Çocuk Enfeksiyon Hastalıkları Kliniği'nde deri ve yumuşak doku enfeksiyonu tanısıyla yatarak tedavi görmüş olan hastaların incelenmesi: On yıllık retrospektif değerlendirme
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Date
2022
Authors
Durgut, Begüm Özgürbüz
Journal Title
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Deri ve yumuşak doku enfeksiyonları (DYDE), çocukluk çağında sık görülür. Çoğu ayaktan izlenir, ancak invaziv tipleri hastaneye yatış gerektirir. Bu tez çalışmasında on yıllık sürede (2009-2018) deri ve yumuşak doku enfeksiyonu tanısıyla Çocuk Enfeksiyon Hastalıkları Kliniği'ne (ÇHEK) yatırılan 355 olgunun demografik, klinik, laboratuvar, risk faktörleri ile birlikte prognostik verilerinin retrospektif olarak değerlendirilmesi amaçlandı. On yıllık sürede DYDE tanısıyla yatan olgular, tüm Çocuk Sağlığı ve Hastalıkları (ÇSH) kliniğine yatan olguların %0,9'unu, tüm ÇEHK'ne yatan olguların %8'ini oluşturdu. DYDE'ları içinde selülit %31 (n=111), preseptal selülit %24,2 (n=86), servikal lenf nodu absesi %10 (n=34), subkutan abse %10 (n=36), impetigo %8 (n=29) oranında saptandı. Olguların medyan yaşı 6 yıl, %60,3'ü (n=214) erkek idi. Başvuru öncesi semptom süresi medyan 5 gündü. Olguların %26'sının (n=93) kronik hastalığı vardı. Başvuru öncesi olguların %52'si (n=182) antibiyotik kullanmıştı. Olguların %16'sında (n=57) yatışında kan veya yara/abse kültüründe etken üredi. En sık saptanan mikroorganizmalar S.aureus (%46, MRSA (%7), MSSA (%37)), streptokok spp. (%16), koagülaz negatif stafilokoklar (%14)'dı. Altı olguda yoğun bakım yatışı vardı. Olguların tümüne ampirik parenteral antibiyotik başlandı, %16 olguya (n=56) ek olarak drenaj ve/veya cerrahi tedavi uygulandı. Hastanede toplam yatış süresi medyan 6 gündü. Kronik hastalığı, yoğun bakım yatışı (YBÜ) ve önceden antibiyotik kullanan olguların yatış süreleri (sırasıyla medyan 7, 8, 7 gün) cerrahi/drenaj uygulanan olgulardan (11 gün) anlamlı olarak daha kısaydı (p<0,05). Herbir olgunun ortalama toplam yatış maliyeti 780,41 TL (1075,23±1146,05, 46,2-11531,59), ortalama günlük maliyeti 135 TL (600,52±1339,27, 14,03-3913,94) bulundu. Dolar cinsinden (10 yıllık ortalama $ kuru, 1$= 2,45 TL) ortalama toplam yatış maliyeti 255,77 $ (418,69± 564,31, 53,48- 7252,57), ortalama günlük maliyeti 43,36 $ (58,33± 142,91, 5,17- 2574,96) bulundu. Hiçbir olgu kaybedilmedi. Sonuç olarak; ÇSH'a yatan tüm hastaların yaklaşık %1'ini, ÇEHK'ne yatan tüm hastaların %8'ini DYDE olguları oluşturdu. En sık MSSA (%39) üredi ve ortalama yatış süresi 6 gündü. Olguların ortalama toplam yatış maliyeti 780 TL, ortalama günlük maliyeti 135 TL bulundu. Bu verilerle ÇSH klinik pratiğinde DYDE sık görülen bir hastalık olup; bu durumun dikkate alınması ve eğitim programında yer alması uygun olacaktır. Ayrıca hastaların ayaktan optimal tedavileri hastane yatışını azaltabilir. Sonuç olarak; DYDE sık görülmekte olup ayaktan ilk gören hekimin antibiyotik tedavisi hastaneye yatışı azaltabilir.
