Yenidoğan Yoğun Bakım Ünitesi ve Çocuk Hematoloji-Onkoloji Kliniğinde yatan hastalarda hastane enfeksiyonları: Bir yıllık sürveyans çalışması
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Date
2009
Authors
Kavurt, Ayşen Sumru
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Publisher
Uludağ Üniversitesi
Abstract
Hastane enfeksiyonları (HE), ciddi boyutlarda mortalite morbidite ve ekonomik kayıplara neden olan önemli bir problemdir. Sürveyans çalışmaları hastane enfeksiyon kontrol programlarının temelini oluşturur. HE sürveyansı, enfeksiyon önlemi için yapılan tüm diğer metodlarla birlikte enfeksiyon oranlarını azaltmada değerlidir.Bu çalışma ile 1 yıl süresince Yenidoğan Yoğun Bakım Ünitesi (YDYBÜ), Yenidoğan (YD) Kliniği ve Çocuk Hematoloji Onkoloji (HO) Kliniğinde yatmakta olan hastalarda oluşan HE tipleri ve yüzdeleri, HE ile ilişkili mortalite oranları, risk faktörleri ve bunların mortaliteye katkısı ile sık karşılaşılan etkenlerin değerlendirilmesi amaçlanmıştır.Çalışma süresince YDYBÜ'sinde 68, YD kliniğinde 5 ve çocuk HO kliniğinde 44 hastada HE saptandı. Bazı hastalarda birden fazla epizod ve kültür üremesi vardı. YDYBÜ'sinde toplam 128 HE epizotu (hasta başına 1.88 epizod), 199 kültür üremesi saptandı. YD klinikte HE saptanan toplam 5 HE epizotu (hasta başına 1 epizod) gelişti, YD kliniğinde HE tanısı alan hastalarda kültür üremesi saptanmadı. HO kliniğinde toplam 59 HE epizodu (hasta başına 1.34 epizod), ve 46 kültür üremesi saptandı. Genel HE hızı %20.7 (ÇYBÜ, klinik, YDYBÜ, YD klinik ve çocuk HO kliniğinde) olarak saptandı. 100 hasta yatışına göre HE oranı YDYBÜ ve YD kliniğinde 55.4, HO kliniğinde 19.8 bulundu. Tanılar içinde YDYBÜ'sinde pnömoni %35.5 (n=60) oranı ile ilk sırada yer alırken, ikinci sırada kan akımı enfeksiyonları (KAE) (%20.7, n=35), üçüncü sırada menenjit (%14.7 n=25) yer aldı. YD kliniğinde konjunktivit %40 (n=2) oranı ile ilk sırada yer aldı. HO kliniğinde KAE %27.8 oranı ile ilk sırada yer alırken, ikinci sırada oral mukozit (%17.6, n=12), üçüncü sırada pnömoni (%10.2, n=7) yer aldı. Hastalara uygulanan invaziv prosedürler göz önüne alındığında; YDYBÜ'sinde santral kateter ile ilişkili KAE oranı 15/1000 kateter günü, ventilasyon ile ilişkili pnömoni (VİP) oranı 12/1000 mekanik ventilasyon günü, HO kliniğinde santral kateter ile ilişkili KAE oranı 15/1000 kateter günü, VİP oranı 28/1000 mekanik ventilasyon günü olarak bulundu. YDYBÜ'sinde etken olarak saptanan mikroorganizmalardan gram negatifler %49.2, gram pozitifler %42.5, funguslar %8.2 oranında, HO kliniğinde gram pozitifler %45.6, gram negatifler %43.4, funguslar %11 oranında saptandı.YDYBÜ'sinde KAE'de en sık görülen mikroorganizmalar gram pozitiflerdi (%61). Hastane kaynaklı pnömonide gram negatifler %81.2 oranı ile ilk sırada yer aldı. Üriner sistem enfeksiyonunda (ÜSE) en sık görülen mikroorganizmalar gram pozitiflerdi (%61,5). HO kliniğinde KAE' unda en sık görülen mikroorganizmalar gram pozitiflerdi (%68). ÜSE'da en sık görülen mikroorganizmalar gram negatiflerdi (%75). Risk faktörleri incelendiğinde ise; YDYBÜ'sinde yatan hastalarda santral kateter, mekanik ventilasyon, transfüzyon, total parenteral nütrisyon, prematürite sık görülen risk faktörleri olarak saptandı. HO kliniğinde yatan hastalarda immunsupsesif tedavi, nötropeni, santral kateter varlığı, uzamış yatış sık görülen risk faktörleri olarak bulundu. Mortalite oranı YDYBÜ'sinde %8.5, HO kliniğinde %16.9 saptandı.Merkezlerin kendi hasta profillerini, hastane florasını oluşturan mikroorganizmaları ve bunların direnç özelliklerini, her bölümdeki HE dağılımı ve sıklığını bilmeleri doğru enfeksiyon kontrol yaklaşımlarının geliştirilmesini sağlar. Bu çalışma üniversitemiz hastanesi YDYBÜ ve çocuk HO kliniğinde yatan hastalarda gelişebilecek HE'larına karşı doğru önlemlerin alınmasına doğru tedavi yaklaşımlarının sağlanmasına yardımcı olacaktır.
