Derya SEYMAN, Filiz KİZİLATES, Nefise OZTOPRAK, Hande BERK, Alper TAHMAZ, Armagan AYDİN, Mustafa YİLDİZ

Kanser hastalarında sağlık Hizmeti-ilişkili enfeksiyonlar

Amaç: Kanser hastalarında enfeksiyonlar önemli morbidite ve mortalite nedenleridir. Çalışmada solid tümörlü erişkin hastalarda sağlık hizmeti-ilişkili enfeksiyonların (SHİE) özellikleri ve etyolojik etkenlerin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Solid tümörü olan ve Antalya Eğitim ve Araştırma Hastanesi onkoloji kliniğinde Ocak 2012- Aralık 2014 tarihleri arasında yatırılan hastalar retrospektif olarak incelendi. Bulgular: Kırk sekiz hastada 65 SHİE (35 hastada bir, dokuz hastada iki ve dört hastada üç atak) saptandı. Enfeksiyon ataklarının %92.3'ünde hastalar nötropenikti. On sekiz (%27.7) kandolaşımı enfeksiyonu (KDE), bir (%1.5) santral kateter-ilişkili KDE, 14 (%21.5) pnömoni, 11 (%17.0) idrar yolu enfeksiyonu (İYE), yedi (%10.7) sekonder bakteremi, sekiz (%12.3) kateter- ilişkili İYE ve altı (%9.3) yumuşak doku enfeksiyonu tespit edildi. Elli dört (%77.1) gram-negatif, 12 (%17.1) gram- pozitif ve dört (%5.8) mantar olmak üzere toplam 70 etken izole edildi. Escherichia coli en sık görülen mikroorganizmaydı (%41.4) ve %65.5'i genişlemiş spektrumlu beta-laktamaz pozitifti. Acinetobacter baumannii izolatları karbapenemlere, koagülaz negatif stafilokoklar (KNS) metisiline dirençli idi. KDE oranı %40.0 idi ve 18 (%64.2) gram-negatif, dokuz (%32.1) gram-pozitif ve bir (%3.7) mantar olmak üzere 28 mikroorganizma izole edildi. En sık etkenler; Escherichia coli (%39.2) ve KNS (%25.0) idi. Sonuç: İmmünsupresif hastalarda etkin empirik antimikrobiyal tedavi için bölgesel etken mikrooranizmaları ve direnç paternlerini bilmek önemlidir. Bu bulgular ışığında GSBL üreten gram-negatif bakterilere bağlı enfeksiyon oranlarının yüksek olduğu merkezlerde ve gram-pozitif bakterilere bağlı enfeksiyon şüphesinde başlangıç antibiyotik tedavisi bu etkenleri de kapsayacak şekilde genişletilebilir.

Healthcare-associated infections in patients with cancer

Objective: Infections are major causes of morbidity and mortality in patients with cancer. We aimed to determine the epidemiological features and etiologic agents in healthcare-associated infections (HCAI) in adult patients with solid tumors. Material and Methods: Patients with solid tumors admitted to oncology unit of Antalya Education and Research Hospital between January 2012- December 2014 were evaluated retrospectively. Results: There were 65 HCAI in 48 patients (35 with one, nine with two, and four with three episodes). In 92.3% of the episodes, the patients were neutropenic. There were 18 (27.7%) bloodstream infection (BSI), one (1.5%) central line-associated BSI, 14 (21.5%) pneumoniae, 11 (17.0%) urinary tract infection (UTI), seven (10.7%) secondary bacteremia, eight (12.3%) catheter-associated UTI and six (9.3%) soft tissue infections. Totally, 70 agents including 77.1% gram-negative, 17.1% gram-positive and 5.8% fungi were isolated. The most frequent microorganism was Escherichia coli (41.4%), 65.5% were producing extended spectrum betalactamase (ESBL). Acinetobacter baumannii isolates were resistant to carbepenems, coagulase negative staphylococci (CNS) isolates were resistant to methicillin. BSI rate was 40.0% and 28 microorganisms including 64.2% gram-negative, 32.1% gram-positive and 3.7% fungi were isolated. The most frequent microorganisms were E.coli (39.2%) and CNS (25.0%). Conclusion: For effective empirical antimicrobial therapy, knowing the local causative agents and resistance patterns is important in immunosuppressive patients. In the light of these findings, in centers with high rate of infections caused by ESBL producing bacteria or in case of suspicion of infection with methicilin resistant gram-positive bacteria, initial antimicrobial therapy can be extended covering these agents.

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