Ruşen UZUN, Burcu KARABOĞA, Aykut ÇİLLİ

Sağlık bakımıyla ilişkili pnömoni

Giriş: Son yıllarda sağlık sistemindeki değişiklikler sonucunda, hastaneye yatış, uzun süreli bakım evinde kalma, ayaktan infüzyon tedavisi, evde bası yarası bakımı, hemodiyaliz merkezinde tedavi öyküsü bulunanlarda gelişen pnömoni sağlık bakımıyla ilişkili pnö- moni olarak tanımlanmaktadır. Materyal ve Metod: Bu çalışmanın amacı 1 Ocak 2009 - 1 Haziran 2012 tarihleri arasında Akdeniz Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Kliniği'nde yatan sağlık bakımıyla ilişkili pnömoni (SBİP) olguları retrospektif olarak değerlendirildi. Bu dönemde tanı almış toplam 195 pnömonili olgunun, 76 (%38.9)sı SBİPli ve 119 (%61.1)u toplumdan gelişen pnömonili (TGP) idi. Bulgular: SBİP olgularının, 61 (%80.3)inin son 90 gün içinde iki veya daha fazla gün hastaneye yatış öyküsü, 7 (%9.2)sinin son 30 günde hemodiyaliz merkezinde tedavi alma öyküsü, 3 (%3.9)ünde evde bası yarası tedavisi uygulanması, 1 (%1.3) olguda ise uzun süreli bakımevinde kalma öyküsü ve evde infüzyon tedavisi alma öyküsü olduğu saptandı. TGPli grup ile karşılaştırıldığında SBİP olgularının komorbiditesi daha fazla (%94.6ya %73.1; p< 0.001) ve ortalama PSI skoru (104.4e 90.2; p< 0.05) daha yüksek idi. 18 SBİP (%23.6) ve 11 (%9.2) TGP olgusunda etken saptanmış idi. En sık izole edilen mikroorganizmalar, SBİPte Streptococcus pneumonia, Acinetobacter baumannii, Staphylococcus aureus (MRSA) iken, TGPde Streptococcus pneumonia, Klebsiella spp.; Pseudomonas aeruginosa, Moraxella catarrhalis idi. Ulusal ve uluslararası rehberlere göre SBİP grubunda olguların %73.7si, TGP grubunda ise %98.3ünde uygun tedavinin başlandığı saptandı (p< 0.001). Ortalama hastanede yatış süresi (12.7 ± 1.1e karşı 7.8 ± 0.5 gün; p< 0.05) ve mortalite oranı (%22.4e %4.2; p< 0.001) SBİP grubunda TGPye göre yüksek idi. Ortalama yatış maliyetleri incelendiğinde, SBİP maliyetinin (4150.6 ± 892 TLye karşı 2078.7 ± 571 TL; p< 0.05) TGPden daha fazla olduğu saptandı. Sonuç: Sonuç olarak, SBİPli hastaların hasta özellikleri, komorbid durumları, etken mikroorganizmaları, yatış süreleri, maliyetleri ve prognozları TGP grubundan farklıdır. Pnömoni tanısı konulan hastalar SBİP açısından sorgulanmalı ve ampirik antibiyotik tedavisi başlanırken geniş spektrumlu (dirençli mikroorganizmaları kapsayacak şekilde) antibiyotikler tercih edilmelidir.

Health-care associated pneumonia

Introduction: Health-care associated pneumonia (HCAP) is defined as pneumonia that develops in patients with a history of recenhospitalization, hemodialysis as an outpatient, residence in a nursing home, outpatient intravenous therapy and home wound care. Materials and Methods: We retrospectively assessed patients who have been hospitalized in Department of Chest Diseases, Akdeniz University, Faculty of Medicine due to HCAP between 1 January 2009 and 1 June 2012. Of the total 195 pneumonia cases, 76 (38.9%) was HCAP and 119 (61.1%) was CAP. Results: Among HCAP cases, 61 (80.3%) had recent hospitalisation in the last 90 days, 7 (9.2%) went under hemodialysis in the last 30 days, 3 (3.9%) had a history of decubitus management in house, 1 (1.3%) had a long term accomodation in social-care center and 1 (1.3%) had a history of infusion therapy at home. Comorbidity in HCAP group was higher than CAP group (94.6% vs resp. 73.1%; p< 0.001) and mean PSI scores were also higher in HCAP group (104.4 - 90.2; p< 0.05). A causative microorganism was detected in 18 HCAP (23.6%) and in 11 CAP (9.2%) cases. It was determined that appropriate treatment was started in 73.7% of HCAP cases and 98.3% of CAP cases according to national and international guidelines (p< 0.001). Both mean hospitalization duration (12.7 ± 1.1 vs 7.8 ± 0.5 days, resp; p< 0.05) and mortality rates (22.4% vs 4.2%; p< 0.001) were higher in HCAP group. Furthermore, mean cost of hospitalization was also greater for HCAP group than CAP group (4150.6 ± 892 TL vs 2078.7 ± 571 TL; respectively p< 0.05). Conclusion: In conclusion; patient characteristics, comorbidity status, causative organisms, duration and cost of hospitalization and prognosis of patients with HCAP was different from patients with CAP

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