Nosocomial infections (NI) that cause mortality, morbidity and economic loss constitude a serious problem. Surveillace studies are one of the most important tools in prevention of NI. Along with various other methods for prevention, the surveillance of nosocomial infecitons has been shown to be vulnerable for reducing infection rates.The aim of the current study is to evaluate the NI types and proportions, mortality rates related to NI, contribution of NI to mortality and risk factors and frequently encountered microorganisms, among patients who were hospitalized in Neonatal Intensive Care Unit (NICU) Pediatric Hematology and Oncology Department throutout 1 year.Sixty eight patients in NICU, five patients in neonatology department and fourty four patients in pediatric hematology oncology department developed NI. Some patients had more than one NI episodes and positive cultures. Total of 128 NI episodes (mean episode ratio for each patient was 1.88), 199 organisms were isolated in NICU. In neonatology department total of 5 NI episodes were detected. In pediatric hematology and oncology department total of 56 NI episodes, and 44 organisms were isolated. The incidence of NI (pediatric intensive care unit, NICU and pediatric hematology-oncology department) was 20.7%. For 100 admitted patients in NICU and neonatalogy department NI ratio was 55.7 and in pediatric hematology -oncology department it was 19.8. In NICU pneumonia was the first among diagnosis with 35.5% (n=60) ratio, primary blood stream infeciton (BSI) was the second with 20.7% ratio (n=35), and the meningitis with 14.7% (n=25) shared the third place. In neonatology department conjuctivitis was the first among diagnosis with 40% ratio. In pediatric hematology-oncology department BSI was the first among diagnosis with %27.8 ratio, oral mucocitis was the second with 17.6% ratio (n=12), and the pneumonia with 10.2% (n=7) shared the third place. Considering the invasive procedures, central line associated BSI, ventilator associated pneumonia were found as 15 and 12/1000 catheter days respectively in NICU, 15 and 28/1000 catheter days respectively in pediatric hematology-oncology department. In NICU the proportions of microorganisms that were determined as the cause of NI were gram negative bacteria, gram positive bacteria and fungi 49.2%, 42.5% and 8.2% respectively. In pediatric hematology?oncology department the proportions of microorganisms that were determined as the cause of NI were gram positive, gram negative and fungi 45.6%, 43.4% and 11% respectively. In NICU gram positive bacteria were the most common microorganism in BSI (%61). Gram negatives were most frequently encountered cause of hospital related pneumonia (%81.2). The most common cause of urinary tract infections (UTI) was gram positives by 61.5%. In pediatric hematology-oncology department gram positive bacteria were the most common microorganism in BSI (%61.5). The most common cause of UTI was gram negatives by %75.The most common risk factors among the patients in NICU were; invasive prosedures, transfusion, total parenteral nutrıtion and prematurity.The mean mortality rate in NICU and pediatric hematology-oncology department was 8.5 % and 16.9% respectively.By knowing patients profiles, microorganisms that make up the hospital flora, the resistance status of the microorganisms and NI prevelance and frequency in each clinic hospitals can develop proper control methods. Determination of the situation through the current study, will be helpful in taking precautions and providing the proper tratments, in case of possible NI in NICU and hematology-oncology deparment.
