Ayper SOMER, Selda HANÇERLİ TORUN, Gürkan ATAY, Manolya KARA, Zeynep ÇİĞDEM KAYACAN, Yesfa Şebnem AYDIN, Kemal NİŞLİ, Agop ÇITAK, Nezahat GÜRLER, Nuran SALMAN, Murat SÜTÇÜ, Bahar AKGÜN KARAPINAR

Bir üniversite hastanesi çocuk yoğun bakım biriminde dirençli gram-negatif enfeksiyonların değerlendirilmesi

Amaç: Sağlık bakımı ilişkili enfeksiyonlar yoğun bakım birimlerinde yüksek hastalık ve ölüme neden olmaktadır. Bu çalışmada, üniversite hastanemiz çocuk yoğun bakım birimindeki dirençli gram negatif enfeksiyonların özellikleri değerlendirilirken; çok ilaca dirençli ve genişletilmiş ilaç direnci olan enfeksiyonların karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada Ocak 2011–Aralık 2015 yılları arasında, fakültemiz çocuk yoğun bakım biriminde yatışı sırasında gram negatif enfeksiyon saptanan çocuk hastalar geriye dönük olarak değerlendirildi. Bulgular: Çalışma döneminde birimimize 1 030 hasta yatırıldı; sağlık bakımı ilişkili enfeksiyon sıklığı %17,2, sıklık yoğunluğu 1 000 hasta günü başına 32,7 idi. 1 000 cihaz günü başına sağlık bakımı ilişkili enfeksiyon sıklığı ve cihaz kullanım oranı sırasıyla 66,9 ve 0,59 olarak hesaplandı. Yaş ortancası 22 (1–205) ay olan 79 hastada, 130 gram negatif enfeksiyon atağı saptandı. En sık saptanan enfeksiyonlar, ventilatör ilişkili pnömoni (n=78, %60) ve kan akım enfeksiyonu (n=38, %29,2) idi. En sık etkenler Pseudomonas aerugi nosa (n=50, %38,5), Kleibsiella pneumonia (n=32, %24,6) ve Acineto bacter baumannii (n=28, %21,5) idi. A. baumannii izolatları arasında piperasilin-tazobaktam ve meropenem direnci sırası ile %96,4 ve %89,3 saptandı. Ampirik karbapenem, aminoglikozid ve florokinolon kullanımı, total parenteral nütrisyon varlığı, yoğun bakım öncesi geçirilmiş gram negatif enfeksiyon öyküsü anlamlı olarak daha yüksekti. Geç dönem ölüm hızı genişletilmiş ilaç direnci varlığında daha yüksek saptandı. Geçirilmiş gram negatif enfeksiyon öyküsü, genişletilmiş ilaç direnci açısından bağımsız risk etmeni Çıkarımlar: Sağlık bakımı ilişkili enfeksiyonlar önemli bir sağlık sorunudur ve önlemede mümkünse her hastanenin kendi enfeksiyon kontrol kurulunun hastane kolonizasyonuna göre stratejiler belirleyip uygulaması önemlidir.

Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care center

Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital. Material and Methods: In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively. Results: One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1–205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobac ter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance. Conclusion: Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.

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