Emrah CAN, Serdar CÖMERT, Fatih BOLAT, Evrim Kıray BAŞ, Ömer GÜRAN, Asiye NUHOĞLU, Sinan USLU, Ali BÜLBÜL

Yenidoğan yoğun bakım biriminde hastane kökenli kan akım enfeksiyonları

Amaç: Yenidoğan Yoğun Bakım Birimi’nde 2008 yılında hastane kökenli kan akım enfeksiyon hızını, etkenlerini, antibiyotik duyarlılığını, zamanından önce ve zamanında doğmuş bebeklerde risk etkenlerini incelemek.Gereç ve Yöntem: Hastaların dosyaları geriye dönük olarak incelendi. Zamından önce ve zamanında doğmuş bebekler için risk etmenleri “multivariate logistic regression” analizi ile değerlendirildi. Bulgular: Bir yıllık süre içerisinde 807 hasta 72 saatten daha uzun süre yattı. Kan kültüründe üreme sayısı 97 idi. Üreme olanların %65,6’sı erken doğmuş, %34,4’ü zamanında doğmuş bebeklerdi. En sık elde edilen mikrorganizmalar koagülaz negatif stafilokok ve Klebsiella pneumonia türüydü. Kan akım enfeksiyon hızı 5,9:1000 gün, katetere bağlı kan akımı enfeksiyon hızı 9,6:1000 gün, ventilatörle ilişkili pnömoni hızı 13,8:1000 gün olarak bulundu. Gram pozitif mikroorganizmalarda glikopeptit direnci görülmedi. Hastane enfeksiyonu için hastane yatış süresi, mekanik ventilasyon ve kateter varlığının anlamlı risk etmenleri olduğu saptandı. Kan kültüründe üreme olanlarda ölüm oranı %12,5 idi. Çıkarımlar: Hastane enfeksiyonları yenidoğan yoğun bakım biriminde önemli hastalık ve ölüm nedenidir. Zamanından önce ve zamanında doğmuş bebeklerde risk etmenlerinin azaltılması sağkalım üzerine önemli katkılar sağlayacaktır.

Hospital acquired bloodstream infections in neonatal intensive care unit

Aim: The aim of this study was to evaluate the risk factors for term and pretem newborns, etiological agents, antibiotic susceptibility and rate of hospital acquired bloodstream infections in newborns hospitalized in our Neonatal Intensive Care Unit during 2008. Material and Method: The medical records of patients were evaluated retrospectively. The risk factors for term and preterm babies were evaluated by multivariate logistic regression analysis. Results: In one year period, 807 patients were hospitalized for longer than 72 hours. A total of 97 hemocultures were found to be positive. Among hemoculture positive newborns 65.6% were found to be preterm and 34.4% term. The most common microorganisms identified were coagulase negative staphylococci and Klebsiella pneumonia. Blood stream infection rate, catheter related blood stream infection rate and ventilator associated pneumonia rate were found to be 5;9:1000 days, 9.6:1000 days and 13.8:1000 days, respectively. Glycopeptide resistance was not observed among gram positive microorganisms. Length of hospital stay, mechanical ventilation and presence of catheter were risk factors for hospital acquired infections. The mortality was found to be 12.5% in newborns with positive hemocultures. Conclusions: Hospital acquired infections are important causes of morbidity and mortality in neonatal intensive care unit. The decrement of risk factors in term and preterm newborns would help to improve the outcome.

