Akgün YAMAN, Refik BURGUT, Şaban İNCECİK, İbrahim KARAYAYLALI, Mehmet ÖZALEVLİ, Neşe SALTOĞLU, Murat GÜNDÜZ

The problem of antimicrobial resistance in nosocomial medical and surgical ıntensive care units ınfections in a university hospital; a two-year prospective study

Amaç: Bir üniversite hastanesinde dört yoğun bakım ünitesinde yatan hastalarda nozokomiyal infeksiyonların sıklığı ile izole edilen patojenlerde antimikrobiyallere direnci belirleme. Yöntem ve Gereç: Medikal, cerrahi ve reanimasyon yoğun bakım ünitelerinde yatan hastalar prospektif olarak izlendi. İzolatlar CDC kritelerine göre belirlenen nozokomiyal infeksiyonlardan toplandı. İzolatların tanımlanması ve antibiyotiklere duyarlılığı Sceptor (Becton Dickinson) otomatize sistemle CCLS kriterlerine göre yapıldı. Bulgular: YBÜ’lerinde yatan 3962 hastada, nozokomiyal infeksiyon insidansı % 6,9; en yüksek oran reanimasyon YBÜ’nde (% 14,7), en düşük oran cerrahi YBÜ’nde (% 2,5) olarak belirlendi. 272 hastada 492 Nİ epizodu belirlendi. Nİ insidansı 1000 hasta gününe 13,1 olarak saptandı. Nİ oranları, üriner sistem (% 32), primer bakteriyemi (% 24), pnömoni (% 20), cerrahi alan (% 13) ve diğer infeksiyonlar % 11 bulundu. Pnömoni Reanimasyon YBÜ’nde en sık saptanan (% 54) Nİ idi. Etkenlerin % 39’u gram pozitif, % 52’si gram negatif bakteri, % 9’u Candida türleri idi. En sık izole edilen bakteri S. aureus (% 18); bunu P. aeruginosa (% 16), Acinetobacter spp. (% 10), koagülaz negatif stafilokok (KNS) (% 10), Klebsiella (% 9), E. coli (% 9), ve Enterococcus spp. (% 9) izlemekteydi. S. aureus türlerinde metisilin direnci % 90, KNS larda % 95, S. aureus ve KNS larda vankomisine direnç saptanmadı. Enterokokların % 8’i vankomisine dirençli idi. Gram negatiflere en etkili antibiyotik karbapenemi, amikasin ve siprofloksasin izlemekteydi. P. aeruginosa suşlarının % 5’i ile Acinetobacter türlerinin % 15’i tüm antibiyotiklere dirençli bulundu. Acinetobacter türlerine en etkin antibiyotikler imipenem (% 73), tobramisin (% 46); Pseudomonas türlerine tikarsilin/klavulanat (% 56), piperasilin (% 44), imipenem (% 33); Klebsiella türlerine imipenem (% 92), E. coli suşlarına imipenem (% 94), amikasin (% 94), siprofloksasin (% 74); Enterobacter türlerine siprofloksasin (% 89), imipenem (% 78) idi.

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