Merih ÇETİNKAYA, Mustafa HACIMUSTAFAOĞLU, Nilgün KÖKSAL, Sumru KAVURT, Solmaz ÇELEBİ, Hilal ÖZKAN, Güven ÖZKAYA

Yenidoğan ve yenidoğan yoğun bakım servisinde hastane enfeksiyonları

Amaç: Bir yılda, Yenidoğan Yoğun Bakım Birimi (YYBB) ve Yenidoğan Kliniği’ne yatan hastalarda gelişen hastane enfeksiyonları (HE) incelendi. Gereç ve Yöntem: Hastane enfeksiyonları Centers for Diseases Control and Prevention (CDC) ölçütlerine göre tanımlandı. Çalışma için Uludağ Üniversitesi Tıp Fakültesi Etik Kurul onayı alındı (04 Mart 2008 tarih ve 2008-5/12 sayılı etik kurul yazısı). Bulgular: Yenidoğan YBB’de yatan 127 hastanın %53’ünde (%58,5’i kültür pozitif), Yenidoğan Kliniği’nde yatan 187 hastanın %2,6’sında (hepsi kültür negatif) HE gelişti. Yenidoğan YBB ve Yenidoğan Kliniği’nde toplam %23 hastada HE gelişti, HE hızı %42,3, yatış gününe göre HE oranı ise 14/1000 hasta günü olarak bulundu. Hastane enfeksiyonları oranı YYBB’de 17,9, Yenidoğan Kliniği’nde 1,6/1000 hasta günü bulundu. Hastane enfeksiyonları olan hastalar, YYBB’de 73,6±47,8 gün, Yenidoğan Kliniği’nde 16,0±6,7 gün yattı. Hastane enfeksiyonları tanısı, YYBB’sinde hastaneye yatışlarının ortalama 29,4±30,9. gününde, Yenidoğan Kliniği’nde 7,6±2,9 gününde konuldu. Yenidoğan YBB’de 128 HE atağında atak ilişkili ölüm oranı %8,5 idi. Hastane enfeksiyonları saptanan 68 hastanın 11’i (%16,1) kaybedildi. Hastane enfeksiyonları tanısı alan hastalar, Yenidoğan YBB’de ortalama yatışının 56,7±50,2. gününde kaybedildi. Hastane enfeksiyonları tanısı konulduktan sonraki ortalama ölüm günü; YYBB’de 25,8±10,2 gün olarak saptandı. Yenidoğan Kliniği’nde HE gelişen hastalarda ölüm saptanmadı. Çıkarımlar: Kliniğimizde Yenidoğan YBB ve Yenidoğan Kliniği’ndeki HE’leri gelişmiş ülkelere göre biraz yüksek, gelişmekte olan ülkelere göre daha düşük saptandı.

Nosocomial infections in neonatology clinic and neonatal intensive care unit

Aim: Nosocomial infections (NI) in a neonatal intensive care unit (NICU) and neonatal clinic were evaluated during a one-year-period. Material and Method: 314 newborns were investigated for nosocomial infections. Local ethics committee approval was given for this study. Nosocomial infections was defined using the CDC criteria. Results: Nosocomial infections developed in 53% of 127 patients (58% with culture positivity) in the NICU and in 2.6% of 187 patients (all with a negative culture) in the neonatal clinic. In total, (NICU plus neonatal clinic), NI developed in 23% of hosptalized patients. Nosocomial infections rate was 42.3% and in terms of patient days, NI rate was 14/1000 patient-day. When evaluated separately, NI developed in 53.5% of patients admitted in NICU and in 2.6% of neonatal clinic patients. Also, NI rates were 17.9/1000 patient-day in NICU and 1.6/1000 patient-day in the neonatal clinic. Patients with NI stayed at the hospital for 73.6±47.8 day in NICU and for 16.0±6.7 day in the neonatal clinic. Nosocomial infections developed on the 29.4±30.9th d in NICU and on the 7.6±2.9th day in the neonatal clinic. In NICU, in terms of 128 NI episodes, the NI related mortality was 8.5%. 16.1% (n: 11) of the patients with NI died. They died on the 56.7±50.2nd day of admission and on the 25.8±10.2nd day second after NI diagnosis. There was no mortality in neonatal clinic patients. Conclusions: Our NI rates were slightly higher than the developed countries and lower than the developing countries.

