Katater İlişkili Üriner Sistem Enfeksiyonlarında Mortalite ile İlişkili Faktörlerin Değerlendirilmesi: 5 Yıllık Retrosepektif Çalışma

Amaç: Bu çalışmanın amacı, kateter ilişkili üriner sistem enfeksiyonlarında (Kİ-ÜSİ) mortalite ile epidemiyolojik faktörler, komorbid durumlar, antibiyotik direnci, ampirik antimikrobiyal tedavi ve laboratuvar parametreleri arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Yoğun bakım ünitesine 1 Ocak 2015 ile 1 Ocak 2020 arasında kabul edilen 18 yaş ve üzeri hastalarda retrospektif bir kohort çalışması tasarlanmıştır. Birincil sonlanım noktası hastanın kabulünün ilk 28 günü içinde ölüm, ikincil sonlanım noktası ise 28. günden sonra sağkalımdı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Çalışmaya medyan yaşı 78, 198’i (%52.8) kadın toplam 375 hasta alındı. En sık saptanan mikroorganizmalar Escherichia coli (%50.9) ve Enterococcus faecalis (%16.8)’idi. Gram negatif bakterilerin üçüncü kuşak sefalosporinlere, siprofloksasine ve meropeneme direnci sırasıyla %41.3, %40 ve %8.6 saptandı. Gram pozitif bakterilerin %0.3’ünde vankomisin direnci tespit edildi. Mortalite oranı %58.1 idi. Artmış mortalite riski ile ilişkili faktörler ≥65 yaş, malignite varlığı, mekanik ventilasyon, APACHE II skoru ≥20 ve septik şok tanısıydı. Daha düşük ölüm riski ile ilişkili tek faktör kültürde E. coli’nin saptanmasıydı. Sonuç: Yaşlılığın, malignitenin, klinik skorlama sistemlerinin ve mikrobiyolojik sonuçların mortalite üzerine etkisi olduğu belirlendi. Bu çalışmanın sonuçları, kılavuzlarda yer alan enfeksiyon kontrol önlemleri ve tedavi önerileri ile birlikte değerlendirildiğinde, Kİ-ÜSİ’ye bağlı mortalitenin azaltılabileceğini düşünmekteyiz..

Anahtar Kelimeler:

Üriner kanal enfeksiyonları, idrar yolu kateterleri, ölüm oranı, antibiyotikler, ilaç direnci, kateter kaynaklı enfeksiyonlar

Evaluation of Factors Associated With Mortality in Catheter-Related Urinary Tract Infections: A 5-Year Retrospective Study

Objective: The aim of the study is to evaluate the relationship between mortality and epidemiological factors, comorbid conditions, antibiotic resistance, empirical antimicrobial therapy, and laboratory parameters in catheter-associated urinary tract infections (CAUTI). Materials and Methods: A retrospective cohort study was designed in patients aged ≥18 years admitted to intensive care unit between 1st Jan 2015 and 1st Jan 2020. The primary endpoint was death within the first 28 days of admission, while the secondary endpoint was survival after 28 days. p value <0.05 was considered statistically significant. Results: A total of 375 patients with a median age of 78 were included in the study; 198 (52.8%) were female. The most commonly detected microorganisms were Escherichia coli (50.9%) and Enterococcus faecalis (16.8%). Resistance to third generation cephalosporin, ciprofloxacin, and meropenem was found in 41.3%, 40%, and 8.6% of Gram-negative bacteria, respectively. Vancomycin resistance was detected in 0.3% of the Gram-positive bacteria. The mortality rate was 58.1%. Factors associated with an increased risk of mortality were age ≥65 years, presence of malignancy, mechanical ventilation, APACHE II score ≥20, and a diagnosis of septic shock. The only factor associated with the lower mortality risk was the detection of E. coli in culture. Conclusion: It was determined that aging, malignancy, clinical scoring systems and microbiological results had an effect on mortality. Considering the results of this study together with the infection control measures, and treatment recommendations in the guidelines, we think that mortality due to CAUTI can be reduced.

Keywords:

Urinary tract infections, urinary catheters, mortality, antibiotics, drug resistance, catheter-related infections,

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