Çocuklarda genişlemiş spektrumlu β-Laktamaz üreten E. coli enfeksiyonlarında risk faktörleri ve klinik sonuçları; beş yıllık çalışma

Amaç: Genişlemiş spektrumlu b-laktamaz (GSBL) üreten bakteriyel patojen prevalansı tüm dünyada, özelikle yoğun bakım ünitelerinde artış göstermektedir. Bu çalışmanın amacı çocuklarda GSBL üreten Escherichia coli (E.coli) enfeksiyonları ile ilişkili risk faktörleri ve klinik sonuçları belirlemekti. Gereç ve Yöntem: Uludağ Üniversitesi Çocuk Kliniğinde, 1 Ocak 2004 ve 31 Aralık 2008 tarihleri arasında vaka-kontrol çalışması yapılması planlanmıştır. GSBL üreten E. coli’ye bağlı enfeksiyon gelişen hastalar ile GSBL üretmeyen E. coli enfeksiyonu olan hastalar karşılaştırıldı. Hastalar önceden antibiyotik kullanımı, altta yatan hastalık, invazif cihaz varlığı, uzamış hastane yatışı, uzamış antibiyotik kullanımı ve diğer demografik özellikler gibi risk faktörleri yönünden analiz edildi. Bulgular: Kliniğimize 1 Ocak 2004 ve 31 Aralık 2008 tarihleri arasında (beş yıllık dönemde) yatarak izlenen 8879 hastadan 136’sında E.coli enfeksiyonu saptandı, sıklık 15.3/1000 hasta yatışı olarak bulundu. Hastaların ortalama yaşları 55.4±52.6 ay (3 gün-18 yaş) ve %60’ı kız idi. GSBL üreten izolatların prevalansı %54.4 olarak bulundu. E. coli enfeksiyonlarının %68’i hastaneden edinilmiş enfeksiyonlardı. Bu çalışmada, GSBL üreten E.coli enfeksiyonları için risk faktörleri olarak çocuk yoğun bakım ünitesinde yatış, hastane kaynaklı enfeksiyon, geniş spektrumlu antibiyotik alımı, uzamış antibiyotik alımı, uzamış yatış, immünsupresif tedavi alımı, kan transfüzyonu uygulaması, santral venöz kateter varlığı ve total parenteral beslenme bulundu (p

Risk factors for and clinical outcomes of infections caused by extended-spectrum β -lactamase-producing escherichia coli in children: Results of a 5 year study

Aim: The prevalence of extended-spectrum beta lactamase (ESBL) producing bacterial pathogens, particulary in intensive care units, has been increasing worldwide. The aim of this study was to define the risk factors and clinical outcomes associated with ESBL-producing Escherichia coli (E.coli) infections in children. Material and Method: We conducted a case-control study between January 1, 2004 and December 31, 2008 at the Uludag University Pediatric Clinic. All patients with ESBL-producing E.coli infections were compared to patients with non-ESBL-producing E.coli infections. Risk factors analyzed included prior antibiotic use, underlying diseases, invasive medical devices, and other demographic characteristics. Results: E.coli infections were diagnosed in 136 of the 8879 patients hospitalized in our center between January 1, 2004 and December 31, 2008 (overall incidence, 15.3 per 1,000 admissions). The mean age of patients was 55.4±52.6 months (3 days-18 years) and 60% were female. The prevalence of ESBL-producing isolates among E.coli was found to be 54.4%. Sixty-eight percent of the E.coli infections were nosocomial. In this study, risk factors for ESBL-producing E.coli infections included pediatric intensive care unit stay, nosocomial infection, therapy with broad-spectrum antibiotics, prolonged exposure to broad-spectrum antibiotics, prolonged hospitalization, use of immunosuppressant medications, blood transfusion, presence of a central venous catheter and total parenteral nutrition (p<0.05). The mortality rate of E.coli infection was found to be 16.9%. Predisposing factors associated with mortality were; presence of septic shock, congenital heart disease, nosocomial infection, presence of ESBL-producing E.coli infections, pediatric intensive care unit stay, therapy with broad-spectrum antibiotics, prolonged exposure to broad-spectrum antibiotics, prolonged hospitalization, neutropenia, presence of central venous catheter and mechanical ventilation (p<0.05). Conclusion: In this study, the prevalence of ESBL-producing isolates among E.coli was 54.4%. The mortality (24.3%) for the patients in the ESBL group was significantly higher than the mortality for the patients in the non- ESBL group (8%) (p<0.05).

Kaynakça

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