Yavuz ORAK, Salih YILDIRIM, Rukiye MENENCİOĞLU, Ahmet ALTUN, Filiz ORAK, Cevdet DÜGER, Esra ÖZPAY, Fatih Mehmet YAZAR

Yoğun Bakım Ünitesinde Ampirik Antibiyotik Kullanımı ve Beslenmenin, Enfeksiyon Görülme Sıklığı ile İlişkisi

Amaç: Bu çalışmanın amacı YBÜ’nde başlanan ampirik antibiyotiğin, kültür sonuçlarıyla ampirik olarak başlanan antibiyotik değişiminin, hastanın beslenme şeklinin ve karşılanan kalori ihtiyacının mortalite ve enfeksiyon gelişimi üzerine etkisini belirlemekti. Yöntemler: Lokal etik kurul onayı alındıktan sonra hastanemiz YBÜ’nde yatan 476 hastanın dosyaları geriye dönük tarandı. Çalışmaya 18 yaş üstü, en az 3 gün mekanik ventilatör tedavisi almış 159 hasta dahil edildi. Kan, idrar ve trakealaspirat kültüründe üreme olup olmadığı belirlendi. Kültür sonucuna göre antibiyotiklerin değişip değişmediği kayıt altına alındı. Beslenme şekilleri, beslenme gün sayısı ve bazal kalori ihtiyacı belirlendi. Bazal kalori ihtiyacının 1, 3 ve 5. günlerde karşılanıp karşılanmadığı araştırıldı. Mortaliteye etki eden faktörler araştırıldı. Bulgular: Ölen hastalarda antibiyotik değişimi anlamlı olarak daha fazlaydı (P = 0.002). Hedef kaloriye ulaşılamayan hastalarda mortalite daha yüksekti (P = 0.01). Ampirik antibiyotik değişimi (r:0.174, P=0.028) , kültür pozitifliği (r:0.177, P=0.026) hedef kaloriye ulaşamama mortalite ile ilişkiliydi(r:0.195, P=0.014) . Subgrup analizde trakealaspirat kültüründe üreme mortaliteyi etkileyen önemli bir faktördü (r: 0.211 P: 0.008). Sonuç: Yoğun bakım ünitesinde yatış, gün sayısı, antibiyotik değişimi, kültür pozitifliği ve beslenmede hedef kaloriye ulaşamama mortalite ile ilişkilidir.

The use of empirical antibiotics in intensive care unit and relationship between nutrition and the incidence of infection

Objective: Aim of study is to determine which antibiotic is started empirically in the ICU and to investigate whetherthe antibiotic started according to culture result was changed or not and the effect of this change on mortality, and toinvestigate the relationship between mortality and infection by determining whether enteral and parenterally fedpatients have attained sufficient calorie level.Method: After the approval of the local ethics committee, the files of 476 patients hospitalized in our hospital wereretrospectively reviewed. A total of 159 patients over 18 years of age who received mechanical ventilation therapy forat least 3 days were included in the study. Blood, urine and tracheal aspirate culture were determined. It wasrecorded whether antibiotics had changed according to the culture result. Nutritional patterns, number of feedingdays and basal caloric need were determined. It was investigated whether basal calorie need was met on 1, 3 and 5days. Factors affecting mortality were investigated.Results: Antibiotic exchange was significantly higher in the patients who died (P = 0.002). Mortality was higher inpatients who were unable to reach the target calorie (P = 0.01). Empirical changes in antibiotics (r: 0.174, P = 0.028),and culture positivity (r: 0.177, P = 0.026) were associated with mortality (r: 0.195, P = 0.014). In the subgroupanalysis, reproduction in tracheal aspirate culture was an important factor affecting mortality (r: 0.211 P: 0.008).Conclusions: The number of days of hospitalization, antibiotic change, culture positivity and inability to reach thetarget calories in nutrition are associated with mortality in the intensive care unit

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