Skin and soft tissue infections (SSTI) are common in childhood. Most are outpatients, but the invasive types require hospitalization. In this thesis study, it was aimed to retrospectively evaluate the demographic, clinical, laboratory, risk factors and prognostic data of 355 cases hospitalized in the Pediatric Infectious Diseases Clinic (PIDC) with the diagnosis of skin and soft tissue infection in a ten-year period (2009-2018). In a 10-year period, patients hospitalized with the diagnosis of SSTI constituted 0.9% of all cases admitted to the Child Health and Diseases (CHDC) clinic, and 8% of all cases admitted to PIDC. Among SDIs, cellulitis 31% (n=111), preseptal cellulitis 24.2% (n=86), cervical lymph node abscess 10% (n=34), subcutaneous abscess 10% (n=36), impetigo 8% (n=29) was detected. The median age of the cases was 6 years, 60.3% (n=214) were male. The median duration of symptoms before admission was 5 days. 26% (n=93) of the cases had chronic disease. Before admission, 52% (n=182) of the cases had used antibiotics. In 16% (n=57) of the cases, the causative agent grew in blood or wound/abscess culture during hospitalization. The most frequently detected microorganisms were S. aureus (46%, MRSA (%7), MSSA (%37)), streptococcus spp. (16%) and coagulase negative staphylococci (14%). Six patients had intensive care admissions. Empirical parenteral antibiotics were started in all cases, and drainage and/or surgical treatment were applied in addition to 16% of cases (n=56). The median total hospital stay was 6 days. Patients with chronic disease, intensive care unit stay (ICU), and hospital stay (median 7, 8, 7 days, respectively) were significantly shorter than those who underwent surgery/drainage (11 days) (p<0.05). The mean total hospitalization cost of each case was 780,41 TL (1075,23±1146,05, 46,2-11531,59), and the average daily cost was 135 TL (600,52±1339,27, 14,03-3913,94). Average total hospitalization cost in dollars (10-year average rate of $, 1$= 2.45 TL) 255.77 $ (418.69± 564.31, 53.48- 7252.57), average daily cost 43.36 $ (58.33±142.91, 5.17- 2574.96). No cases were lost. As a result; SDI cases constituted approximately 1% of all patients admitted to CHDC and 8% of all patients admitted to PIDC. MSSA (%39) was most common and mean hospital stay was 6 days. The average total hospitalization cost of the cases was 780 TL, and the average daily cost was 135 TL. With these data, SSTI is a frequently seen phenomenon in CHD clinical practice is the disease; It would be appropriate to consider this situation and to include it in the training program. In addition, optimal outpatient treatment of patients can reduce hospitalization. As a result; SSTI is common, and antibiotic treatment by the first-time physician may reduce hospitalization.
Skin and soft tissue infections (SSTI) are common in childhood. Most are outpatients, but the invasive types require hospitalization. In this thesis study, it was aimed to retrospectively evaluate the demographic, clinical, laboratory, risk factors and prognostic data of 355 cases hospitalized in the Pediatric Infectious Diseases Clinic (PIDC) with the diagnosis of skin and soft tissue infection in a ten-year period (2009-2018). In a 10-year period, patients hospitalized with the diagnosis of SSTI constituted 0.9% of all cases admitted to the Child Health and Diseases (CHDC) clinic, and 8% of all cases admitted to PIDC. Among SDIs, cellulitis 31% (n=111), preseptal cellulitis 24.2% (n=86), cervical lymph node abscess 10% (n=34), subcutaneous abscess 10% (n=36), impetigo 8% (n=29) was detected. The median age of the cases was 6 years, 60.3% (n=214) were male. The median duration of symptoms before admission was 5 days. 26% (n=93) of the cases had chronic disease. Before admission, 52% (n=182) of the cases had used antibiotics. In 16% (n=57) of the cases, the causative agent grew in blood or wound/abscess culture during hospitalization. The most frequently detected microorganisms were S. aureus (46%, MRSA (%7), MSSA (%37)), streptococcus spp. (16%) and coagulase negative staphylococci (14%). Six patients had intensive care admissions. Empirical parenteral antibiotics were started in all cases, and drainage and/or surgical treatment were applied in addition to 16% of cases (n=56). The median total hospital stay was 6 days. Patients with chronic disease, intensive care unit stay (ICU), and hospital stay (median 7, 8, 7 days, respectively) were significantly shorter than those who underwent surgery/drainage (11 days) (p<0.05). The mean total hospitalization cost of each case was 780,41 TL (1075,23±1146,05, 46,2-11531,59), and the average daily cost was 135 TL (600,52±1339,27, 14,03-3913,94). Average total hospitalization cost in dollars (10-year average rate of $, 1$= 2.45 TL) 255.77 $ (418.69± 564.31, 53.48- 7252.57), average daily cost 43.36 $ (58.33±142.91, 5.17- 2574.96). No cases were lost. As a result; SDI cases constituted approximately 1% of all patients admitted to CHDC and 8% of all patients admitted to PIDC. MSSA (%39) was most common and mean hospital stay was 6 days. The average total hospitalization cost of the cases was 780 TL, and the average daily cost was 135 TL. With these data, SSTI is a frequently seen phenomenon in CHD clinical practice is the disease; It would be appropriate to consider this situation and to include it in the training program. In addition, optimal outpatient treatment of patients can reduce hospitalization. As a result; SSTI is common, and antibiotic treatment by the first-time physician may reduce hospitalization.
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Keywords
Deri ve yumuşak doku enfeksiyonları, Demografik özellikler, Çocuk, Skin and soft tissue infections, Demographic characteristics, Pediatric
Citation
Durgut, B. Ö. (2022). Çocuk Enfeksiyon Hastalıkları Kliniği'nde deri ve yumuşak doku enfeksiyonu tanısıyla yatarak tedavi görmüş olan hastaların incelenmesi: On yıllık retrospektif değerlendirme. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.