Aslıhan CANDEVİR, Behice KURTARAN, Filiz KİBAR, Emre KARAKOÇ, Hasan Salih Zeki AKSU, Yeşim TAŞOVA

Türkiye'deki bir hastanenin invazif araç ilişkili enfeksiyon hızları; dört yıllık deneyim

Amaç: Merkezimizdeki invazif araç ilişkili enfeksiyon hızlarının, etken mikroorganizmaların ve direnç paternlerinintespit edilerek standardizasyon sağlanması ve Türkiye ile gelişmiş ülkelerdeki hastaneler ile karşılaştırma yapılması.Yöntem ve gereç: Yoğun bakımlarda toplam hasta günü, ventilatör günü, santral kateter günü ve üriner kateter günlerikayıt edildi ve invazif araç ilişkili enfeksiyon hızları hesaplandı. Hastalardan klinik örnekler alınarak uygun ortama ekildive enfekte eden mikroorganizmalar ile direnç paternleri tespit edildi.Bulgular: Toplam olarak % 16,4 oranında ve 12, 12/1000 hasta gününde 1450 invazif araç ilişkili enfeksiyon tespitedilmiştir. Ventilatör ilişkili pnömoni hızı 21, 12/1000 ventilatör günü ve en sık görülen patojen Acinetobacter baumanniiidi. Santral kateter ilişkili kan dolaşım enfeksiyonu hızı 9,14/1000 kateter günü ve en sık izole edilen patojen A. baumanniiidi. Kateter ilişkili üriner sistem enfeksiyon hızı ise 10,12/1000 kateter günü ve en sık karşılaşılan patojen Candida türleriidi. MRSA oranı 2006 yılında % 89.6’dan 2009 yılında % 61.8’e düştü (P < 0,001). ESBL oranları çalışma yıllarındaEscherichia coli’de % 70,7 ve % 45,6 arasında, Klebsiella pneumoniae’de ise % 66,7 ve % 55,9 arasında idi. Enterokok türleriarasında vankomisin direnci % 34,3 ve % 21,7 arasındaydı.Sonuç: Hastanemiz enfeksiyon hızları ülke verileriyle benzer ancak gelişmiş ülkelere oranla yüksek bulundu. Bu yüksekenfeksiyon hızları ve antimikrobiyallere direnç oranları göz önüne alındığında enfeksiyon kontrol önlemlerine uyumunacil olarak arttırılması ve daha etkili antibiyotik kontrol politikaları geliştirilmesine ihtiyaç vardır.

Anahtar Kelimeler:

Araç ilişkili enfeksiyon, direnç, nozokomiyal

Invasive device-associated nosocomial infections of a teaching hospital in Turkey; four years’ experience

To determine our setting's IDAI rates, infecting microorganisms, and their resistance patterns to achieve standardization and make comparisons among other Turkish and developed country hospitals all over the world. Materials and methods: The numbers of total patient days, ventilator days, central catheter days and, urinary catheter days in the ICUs were recorded and IDAI rates were calculated. Clinical specimens were obtained from patients, cultivated at appropriate culture media, and infecting microorganisms and resistance patterns were determined. Results: Totally 1450 invasive device-associated infection episodes were determined (16.4% of patients) with a rate of 21.12/1000 days. Ventilator associated pneumonia rate was 22.05/1000 ventilator days and most common microorganism was Acinetobacter baumannii. Central catheter associated blood stream infection rate was 9.14/1000 central catheter days and the most common infecting organism was A. baumannii. Catheter associated urinary infection rate was 10.12/1000 urinary catheter days and the most common pathogen was Candida species. MRSA rate decreased from 89.6% in 2006 to 61.8% in 2009 (P < 0.001). ESBL production rates were between 70.7% and 45.6% in Escherichia coli and 66.7% and 55.9% in Klebsiella pneumoniae isolates. Vancomycin resistance among Enterococci was between 34.3% and 21.7% in these years. Conclusion: Our hospital infection rates were found to be similar to those of country data but higher than those in developed nations. Considering the high infection and resistance rates to most of the available antibiotics, it is highly urgent that infection control measures be taken and more effective antibiotic control policies be adopted.

Keywords:

nosocomial, resistance, Device associated infection,

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