Düzce Üniversitesi Tıp Fakültesi hastanesi yoğun bakım ünitelerinde hastane enfeksiyon etkenleri ve antibiyotik duyarlılıkları
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Tarih
2015
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Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışma Ocak 2009-Aralık 2013 tarihleri arasında yoğun bakımlarda yatarak tedavi gören ve en az 48 saat takip edilen hastaların verilerinin retrospektif olarak taranmasıyla yapıldı. Hastane enfeksiyonu tanısı konulmasında Hastalık Kontrol ve Önleme Merkezi (CDC) tanı kriterleri kullanıldı. Hastane enfeksiyon dansitesi hesaplanması için (Hastane enfeksiyonu sayısı/hasta günü)x1000 formülü kullanıldı. Etken mikroorganizmaların tanımlanması ve antibiyotik duyarlılıkları CLSI standartlarına uygun olarak yapılmıştır. Çalışma boyunca 2612 hastanın 447'sinde 893 enfeksiyon atağı gelişmiş olup; 785 (%87.9)'inde 934 mikroorganizma elde edilirken; 108 (%12.1) atakta etken saptanamadı. HE hızı %32.1, insidans dansitesi 33 olarak belirlenmiştir. HE gelişen hastaların %55.5'i kadın, %45.5'i erkekti. Kadınların yaş ortalaması 64.4 yıl, erkeklerin 70.1 yıl idi. En sık komorbid nedenler arasında hipertansiyon (%49.1) ve diyabet (%32.5) yer almaktaydı. HE içinde en sık hastane kökenli pnömoni, ikinci sıklıkta hastane kökenli bakteriyemi ve üçüncü sıklıkta üriner sistem enfeksiyonu saptandı. Hastane kökenli pnömonilerin %98.1'i ventilatör ilişkili pnömoni, hastane kökenli bakteriyemilerin %34.8'i santral venöz katater ilişkili bakteriyemiydi. Yoğun bakım enfeksiyonu etkeni olarak izole edilen bakterilerin %26.2'si Acinetobacter spp., %26'sı Pseudomonas spp., %9.9'u Escherichia coli, %8.5'i Metisilin dirençli S. aureus (MRSA), %5.3'ü Candida spp. ve %4.7'si Enterococcus spp. olarak bulundu. Acinetobacter türlerinin en duyarlı olduğu antimikrobiyaller kolistin, tigesiklin iken, Pseudomonas spp.' nin kolistin, amikasin, piperasilin-tazobaktamdır. Yoğun bakım enfeksiyonları tüm dünyada olduğu gibi hastanemiz için ciddi bir sorundur. Bu enfeksiyonların kontrolünün sağlanmasında sürveyans çalışmaları esastır. Hastane enfeksiyonlarının kontrolünün sağlanabilmesi için sürveyans çalışmalarının sürdürülerek her merkezin kendi enfeksiyon dağılımlarını, hastane florasını oluşturan mikroorganizmaları, direnç paternlerini belirlemesi ve ampirik tedavide doğru antibiyotik kullanımını yaygınlaştırması gerekmektedir. Yoğun bakım ünitelerine özel olarak fazla görülen enfeksiyonlara yönelik önlemlerin alınması ve enfeksiyon kontrol standartlarına uyumun artırılması için daha fazla çalışmaların yapılması gerekmektedir.
