Çiğdem EROL, Nuran SARI, Sahika Zeynep AKI, Esin ŞENOL

Febril nötropenik hastalarda bakteriyemi sıklığı, risk faktörleri ve epidemiyolojisi

Amaç: Kan dolaşımı infeksiyonları febril nötropenik hastalarda, ciddi morbidite ve mortalite ile seyretmektedir. Farklı merkezler arasında ve aynı merkezde yıllar içerisinde bakteriyemi epidemiyolojisi ve risk faktörleri değişiklikler göstermektedir. Bu çalışmanın amacı Kasım 2007-Kasım 2008 tarihleri arasında Ankara’da bir üniversite hastanesinde bakteriyemi sıklığını, risk faktörlerini ve epidemiyolojisini belirlemektir. Gereç ve Yöntemler: Çalışmamızda 115 hematolojik maligniteli hastada gelişen 177 febril nötropeni atağı ve 108 kan dolaşımı enfeksiyonu incelenmiştir. Olgular kan dolaşımı enfeksiyonu gelişen, kontrol grup ise gelişmeyen hasta grubu olarak tanımlanmıştır. Olgular ve kontroller risk faktörleri, komplikasyonlar ve mortalite oranları yönünden karşılaştırılmış; izole edilen mikroorganizmalar ve duyarlılık paternleri incelenmiştir. Bulgular: Epizodlarının %61’inde bakteriyemi gelişmiş, bunların %42.6’sı kateterle ilişkili bulunmuş ve atak ilişkili mortalite hızı %12.4 saptanmıştır. Altta yatan malignitesi kontrol altında olmayan, uzun süreli derin nötropenisi olanlarda bakteriyemi daha yüksek oranda izlenmiştir. Kök hücre nakil ünitesinde yatmak, altta yatan malignite tanıları, nakil uygulama türünden bağımsız olarak kök hücre nakli varlığı, malignite evresi, santral venöz kateter, mukozit ve ishal varlığı kan dolaşımı enfeksiyonu gelişimi ile ilişkili bulunmuş; altta yatan malignite evresi ve santral venöz kateter varlığı bağımsız risk faktörleri olarak tanımlanmıştır. En sık etkenleri olarak gram-pozitif bakteriler (%76.8); bunlar içinde de en sık koagülaz negatif stafilokoklar (%63.6) saptanmıştır. Metisilin direnci koagülaz negatif stafilokoklarda %64 bulunmuştur. Gram-negatif bakteriler içerisinde ise en sık Escherichia coli izole edilmiştir. Escherichia coli izolatlarında kinolon direnci %82.1 saptanmıştır. Sonuç: Sonuç olarak febril nötropenik hastalarda kan dolaşımı enfeksiyonu sıklığının, risk faktörlerinin ve epidemiyolojisinin izlemi, her merkezin kendi empirik tedavi yaklaşımını belirleyebilmesi için önemlidir.

Anahtar Kelimeler:

Febril nötropeni, kan dolaşımı infeksiyonu, risk faktörleri

The frequency, epidemiology and risk factors of bloodstream infections in febrile neutropenic patients with hematologic malignancies

Aim: Bacteremia is considered as the most significant cause of mortality and morbidity in febrile neutropenic patients. The epidemiology and risk factors might differ among institutions and over the time period. The aim of this study is to evaluate the frequency, epidemiology and factors predictive of bacteremia in neutropenic patients in a university hospital in Ankara between November 2007 and November 2008. Material and Methods: 177 febrile neutropenic episodes of 115 patients with hematological malignancies were included in this study. Cases were defined as patients with bloodstream infection and controls were the patients without bloodstream infections. We evaluated the cases and controls for the risk factors, complications and mortality rates. Microorganisms isolated from blood samples and their susceptibility patterns were also analysed. Results: The prevalence of bacteremia was 61%, 42.6% of them were catheter related and mortality rate was 12.4%. Bloodstream infections are more common in the patients with uncontrolled underlying disease and long term severe neutropenia. Duration of severe neutropenia (neutrophile count

Keywords:

Febrile neutropenia, bloodstream infection, risk factors,

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