Hüsniye YÜCEL, Ferit KULALI, Ahmet Yağmur BAŞ, Nihal DEMİREL, Sara EROL, Deniz YAPRAK, İlter ARİFOĞLU

Üçüncü basamak bir yenidoğan yoğun bakım ünitesinde metisilin dirençli Staphylococcus aureus kan dolaşımı enfeksiyonlarının görülme sıklığı ve risk faktörleri

Giriş: Metisilin dirençli Staphylococcus Aureus (MRSA) infeksiyonları, yenidoğan yoğun bakım ünitesi (NICU)’ndeki hastalar için önemli bir morbidite ve motalite nedenidir. MRSA enfeksiyonlarının gelişimine zemin hazırlayan risk faktörlerinin belirlenmesi, enfeksiyonların önlenmesi açısından son derece önemlidir. Bu çalışmada, MRSA enfeksiyonlarına ait risk faktörlerini saptamayı amaçladık. Gereç ve Yöntemler: Bu retrospektif çalışma, 1 Ocak 2011 – 31 Aralık 2015 takvim yılları arasında üçüncü basamak bir NICU’da yapıldı. Çalışmaya, kan kültürülerinde Staphylococcus Aureus (S. aureus) izole edilen tüm hastalar alındı. Antibiyogram sonucuna göre, hastalar iki gruba ayrıldı: MRSA ve metisilin duyarlı S. aureus (MSSA). Hastaların demografik özellikleri ile klinik ve laboratuvar bulguları dökümente edildi. Bulgular: NICU’ya kabul edilen 9864 hastanın 54’ünde S. aureus enfeksiyonu saptandı. S. aureus enfeksiyonları, 1500 gr altındaki infantlarda (35 of 1542 infants), 1500 gr ve üzerindeki infantlara (19 of 8322 infants) göre daha sık görülmekte idi [p<0.001 IRR=9.94 CI=(5.69 - 17.39)]. Olguların % 79.6 (43 of 54)’ında MSSA, % 20.4 (11 of 54)’ünde ise MRSA suşları tespit edildi. MRSA enfeksiyonları 1500 gr ve altındaki bebeklerde 1500 gr ve üstü bebeklerden daha sık görülmesine rağmen, MRSA enfeksiyonları ile doğum ağırlığı arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Doğum ağırlığı, gebelik yaşı, cinsiyet, SNAPPE skoru, tedavi yöntemleri (santral venöz kateter, total parenteral beslenme, yardımlı ventilasyon) ve kullanılan antibiyotikler (prenatal veya ampirik) metisilin direnci açısından anlamlı bir fark oluşturmadı. Tartışma: S. aureus enfeksiyonları için en önemli risk faktörü, çok düşük doğum ağırlığına (<1500 gr) sahip olmaktır.

Anahtar Kelimeler:

Metisilin direnci, antibakteriyel ilaçlar, NICU, çok düşük doğum ağırlığı, santral venöz kateter

Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) infections are significant causes of morbidity and mortality for the patients in neonatal intensive care unit (NICU). The identification of risk factors that lead up to the development of MRSA infections is of utmost importance in terms of preventing infections.In this study, we aim to determine the risk factors of MRSA infections.Material and Methods: This retrospective study was conducted in a tertiary NICU between 1stJanuary 2011 and 31stDecember 2015. All patients with S. aureus isolated from blood cultures were included in the study. According to the antibiogram pattern, the patients were separated into two groups: MRSA and methicillin-susceptible Staphylococcus aureus (MSSA). Results: S. aureus infections were more frequent in infants under 1500 g (2.27%) than in infants of 1500 g and above (0.23%) [OR=10.149, CI: 5.790-17.790, p<0.001]. MSSA was identified in 79.6% (43 of 54) of cases, and MRSA strains were identified in 20.4% (11 of 54) of cases. Although, MRSA infections were more frequent in infants under 1500 g than in infants of 1500 g and above, there was no statistically significant association between MRSA and birth weight [OR=1.580, CI: 0.366-6.831, p=0.728]. We found that birth weight, gestational age, sex, SNAPPE score, therapeutic procedures (central venous catheter, total parenteral nutrition, assisted ventilation) and antibiotics used (prenatal or empirical) did not make a significant difference in terms of methicillin resistance. Conclusion: Very low birth weight is the most important risk factor for both S. aureus infections.

Keywords:

Methicillin resistance, anti-bacterial agents, NICU, very low birth weight, central venous catheters,

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