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Giriş ve Amaç Yoğun bakım ünitelerinde (YBÜ) gelişen hastane enfeksiyonları (HE) yüksek mortalite ve morbidite sebebi olduğundan ciddi bir sorundur. Bu çalışmada üçüncü basamak genel yoğun bakım ünitesinde gelişen hastane kökenli enfeksiyonların tanıları, sistemlere göre dağılımları ve etken patojenleri değerlendirildi ve bu verilere dayalı olarak yeni enfeksiyon kontrol stratejileri geliştirilmesi amaçlandı. Gereç ve Yöntem: Enfeksiyon Hastalıkları Kliniğince izlenen genel YBÜ’lerinde 01.01.2018-31.12.2019 tarihleri arasında aktif prospektif sürveyans ile kayıt altına alınan hastane kökenli enfeksiyonlar retrospektif olarak incelendi. Bulgular: Genel YBÜ’lerde iki yıllık süreçte 1189 hastanın 8468 yatış günü takibinde 90 hastada 95 HE epizodu tanımlandı. Genel YBÜ’de Hastane enfeksiyon hızı 7,98 hastane enfeksiyon insidans dansitesi 11,21 olarak tespit edildi. HE dağılımına bakıldığında, hastalarda en sık pnömoni dışı gelişen alt solunum yolu enfeksiyonu (%36,8) tespit edilirken bunu sırası ile spesifik laboratuar bulguları olan pnömoni (%33,6), ventilatör ilişkili pnömoni (VİP) (%10,5), santral venöz kateter ilişkili kan dolaşımı enfeksiyonu (SVKİ-KDE) (%9,4), laboratuar tarafından kanıtlanmış KDE (LTD-KDE) (%6,3) ve kateter ilişkili üriner sistem enfeksiyonu (Kİ-ÜSE) (%3,1) izlemekteydi. Etkenlerin sistem enfeksiyonlarına göre dağılımına bakıldığında sırasıyla pnömoni dışı gelişen alt solunum yolu enfeksiyonun’da Acinetobacter spp. (%48,7), Klebsiella pneumoniae (%25,6), Psödomonas aeruginosa (%12,8), Serratia marcescens (%5,1), Escherichia coli (%2,5), Enterobacter cloacae (%2,5), Candida albicans (%2,5) yer almaktaydı, %11,4’ü polimikrobiyaldi. Sonuç: Hastanelerde özellikle YBÜ’lerde hastane enfeksiyonlarının görülmesi kaçınılmazdır ve hastanelerin hayati önem taşıyan sağlık hedeflerinden biri de bu durumu kontrol etmek ve yönetmektir. Hastane enfeksiyonu oranlarını azaltmak için zamanında ve uygun terapötik girişimlerde bulunulmalıdır. İhtiyaç halinde doğru endikasyonla kateterler takılmalı ve kateter uygulaması azaltılmalıdır. Hastanelerin kendi sürveyans verilerine dayalı akılcı antibiyoterapi uygulama programları geliştirmeleri önemli bir noktadır.
Introduction and Purpose Intense care units developing hospital infections (HE) is a serious problem because it is a cause of high mortality and morbidity. This study assessed the diagnoses of hospital-based infections developing in the third stage general intensive care unit, the distribution according to systems and the pathogens, and aimed at developing new infections control strategies based on these data. Method and means: Infectious diseases Clinically monitored general medical clinics with active prospective surveillance from 01.01.2018 to 31.12.2019 registered hospital-based infections were examined retrospectively. Results: In the two-year period, 1189 patients were diagnosed with 95 HE episodes in 90 patients, followed by 8468 sleep days. In general, the hospital infection rate was 7.98; the hospital infection incidence rate was 11.21. With regard to the HE distribution, the patient was diagnosed with non-pneumonial development of lower respiratory infection (36.8%) while it was followed by specific laboratory findings respectively with pneumonia (33.6%) and ventilator-related pneumonia (VIP) (10.5%) and central venous catheter-related blood circulation infection (SVKI-KDE) (9.4%) and laboratory-proofed KDE (LTD-KDE) (6.3%) and catheter-related urine system infection (KIE-USE) (3.1%). When considering the distribution of factors according to system infections, acinetobacter spp in the sub- respiratory tract infection that develops non-pneumonia respectively. (%48,7), Klebsiella pneumoniae (%25,6), Psödomonas aeruginosa (%12,8), Serratia marcescens (%5,1), Escherichia coli (%2,5), Enterobacter cloacae (%2,5), Candida albicans (%2,5) were included, 11.4% polymicrobial. The result: Hospital infections are inevitable, especially in hospitals, and one of the vital health goals of hospitals is to control and manage this situation. Treatments should be taken in time and appropriate therapeutic measures to reduce the rates of hospital infection. If necessary, catheters should be installed with the correct indication and the application of catheters should be reduced. It is an important point for hospitals to develop logical antibiotic therapy application programs based on their own surveillance data.
Abstract Introduction and Objective: Nosocomial infections (NIs) in intensive care units (ICUs) are serious problems because of high mortality and morbidity. Here, it was aimed to evaluate diagnoses, distribution and pathogens of NIs in two tertiary general ICUs (GICU) of a hospital and develop new infection control strategies based on the data. Material and Methods: NIs followed in the infectious diseases department and recorded by active prospective surveillance between January 2018-December 2019 in GICUs were retrospectively analyzed. Results: Ninety-five NI episodes were identified in 90 patients during 8468 hospitalization days of 1189 patients in a two-year period. While NI rate in GICUs was 7.98, incidence of NI density was determined as 11.21. Considering the distribution of NIs, lower respiratory tract infections (LRTI) (36.8%) were detected as highest and followed as specific laboratory findings by pneumonia (33.6%), ventilator-associated pneumonia (VAP) (10.5%), central venous catheter-related blood stream infections (CVCR-BSI) (9.4%), laboratory-proven BSI (6.3%) and catheter-associated urinary tract infections (CR-URI) (3.1%). Given the distribution of the factors concerning system infections, agents leading to LRTI other than pneumonia were as follows: Acinetobacter spp. (48.7%), Klebsiella pneumoniae (25.6%), Pseudomonas aeruginosa (12.8%), Serratia marcescens (5.1%), Escherichia coli (2.5%), Enterobacter cloacae (2.5%) ) and Candida albicans (2.5%), and 11.4% were polymicrobial. Conclusion: NIs are inevitable entities in hospitals, especially in ICUs, and one of the vital goals of hospitals is to control and manage such a situation. Timely and appropriate therapeutic interventions should be designed to reduce NI rates. If needed, catheters should be inserted with correct indication, and catheter application should be reduced. It is important that hospitals develop comprehensive antibiotherapy programs based on their own surveillance data.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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