hastalarından, balgam/solunum yolu örneklerinde etken üretilebilmiş olan 52 olgu; yaş, cinsiyet, eşlik eden kronik hastalıklar, etken spektrumu, yatış süreleri, yoğun bakım ihtiyacı, başlangıç tedavisin yanıt ve ölüm oranı açısından retrospektif olarak incelendi.Bulgular: Toplam 52 olgu; 35 erkek (%67), 17 kadın (%33) hastadan oluşuyordu. Yaş ortalaması 71.87 bulundu. En sık görülen ek hastalık 42 (%81) olgu ile KOAH'tı. Yirmialtı hastada (%50) yoğun bakım gereksinimi ortaya çıktı. Nörolojik komorbidite YBÜ ihtiyacı (%88) ve mortalite (%77) için anlamlı risk faktörü olarak saptandı. Toplam 22 hasta (%42) kaybedildi. Başlangıç ampirik antibiyotik tedavisine göre takipte antibiyotik değişikliği gereksiniminde ve mortalitede anlamlı farklılık saptanmadı. Etkenlere göre mortalite oranında 13 hasta ile (%65) A. Baumanii ilk sırada yer aldı.Sonuç: Sağlık bakımı ilişkili pnömoni hastalarında tedavi başlangıcında seçilen antibiyotik rejiminin daha geniş spektrumlu tercih edilmesi ile mortalite ve yoğun bakım gereksiniminde azalma saptanmamıştır.

Assessment of Patients with Healthcare Associated Pneumonia in Chest Diseases Hospital

Objective: Healthcare-associated Pneumonia (HCAP) gaining importance as healthcare services getting more accessible. In recent studies, suspicion started to rise about the benefits of broad spectrum antibiotics applied empirically because of healthcare related pneumonia criteria. The aim of this study is to assess HCAP patients to see the difference between broad spectrum antibiotic therapy against narrow spectrum. Method: Having been treated in a chest diseases hospital between January 2013 and July 2014, 52 cases of healthcare-associated pneumonia who had positive cultures for sputum/respiratory tract samples were retrospectively examined in age, sex, comorbid diseases, isolated agent, length of hospitalization, intensive care requirement, need for a change in antibiotics depending on the first line treatment and mortality rate.Results: Thirty-five men (67%) and 17 women (33%) were evaluated. The mean age was 71.87 years. Most common comorbidity was COPD (81%). Twenty-six patients (50%) were in need of intensive care. Neurological diseases were found to be most related with intensive care requirement (88%). Twenty-two patients (42%) were died. A. Baumanii ranked the first with 13 patients (65%) for mortality rate according to agents. Conclusion: In our study, no significant difference found between broad spectrum antibiotics group and the others in terms of mortality and need for ICU.

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