This study was done by retrospectively of patient data who were hospitalized in the intensive care unit and were followed for a minimum of 48 hours between January 2009 and December 2013. Centers for Disease Control and Prevention (CDC) criteria were used in the diagnostic of hospital infections. To calculate the density of hospital-acquired infections (The number of hospital infections / patient day)x1000 formula has been used. Identification of the causative microorganism and antibiotic susceptibility were performed according to CLSI standards. During the study 893 episodes of infection is advanced in 447 cases of 2612 patients; 934 microorganisms is obtained of the in 785 (%87,9); in 108 (%12,1) Attackes there was no factor. HE speed is %32,1 and the incidence density is 33. Of the patients with HE %55,5 of them are women,%45.5 of them are men. Women's average age was 64,4 and men's average age was 70,1. Among the most common comorbid causes hypertension (%49.1) and diabetes (%32.5) were located. The most common hospital-acquired pneumonia in HE, the second most common hospital-acquired bacteraemia and third most frequent urinary tract infections were detected. %98.1 of hospital-acquired pneumonia was ventilator-associated pneumonia, %34.8 of hospital-acquired bacteraemia was central venous catheter-related bacteremia. %26.2 of isolated bacterial infection in intensive care agent was Acinetobacter spp., %26 was Pseudomonas spp., %9.9 was Escherichia coli, %8.5 was Methicillin-resistant S. aureus (MRSA), %5.3 was Candida spp. and %4.7 was Enterococcus spp. While tigecycline, colistin was the most sensitive antimicrobials of Acinetobacter species, of Pseudomonas spp. they are colistin, amikacin, piperacillin-tazobactam. ICU infections are a serious problem for our hospitals as well as all over the world. Surveillance studies are essential in ensuring the control of these infections. In order to ensure the control of hospital infections maintaining the surveillance study each center should define their own distribution of infection, microorganisms that form the hospital flora, the resistance patterns and should generalize the correct use of antibiotics for empiric therapy. In order to take precautions for infection occurring more specifically in the intensive care unit and to increase compliance with infection control standards further studies are required.
This study was done by retrospectively of patient data who were hospitalized in the intensive care unit and were followed for a minimum of 48 hours between January 2009 and December 2013. Centers for Disease Control and Prevention (CDC) criteria were used in the diagnostic of hospital infections. To calculate the density of hospital-acquired infections (The number of hospital infections / patient day)x1000 formula has been used. Identification of the causative microorganism and antibiotic susceptibility were performed according to CLSI standards. During the study 893 episodes of infection is advanced in 447 cases of 2612 patients; 934 microorganisms is obtained of the in 785 (%87,9); in 108 (%12,1) Attackes there was no factor. HE speed is %32,1 and the incidence density is 33. Of the patients with HE %55,5 of them are women,%45.5 of them are men. Women's average age was 64,4 and men's average age was 70,1. Among the most common comorbid causes hypertension (%49.1) and diabetes (%32.5) were located. The most common hospital-acquired pneumonia in HE, the second most common hospital-acquired bacteraemia and third most frequent urinary tract infections were detected. %98.1 of hospital-acquired pneumonia was ventilator-associated pneumonia, %34.8 of hospital-acquired bacteraemia was central venous catheter-related bacteremia. %26.2 of isolated bacterial infection in intensive care agent was Acinetobacter spp., %26 was Pseudomonas spp., %9.9 was Escherichia coli, %8.5 was Methicillin-resistant S. aureus (MRSA), %5.3 was Candida spp. and %4.7 was Enterococcus spp. While tigecycline, colistin was the most sensitive antimicrobials of Acinetobacter species, of Pseudomonas spp. they are colistin, amikacin, piperacillin-tazobactam. ICU infections are a serious problem for our hospitals as well as all over the world. Surveillance studies are essential in ensuring the control of these infections. In order to ensure the control of hospital infections maintaining the surveillance study each center should define their own distribution of infection, microorganisms that form the hospital flora, the resistance patterns and should generalize the correct use of antibiotics for empiric therapy. In order to take precautions for infection occurring more specifically in the intensive care unit and to increase compliance with infection control standards further studies are required.
Açıklama
YÖK Tez No: 394015
Anahtar Kelimeler
Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları, Clinical Microbiology and Infectious Diseases, Antibiyotikler, Antibiotics, Antienfektif ajanlar, Anti infective agents, Düzce, Düzce, Enfeksiyon, Infection, Mikrobiyal duyarlılık testleri, Microbial sensitivity tests, Yoğun bakım, Intensive care, Yoğun bakım üniteleri, Intensive care units, Yoğun bakım üniteleri, Intensive care units, Çapraz enfeksiyon, Cross infection