Nosocomial infections (NI) that cause mortality, morbidity and economic loss constitude a serious problem. Surveillace studies are one of the most important tools in prevention of NI. Along with various other methods for prevention, the surveillance of nosocomial infecitons has been shown to be vulnerable for reducing infection rates.The aim of the current study is to evaluate the NI types and proportions, mortality rates related to NI, contribution of NI to mortality and risk factors and frequently encountered microorganisms, among patients who were hospitalized in Neonatal Intensive Care Unit (NICU) Pediatric Hematology and Oncology Department throutout 1 year.Sixty eight patients in NICU, five patients in neonatology department and fourty four patients in pediatric hematology oncology department developed NI. Some patients had more than one NI episodes and positive cultures. Total of 128 NI episodes (mean episode ratio for each patient was 1.88), 199 organisms were isolated in NICU. In neonatology department total of 5 NI episodes were detected. In pediatric hematology and oncology department total of 56 NI episodes, and 44 organisms were isolated. The incidence of NI (pediatric intensive care unit, NICU and pediatric hematology-oncology department) was 20.7%. For 100 admitted patients in NICU and neonatalogy department NI ratio was 55.7 and in pediatric hematology -oncology department it was 19.8. In NICU pneumonia was the first among diagnosis with 35.5% (n=60) ratio, primary blood stream infeciton (BSI) was the second with 20.7% ratio (n=35), and the meningitis with 14.7% (n=25) shared the third place. In neonatology department conjuctivitis was the first among diagnosis with 40% ratio. In pediatric hematology-oncology department BSI was the first among diagnosis with %27.8 ratio, oral mucocitis was the second with 17.6% ratio (n=12), and the pneumonia with 10.2% (n=7) shared the third place. Considering the invasive procedures, central line associated BSI, ventilator associated pneumonia were found as 15 and 12/1000 catheter days respectively in NICU, 15 and 28/1000 catheter days respectively in pediatric hematology-oncology department. In NICU the proportions of microorganisms that were determined as the cause of NI were gram negative bacteria, gram positive bacteria and fungi 49.2%, 42.5% and 8.2% respectively. In pediatric hematology?oncology department the proportions of microorganisms that were determined as the cause of NI were gram positive, gram negative and fungi 45.6%, 43.4% and 11% respectively. In NICU gram positive bacteria were the most common microorganism in BSI (%61). Gram negatives were most frequently encountered cause of hospital related pneumonia (%81.2). The most common cause of urinary tract infections (UTI) was gram positives by 61.5%. In pediatric hematology-oncology department gram positive bacteria were the most common microorganism in BSI (%61.5). The most common cause of UTI was gram negatives by %75.The most common risk factors among the patients in NICU were; invasive prosedures, transfusion, total parenteral nutrıtion and prematurity.The mean mortality rate in NICU and pediatric hematology-oncology department was 8.5 % and 16.9% respectively.By knowing patients profiles, microorganisms that make up the hospital flora, the resistance status of the microorganisms and NI prevelance and frequency in each clinic hospitals can develop proper control methods. Determination of the situation through the current study, will be helpful in taking precautions and providing the proper tratments, in case of possible NI in NICU and hematology-oncology deparment.
Description
Keywords
Hastane enfeksiyonları, Yenidoğan, Çocuk hematoloji-onkoloji hastaları, Risk faktörleri, Mortalite, Nosocomial infections, Newborn, Pediatric hematology-oncology patients, Risk factors, Mortality
Citation
Kavurt, A. S. (2009). Yenidoğan Yoğun Bakım Ünitesi ve Çocuk Hematoloji-Onkoloji Kliniğinde yatan hastalarda hastane enfeksiyonları: Bir yıllık sürveyans çalışması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.