Görkem ŞAHİN, Bahriye ATMIŞ, Engin MELEK, Aysun Karabay BAYAZIT

Çocuklarda hemodiyaliz kateteri ilişkili enfeksiyonlar

Amaç: Bu çalışma ile kronik hemodiyaliz programında olan çocuk hastaların kateter ilişkili kan dolaşım enfeksiyonu (Kİ-KDE), kateter çıkış yeri enfeksiyonu (KÇE) oranlarının ve sorumlu mikroorganizmaların belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamızda takip edilmekte olan kronik hemodiyaliz tedavisindeki 12 hastanın 2015-2017 yılları arasındaki kateter çıkış yeri kültürleri ve kateterden alınan kan kültürleri verileri retrospektif olarak incelendi. Bulgular: 2015, 2016 ve 2017 yılları içerisinde takipte olan 12 hemodiyaliz hastası çeşitli nedenler ile 127 kez yatırılarak tedavi edilmişti. Bu yatışların 17’si (%13,3) Kİ-KDE veya KÇE nedeniyleydi. Bu hastalardan yedisinde (%58,3) hem KÇE hem de Kİ-KDE, ikisinde (%16,6) sadece KÇE ve birinde (%8,3) ise sadece Kİ-KDE saptandı. KÇE şüphesi taşıyan dokuz (%75) hastada 22 kez üreme saptanmıştı. Kültürlerde üreyen mikroorganizmalar sıklık sırasıyla Staphylococcus aureus, Staphylococcus epidermidis, Acinetobacter baumannii complex, Enterobacter cloacae Pseudomonas aeruginosa ve Klebsiella pneumonia idi. Kİ-KDE şüphesi taşıyan 9 (%75) hastada 31 kez anlamlı üreme saptanmıştı. Kültürlerde üreyen mikroorganizmalar sıklık sırasıyla S.aureus, S.epidermidis, E.cloacae, A.baumannii complex, S.hominis ve P.aeruginosa idi.. Sonuç: Kronik hemodiyaliz yapılan çocuklarda Kİ-KDE ve/veya KÇE sıklıkla görülmektedir. Tek başına Kİ-KDE oranı düşük iken, Kİ-KDE ile KÇE’nin aynı anda veya KÇE’yi takiben Kİ-KDE’nun gelişimi nedeniyle kateterin bakımı için aile ve çocuğun eğitimi ilk sırada göz önünde tutulmalıdır.

Hemodialysis catheter related infections in children

Purpose: The aim of this study was to determine the rate of catheter-related bloodstream infection (CRBSI), exit site infection, and responsible microorganisms in pediatric hemodialysis patients. Materials and Methods: In this study, the data of catheter exit site and blood cultures from 12 chronic hemodialysis patients who were followed up during 2015-2017 were retrospectively analyzed. Results: Twelve pediatric hemodialysis patients in 2015, 2016 and 2017 were hospitalized 127 times for various reasons. Seventeen (13.3%) of these hospitalizations were due to CRBSI or exit site infections. Seven of these patients (58.3%) had both CRBSI and exit site infection, two (16.6%) had exit site infection only, and one (8.3%) had CRBSI. Nine (75%) patients with suspected exit site infection had 22 culture positivity. Microorganisms growing in cultures were Staphylococcus aureus, Staphylococcus epidermidis, Acinetobacter baumannii complex, Enterobacter cloacae, Pseudomonas aeruginosa, and Klebsiella pneumonia, respectively. Nine (75%) patients with suspected CRBSI had 31 culture positivity. Microorganisms growing in cultures were S.aureus, S.epidermidis, E.cloacaa, A.baumannii complex, S.hominis, and P. aeruginosa, respectively. Conclusion: In children with chronic hemodialysis, CRBSI and/or exit cite infections are seen as common. While CRBSI rate is low alone, the education of the family and the child for the care of catheter should be considered first due to the development of the CRBSI and exit site infection at the same time, or the development of CRBSI following exit site infection.

Keywords:

children, hemodialysis, catheter-related infections,

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