Pediatrik Kardiyovasküler Cerrahi Yoğun Bakım Ünitesinde Görülen Nozokomiyal İnfeksiyonların Özellikleri, Patojenler ve Mortalite ile İlgili Risk Faktörleri Açısından Değerlendirilmesi

Giriş: Bu çalışmanın amacı, pediatrik kardiyovasküler cerrahi yoğun bakım ünitesinde görülen nozokomiyal infeksiyonları (Nİ) özellikleri, patojenler, mortaliteyle ilgili risk faktörleri ve mortalite sıklığı açısından değerlendirmektir. Hastalar ve Yöntem: Bu retrospektif çalışmada, yaşları 1 ay ila16 yıl arasında değişen, Kartal Koşuyolu Eğitim ve Araştırma Hastanesinde Ocak 2014-Ocak 2016 tarihleri arasında kardiyovasküler cerrahi geçirmiş 838 çocuğun dosyaları değerlendirilmiştir. Hastalık kontrol merkezi kriterlerine göre Nİ tespit edilmiş hastalar çalışmaya alınmıştır. Nİ prevalansı ve çeşitli risk faktörleriyle Nİ arasındaki ilişkiler istatistiksel olarak analiz edilmiştir. Bulgular: Toplam 838 hastadan 54 (%6.4)’ünde Nİ [(solunum sistemi (%53.9), idrar yolu (%24.8), bakteremi (%15.7) ve yara yeri infeksiyonları (%5.6)] mevcuttu. İzole edilen patojenler: Klebsiella pneumoniae (%20.4), Pseudomonas aeruginosa (%18.6), Candida albicans (%18.6), Stenotrophomonas maltophilia (%13.8), Acinetobacter baumannii (%10.5), koagülaz negatif stafilokok (9.1%), metisilin dirençli Staphylococcus aureus (MRSA) (3.6%), Serratia marcescens (1.8%), Citrobacter freundii (%1.8) ve Providencia rettgeri (1.8%) ve Nİ nedeniyle mortalite oranı %13.7 (11/80) bulunmuştur. Çocukların yaşı ve mekanik ventilasyon süresi ile Nİ arasında anlamlı bir ilişki saptanmış (p< 0.05); cinsiyet, nazogastrik beslenme ve eşlik eden anomaliler ile Nİ arasında anlamlı bir ilişki bulunamamıştır (p> 0.05). Sonuç: PKVC sonrası Nİ sıklığı %6.4 ve en sık Nİ morbidite ve mortalite etkeni gram-negatif bakteriler olmuştur. Yoğun bakımda takip edilen hastalarda endotrakeal aspirat, kan, idrar ve yara kültürlerinin gönderilmesi ve NKİ ile ilişkili risk faktörlerinin zamanında değerlendirilmesi, gerekli infeksiyon kontrol önlemlerinin alınarak postoperatif morbidite ve mortalitenin azaltılmasını sağlayacaktır.

Anahtar Kelimeler:

Nozokomiyal infeksiyon, çocuklar, kardiyovasküler cerrahi, yoğun bakım

Evaluation of Properties, Pathogens, and Mortality-Related Risk Factors of Nosocomial Infections in Pediatric Cardiovascular Surgery Intensive Care Unit

Introduction: The aim of this study was to evaluate the properties, pathogens, mortality-related risk factors, and mortality rates of nosocomial infections (NIs) in the pediatric cardiovascular surgery intensive care unit. Patients and Methods: The files of 838 children, aged 0-16 years, who underwent cardiovascular surgery between January, 2014 and January, 2016 in Kartal Koşuyolu Research Hospital were evaluated in this retrospective study. NI was diagnosed according to the Center for Disease Control criteria. The correlations between several risk factors and NI were statistically analyzed. Results: Fifty-four children out of 838 (6.4%) had NI. 29 of them (53.9%) had respiratory tract infections, 14 (24.8%) had urinary tract infections, 8 (15.7%) had bacteremia and 3 (5.6%) had wound site infections. The isolated pathogens were Klebsiella pneumoniae (20.4%), Pseudomonas aeruginosa (18.6%), Candida albicans (18.6%), Stenotrophomonas maltophilia (13.8%), Acinetobacter baumannii (10.5%), coagulase-negative staphylococci (9.1%), methicillin-resistant Staphylococcus aureus (MRSA, 3.6%), Serratia marcescens (1.8%), Citrobacter freundii (1.8%), and Providencia rettgeri (1.8%). The mortality rate due to NI was 13.7% (11/80). There was a statistically significant relationship between NIs and age and duration of mechanic ventilation (p< 0.05), but not between NIs and gender, accompanying abnormalities, and nasogastric feeding (p> 0.05). Conclusion: Gram-negative bacteria were the most common pathogens of NI, which caused mortality. Assessing the responsible pathogens and determining the risk factors will help us to develop effective infection control measures for reducing the morbidity and mortality rates.

Keywords:

Nosocomial infection, pediatry, cardiovascular surgery, intensive care unit,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi