Cerrahi yenidoğan yoğun bakım ünitelerindeki gizli tehlike: Mantar sepsisi

Önbilgi/amaç: Nazokomiyal mantar sepsisi yenidoğan yoğun bakım ünitelerinde son yıllarda giderek artan, mortalitesi yüksek bir sorundur. Uzun süreli ve geniş etki alanlı antibiyotik kullanımı, prematürite ve düşük doğum ağırlığı mantar sepsisinin en önemli nedenlerindendir. Cerrahi yenidoğanlarda mantar sepsisi konusunda literatürde sınırlı bilgi bulunmaktadır. Bu çalışmanın amacı yenidoğan cerrahi yoğun bakım ünitesinde son 7 yılda saptanan mantar sepsisli olguların değerlendirilmesidir. Yöntem: 1995-2001 yıllarında yatırılarak inceleme ve tedavisi yapılan olgular; ortalama başvuru yaşı, cinsiyet, kilo, mantar sepsisi, bakteriyel sepsisle olan ilişki, tedavi yaklaşımı ve mortalite açısından geriye dönük irdelendi. Bulgular: Ünitemizde yılda ortalama 100.3 (87-124) olgunun tanı ve tedavisi yapılmaktadır. 1995-2001 arasında izlenerek mantar sepsisi saptanan 23 olgunun ortalama başvuru yaşı 3.8 gün (1-14 gün), ortalama ağırlığı 2376 gr (1654-6400 gr), erkek/kız oranı ise 17/6 idi. Mantar sepsisi saptanan 23 olgunun 17'sinde eşlik eden bakteriyel sepsis saptandı. Bakteriyel etkenler; Enterobacter Sp. (n=11), Metisiline dirençli staphylococcus aureus (n=4) ve diğer (n=2) olarak belirlenmiştir. Saptanan mantar sepsis etkeni tamamı Candida Albicans'tı. Kandida sepsisi en sık 1995 yılında gözlenmiş, rastlanan 14 olgunun 8'i kaybedilmiştir. Uygulanılan koruyucu antifungal tedavi nedeniyle mantar sepsisi azalmış, 2001 yılında ise hiç saptanmamıştır. Sonuç: Yoğun bakım ünitelerinde uzayan yatış süreleri, nazokomiyal bakteryel sepsis sıklığını attırmakta, bu nedenle kullanılan geniş etki alanlı antibiyotik tedavileri mantar sepsislerine zemin hazırlamaktadır. Mantar sepsislerinin engellenmesi için koruyucu antifungal kullanımı bir çözüm olarak görünmekle birlikte, ek riskler taşımaktadır. Bu durum antibiyotik kullanımını düzenleyen ciddi hastane enfeksiyon politikalarını gerekli kılmaktadır.

A hidden danger in surgical neonatal intensive care units: Fungal sepsis

Background/aim: Nosocomial fungal sepsis has been increasingly recognized and is a highly mortal pathology in neonatal intensive care units. The most common causes of fungal sepsis are prolonged usage of wide spectrum antibiotics, prematurity, and low birth weight. There is limited data in the literature related to fungal sepsis in surgical neonatal intensive care units. The aim of this study is to evaluate the fungal sepsis in the surgical neonatal intensive care unit. Method: Patients treated in surgical intensive care unit. The between 1995 and 2001 were evaluated retrospectively with regard to mean age at admission, sex, weight, fungal sepsis, relation with bacterial sepsis, therapeutical approach, and mortality. Results: On average, 100.3 (87-124) cases per year are treated in our unit. Between 1995 and 2001 23 fungal sepsis cases diagnosed with a, the mean age at admission of 3.8 (1-14) days, the mean weight of 2376 g (1654-6400), and the male/female ratio was 17/6. Of these 23 cases of fungal sepsis, 17 had a concomitant bacterial sepsis. Bacterial agents were Enterobacter sp (n:11), MRSA (n:4), and others (n:2). The causative agent of all of the fungal sepsis was Candida albicans. The year in which the highest number of Candidal infections were seen was 1995 with a total number of 14, 8 of which were lost. With the prophylactic use of antifungal agent, cases of fungal sepsis decreased overtime and no case of fungal sepsis was detected in 2001. Conclusion: Prolonged hospitalization in intensive care units increase the incidence of nosocomial bacterial sepsis and therefore wide-spectum use of antibiotics increases the incidence of fungal sepsis. While prophylactic use of antifungal agents to prevent fungal sepsis seems to be a solution, it has additional risks. This necessitates strict hospital infection policies regulating antibiotic use.

Kaynakça

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