Acinetobacter pnömoni ve bakteriyemilerinde tedavi ve prognostik faktörlerin retrospektif olarak değerlendirilmesi
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Date
2011
Authors
Özvatan, Tülay Şener
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
A.baumannii son yıllarda hastane enfeksiyonlarında karşılaştığımız en sık etkenlerden birisidir. Cansız yüzeylerde varlığını sürdürerek yoğun bakım ünitelerinde salgınlara yol açması ve çok fazla antibiyotiğe dirençli olması tedaviyi zorlaştırmakta, yatış süresini uzatarak hastanelere büyük ekonomik yük getirmektedir. Bu nedenle epidemiyolojisi, risk faktörleri ve tedavisi hakkında yeni çalışmalara ihtiyaç vardır.Bu çalışmanın amacı erişkin hastalarda A.baumannii veya A.baumannii/calcoaceticus complex'in neden olduğu nozokomiyal kan dolaşımı ve nozokomiyal pnömoni olgularında tedavinin ve prognostik risk faktörlerinin retrospektif olarak değerlendirilmesidir.Çalışmada 213 bakteriyemik ve 356 nozokomiyal pnömoni tanılı hasta değerlendirildi. Bakteriyemide klinik yanıt % 61.5, 14.gün mortalitesi % 36.2, 30.gün mortalitesi % 50.3 olarak bulundu. Ağır sepsis, septik şok, APACHE II ≥ 20 ve immünsüpresyon 14.gün ve 30.gün mortalitesi için bağımsız risk faktörleri olarak bulundu. Kolistin kullanılması 14.gün mortalitesi, multitravma nedeniyle yatış olması ise 30.gün mortalitesi için koruyucu faktörler olarak saptandı.Çalışmamızda A.baumannii % 94.9 oranında ventilatörle ilişkili pnömoni, % 5.1 oranında ise nozokomiyal pnömoniye neden oldu. Genel olarak klinik yanıt % 57.2, 14.gün mortalitesi % 39.6, 30.gün mortalitesi % 53.1 olarak hesaplandı. Ağır sepsis, septik şok, APACHE II ≥ 20 14.gün ve 30.gün mortalitesi için anlamlı bulunan bağımsız risk faktörleri oldu.A.baumannii'nin neden olduğu enfeksiyonlarda hastalar olası risk faktörleri açısından değerlendirilmeli, başlanan tedavi kültür sonuçlarına göre kısa zamanda modifiye edilmelidir. Karbapenem direncinin tüm dünyada artması özellikle yoğun bakım ünitelerinde enfeksiyon kontrol önlemlerinin eksiksiz uygulanmasını gerektirmektedir.
A.baumannii is one of the most common pathogen causing nosocomial infections in recent years. Extending of hospitalization is getting a great economic burden for hospitals because of outbreaks in intensive care units associated with existence at inanimate surfaces and treatment complicating by resistance to more antibiotics. Therefore, new studies are needed to investigate the treatment, epidemiology and risk factors.The purpose of this study is a retrospective assessment of treatment and prognostic risk factors of nosocomial pneumonia and nosocomial blood stream infection caused by A.baumannii or A.baumannii/calcoaceticus complex in adult patients.We evaluated 213 patients diagnosed with bacteraemia and 356 patients diagnosed with nosocomial pneumonia in this study. Clinical resolution rate was % 61.5, 14-day mortality rate was % 36.2 and 30-day mortality rate was % 50.3 in bacteremia. Severe sepsis, septic shock, APACHE II score ≥ 20 and immunosuppression were independent risk factors associated with 14-day and 30-day mortality. Use of colistin and hospitalization due to multitravma were identified as protective factors for 14-day mortality and 30-day mortality respectively.In our study, the rate of ventilator-associated pneumonia was % 94.9 and the rate of nosocomial pneumonia was % 5.1 caused by A.baumannii. In general, clinical response was % 57.2, 14-day mortality was % 39.6, 30-day mortality was % 53.1. The significant factors associated with 14-day and 30-day mortality were severe sepsis, septic shock and APACHE II score ≥ 20.Patients that have infections caused by A.baumannii must evaluated for possible risk factors and ampirical treatment should be modified as soon as possible according to culture results. Full implementation of infection control measures requires particularly in intensive care units because of increasing rate of carbapenem resistance all over the world.
A.baumannii is one of the most common pathogen causing nosocomial infections in recent years. Extending of hospitalization is getting a great economic burden for hospitals because of outbreaks in intensive care units associated with existence at inanimate surfaces and treatment complicating by resistance to more antibiotics. Therefore, new studies are needed to investigate the treatment, epidemiology and risk factors.The purpose of this study is a retrospective assessment of treatment and prognostic risk factors of nosocomial pneumonia and nosocomial blood stream infection caused by A.baumannii or A.baumannii/calcoaceticus complex in adult patients.We evaluated 213 patients diagnosed with bacteraemia and 356 patients diagnosed with nosocomial pneumonia in this study. Clinical resolution rate was % 61.5, 14-day mortality rate was % 36.2 and 30-day mortality rate was % 50.3 in bacteremia. Severe sepsis, septic shock, APACHE II score ≥ 20 and immunosuppression were independent risk factors associated with 14-day and 30-day mortality. Use of colistin and hospitalization due to multitravma were identified as protective factors for 14-day mortality and 30-day mortality respectively.In our study, the rate of ventilator-associated pneumonia was % 94.9 and the rate of nosocomial pneumonia was % 5.1 caused by A.baumannii. In general, clinical response was % 57.2, 14-day mortality was % 39.6, 30-day mortality was % 53.1. The significant factors associated with 14-day and 30-day mortality were severe sepsis, septic shock and APACHE II score ≥ 20.Patients that have infections caused by A.baumannii must evaluated for possible risk factors and ampirical treatment should be modified as soon as possible according to culture results. Full implementation of infection control measures requires particularly in intensive care units because of increasing rate of carbapenem resistance all over the world.
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Keywords
A.baumannii, Nozokomiyal pnömoni, Kan dolaşımı enfeksiyonu, Nosocomial pneumonia, Bloodstream infection
Citation
Özvatan, T. Ş. (2011). Acinetobacter pnömoni ve bakteriyemilerinde tedavi ve prognostik faktörlerin retrospektif olarak değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.