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1. Moore DL. Nosocomial infections in newborn nurseries and neonatal intensive care units. In: Mayhall CG (ed). Hospital epidemiology and infection control. Baltimore: Williams-Wilkins, 1996: 535-64.
2. Yalaz M, Arslanoğlu S, Çetin H, et al. Üçüncü basamak Yenidoğan Yoğun Bakım Merkezi’nde kanıtlanmış nozokomiyal sepsis etkenlerinin değerlendirilmesi: iki yıllık analiz. ADÜ Tıp Fakültesi Dergisi 2004; 5: 5-9.
3. Couto RC, Carvalho EA, Pedrosa TM, Pedroso ER, Neto MC, Biscione FM. A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units. Am J Infect Control 2007; 35: 183-9.
4. Su BH, Hsieh HY, Chiu HY, Lin HC, Lin HC. Nosocomial infection in a neonatal intensive care unit: a prospective study in Taiwan. Am J Infect Control 2007; 35: 190-5.
5. Jeong IS, Jeong JS, Choi EO. Nosocomial infection in a newborn intensive care unit (NICU), South Korea. BMC Infect Dis 2006; 6: 103.
6. Efird MM, Rojas MA, Lozano JM, et al. Epidemiology of nosocomial infections in selected neonatal intensive care units in Columbia, South America. J Perinatol 2005; 25: 531-6.
7. van der Zwet WC, Kaiser AM, van Elburg RM, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005; 61: 300-11.
8. Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR, Pediatric Prevention Network. Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units. Am J Infect Control 2001; 29: 152-7.
9. Gikas A, Pediaditis J, Papadakis JA, et al. Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. J Hosp Infect 2002; 50: 269-75.
10. Salamati P, Rahbarimanesh AA, Yunesian M, Naseri M. Neonatal nosocomial infections in Bahrami Children. Indian J Pediatr 2006; 73: 197-200.
11. Özdemir N, Soysal A, Bilgen H, Çulha G, Bakır M, Özek E. Marmara Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesi 2001 yılı nozokomiyal enfeksiyonları. Hastane İnfeksiyonları Dergisi 2004; 8: 256-60.
12. Çelebi S, Hacımustafaoğlu M, Özdemir O, Özakın C. Nosocomial gram-positive bacterial infections in children: results of a 7 year study. Pediatr Int 2007; 49: 875-82.
13. Yalaz M, Cetin H, Akisu M, Aydemir S, Tunger A, Kültürsay N. Neonatal nasocomial sepsis in a level III NICU: evaluation of the causative agents and antimicrobial susceptibilities. Turk J Pediatr 2006; 48: 13-8.
14. Turkish Neonatal Society, Nosocomial Infections Study Group. Nasocomial infections in neonatal units in Turkey : epidemiology problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010; 52: 50-7.
15. Erdoğan F, Arslan S. Nozokomiyal enfeksiyonlar (1998-1992) XXX. Türk Pediatri ve II. Ulusal Neonataloji Kongresi, 14-18 Haziran 1993, İstanbul, Kongre Özet Kitabı, P144: 35-6.
16. Huskins WC, Goldmann DA. Prevention and control of nosocomial infections in healty care fasilities that serve children. Hospital control of infections. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds). Textbook of pediatric infectious diseases. 5.baskı. Philadelphia: WB Saunders, 2004: 2924-41.
17. Rosenthal VD, Maki DG, Graves N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008; 36: 1-12.
18. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16: 128-40.
19. Clark R, Powers R, White R, Bloom B, Sanchez P, Benjamin DK Jr. Nosocomial Infection in the NICU: A medical complication or unavoidable problem? J Perinatol 2004; 24: 382-8.
20. Aziz K, McMillan DD, Andrews W, et al. Canadian Neonatal Network. Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr 2005; 5: 22.
21. Auriti C, Maccallini A, Di Liso G, Di Ciommo V, Ronchetti MP, Orzalesi M. Risk factors for nosocomial infections in a neonatal intensive-care unit. J Hosp Infect 2003; 53: 25-30.
22. Mireya UA, Martí PO, Xavier KV, Cristina LO, Miguel MM, Magda CM. Nosocomial infections in paediatric and neonatal intensive care units. J Infect 2007; 54: 212-20.
23. Geffers C, Baerwolff S, Schwab F, Gastmeier P. Incidence of health care-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. J Hosp Infect 2008; 68: 214-21.
24. Hufnagel M, Burger A, Bartelt S, Henneke P, Berner R. Secular trends in pediatric bloodstream infections over a 20-year period at a tertiary care hospital in Germany. Eur J Pediatr 2008; 167: 1149-59.
25. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. A report from the National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol 1991; 12: 609-21.
26. Saçar S, Toprak KS, Asan A, Cevahir N, Serin S, Turgut H. Pamukkale Üniversitesi Hastanesi’nde hastane enfeksiyonları sürveyansı: üç yıllık analiz. İnfeksiyon Dergisi (Turkish Journal of Infection) 2008; 22: 15-21.
27. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth wieght neonataes: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110: 285-91.
28. Urrea M, Pons M, Serra M, Latorre C, Palomeque A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 2003; 22: 490-4.
29. Soysal A, Toprak D, Yavuz B, ve ark. Marmara Üniversitesi Tıp Fakültesi Pediatri Servisi’nde 2004 yılı nozokomiyal enfeksiyonları. Hastane Enfeksiyonları Dergisi 2006; 10: 143-8.
30. Köksal N, Kurtoğlu B, Bayram Y, Hacımustafaoğlu M. Neonatal nozokomiyal infeksiyon gelişen olgularımız. 44. Milli Pediatri Kongresi, 4-8 Eylül, 2000, Bursa. Kongre Kitabı, (P359),s.189.
31. Raymond J, Aujard Y. Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol 2000; 21: 260-3.
32. Gray J, Gossain S, Morris K. Three year survey of bacteremia and fungemia in a pediatric intensive care unit. Pediatr Infect Dis J 2001; 4: 416-21.
33. Babazono A, Kitajima H, Nishimaki S, et al. Risk factors for nosocomial infection in the neonatal intensive care unit by the Japanese Nosocomial Infection Surveillance (JANIS). Acta Med Okayama 2008; 62: 261-8.
34. Gastmeier P, Geffers C, Schwab F, Fitzner J, Obladen M, Rüden H. Development of a surveillance system for nosocomial infections: the component for neonatal intensive care units in Germany. J Hosp Infect 2004; 57: 126-31.
35. Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics 2006; 117: 1680-7.
36. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. Pediatrics 1999; 103: 39-47.