PDF

___

1. Philip AG. The changing face of neonatal infection: experience at a regional medical center. Pediatr Infect Dis J 1994; 13: 1098-102. [Özet]
2. Gladstone IM, Ehrenkranz RA, Edberg SC, Baltimore RS. A ten-year review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J 1990; 9: 819-25. [Özet]
3. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110: 285-91. [Özet]
4. Gray JW. Surveillance of infection in neonatal intensive care units. Early Hum Dev 2007; 83: 157-63. [Özet]
5. Sohn AH, Garrett DO, Sinkowitz-Cochran RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001; 139: 821-7. [Özet]
6. Singh N. Large infection problems in small patients merit a renewed emphasis on prevention. Infect Control Hosp Epidemiol 2004; 25: 714-6. [Özet]
7. 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.
8. Drews MB, Ludwig AC, Leititis JU, Daschner FD. Low birth weight and nosocomial infection of neonates in a neonatal intensive care unit. J Hosp Infect 1995; 30: 65-72. [Özet]
9. Nagata E, Brito AS, Matsuo T. Nosocomial infections in a neonatal intensive care unit: incidence and risk factors. Am J Infect Control 2002; 30: 26-31. [Özet]
10. Efird MM, Rojas MA, Lozano JM, et al. Epidemiology of nosocomial infections in selected neonatal intensive care units in Colombia, South America. J Perinatol 2005; 25: 531-6. [Özet]
11. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365: 1175-88.
12. Mahieu LM, De Muynck AO, Ieven MM, De Dooy JJ, Goossens HJ, Van Reempts PJ. Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit. J Hosp Infect 2001; 48: 108-16. [Özet]
13. 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. [Özet]
14. Campins M, Vaque J, Rossello J, et al. Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. EPINE Working Group. Am J Infect Control 1993; 21: 58-63. [Özet]
15. Yapicioglu H, Satar M, Ozcan K, et al. A 6-year prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey. J Paediatr Child Health 2010; 46: 337-42. [Özet]
16. Bülbül A, Taşdemir M, Pullu M, Okan F, Bülbül L, Nuhoğlu A. Yenidoğan yoğun bakım birimindeki hastane enfeksiyonları. Şişli Etfal Hastanesi Tıp Bülteni 2009; 43: 27-32. [Özet]
17. 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.
18. Yapicioglu H, Ozcan K, Sertdemir Y, et al. Health care-associated infections in a neonatal intensive care unit in Turkey in 2008: Incidence and risk factors, a prospective study. J Trop Pediatr 2010. [Epub ahead of print] [Özet]
19. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32: 470-85. [Özet]
20. Perlman SE, Saiman L, Larson EL. Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 2007; 35: 177-82. [Özet]
21. Yuan TM, Chen LH, Yu HM. Risk factors and outcomes for ventilator-associated pneumonia in neonatal intensive care unit patients. J Perinat Med 2007; 35: 334-8. [Özet]
22. Mahieu LM, Buitenweg N, Beutels P, De Dooy JJ. Additional hospital stay and charges due to hospital-acquired infections in a neonatal intensive care unit. J Hosp Infect 2001; 47: 223-9. [Özet]
23. Macharashvili N, Kourbatova E, Butsashvili M, Tsertsvadze T, McNutt LA, Leonard MK. Etiology of neonatal blood stream infections in Tbilisi, Republic of Georgia. Int J Infect Dis 2009; 13: 499-505. [Özet]
24. Su BH, Hsieh HY, Chiu HY, Lin HC. Nosocomial infection in a neonatal intensive care unit: a prospective study in Taiwan. Am J Infect Control 2007; 35: 190-5. [Özet]
25. 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. [Özet]
26. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010; 52: 50-7. [Özet]
27. Yalaz M, Cetin H, Akisu M, Aydemir S, Tunger A, Kultursay N. Neonatal nosocomial sepsis in a level-III NICU: evaluation of the causative agents and antimicrobial susceptibilities. Turk J Pediatr 2006; 48: 13-8. [Özet]
28. Bizzarro MJ, Gallagher PG. Antibiotic-resistant organisms in the neonatal intensive care unit. Semin Perinatol 2007; 31: 26-32. [Özet]
29. Aurangzeb B, Hameed A. Neonatal sepsis in hospital-born babies: bacterial isolates and antibiotic susceptibility patterns. J Coll Physicians Surg Pak 2003; 13: 629-32. [Özet]