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Amaç: Bu çalışmanın amacı, Ankara Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon yoğun bakım ünitesinde yatan hastalarda gelişen kateter ilişkili üriner sistem infeksiyonlarının hızlarının ve infeksiyon etkenlerinin retrospektif değerlendirilmesidir. Gereç ve Yöntemler: Çalışmaya, 1 Ocak 2018-31 Aralık 2019 tarihleri arasında Anesteziyoloji ve Reanimasyon yoğun bakım ünitesi (ARYBÜ)’nde yatan ve kateter ilişkili üriner sistem infeksiyonu tanısı konulan hastalar dahil edildi. Hasta verileri enfeksiyon kontrol hemşirelerinin günlük vizitleri ve enfeksiyon hastalıklarının günlük konsültasyon kayıtlarından ve Ulusal Hastane Enfeksiyonları Sürveyans Ağı İNFLİNE programı verilerinden, laboratuvar verileri ise Mikrobiyoloji laboratuarından elde edildi. Hastaların demografik verileri, üriner kateterle ilişkili enfeksiyonları, enfeksiyon etkenleri, hastalardaki komorbid durumların varlığı kaydedildi. Bulgular: Anesteziyoloji ve Reanimasyon yoğun bakım ünitesinde iki yıllık sürede 17910 hasta gününde 1243 hasta takip edilmişti. Hastaların üriner kateter günü 17470 gün idi. Çalışmanın yapıldığı dönemde toplam 85 hastaya 116 Kİ-ÜSİ tanısı konuldu. Üriner kateter kullanım oranı 0.97, kateterle ilişkili üriner sistem infeksiyonu hızı (Kİ-ÜSİ) ise 6.63 olarak saptandı. 2019 yılı Sağlık Bakanlığı Eğitim ve Araştırma Hastaneleri ARYBÜ’lerinin sürveyans verileri ile karşılaştırıldığında; hastanemizin ARYBÜ üriner kateter kullanım oranının %25 persentil ile uyumlu olduğu, Kİ-ÜSE hızının ise %90 persentilin üzerinde olduğu saptandı.Hastaların 47 (% 55)’si kadın, 38 (%45)’i erkek, yaş median değeri 66 idi. Hastaların tümünde üriner kateter mevcuttu. Hastalarda görülen komorbid hastalıklar; 44 (%51.8) hastada nörolojik hastalık (serebrovasküler olay, demans vb.), 40 (%47.1) hastada hipertansiyon, 28 (%32.9) hastada diyabetes mellitus, 20 (%23.5) hastada KOAH ve iki (%2.4) hastada kronik böbrek hastalığı olarak belirlendi. Hastaların 72 (%84.7)’si entübe idi ve 19 (%22.4)’unda dekübit ülseri mevcuttu. Kİ-ÜSİ etkenlerinin dağılımı incelendiğinde 27 (%31.8) hastada birden fazla etkenin izole edildiği görüldü. Üriner sistem etkenleri 18 (%21.2) hastada Klebsiella türleri (spp.), 10 (%11.8) hastada Escherichia coli, dokuz (%10.6) hastada Enterococcus spp.,sekiz (%9.4) hastada Pseudomonas spp., yedi (%8.2) hastada Proteus spp., dört (%4.7) hastada Acinetobacter spp., bir (%1.2) hastada Staphylococcus aureus ve bir (%1.2) hastada Enterobacter spp. olarak belirlendi. Kİ-ÜSİ saptanan 85 hastanın 19’unda kan kültüründe de aynı etken izole edildi. Kan kültüründen en sık izole edilen etkenler sırasıyla; altı olguda birden fazla etken, yedi Klebsiella spp., iki E. coli ve iki Enterococcus spp., bir Acinetobacter spp., bir Proteus spp. olarak belirlendi. Sonuç: Yoğun bakım ünitelerinde kateter ilişkili üriner sistem infeksiyonu oranlarının azaltılması için üriner kateter takılması endikasyonlarının iyi belirlenmesi, gereklilik ortadan kalktığında kateterin çekilmesi ve enfeksiyon kontrol önlemlerine dikkat edilmesi uygun bir yaklaşım olacaktır. Yoğun bakım ünitesinde yatan hastalarda hastane infeksiyonu etkenlerinin belirlenmesi, ampirik tedavide yol gösterici olacağından mortalite ve morbidite oranlarının azaltılmasına da katkı sağlayacaktır.
Purpose: The purpose of this study is to retrospective evaluation of the rates and infectious factors of catheter-related urinary system infections developing in patients based in the Ankara Education and Research Hospital, Anesthesiology and Reanimation Intensive Care Unit. Tools and Methods: The study included patients diagnosed with catheter-related urinary system infection in the Anesthesiology and Rehabilitation Intensive Care Unit (ARYBÜ) between 1 January 2018 and 31 December 2019. Patient data were obtained from the daily visits of infection control nurses and from the daily consultation records of infectious diseases and from the National Hospital Infections Surveillance Network INFLINE program data, and laboratory data from the Microbiology Laboratory. Demographic data of patients, infections associated with urine catheter, infectious factors, the presence of complicated conditions in patients were recorded. Results: Anesthesiology and Reanimation intensive care units followed 1,243 patients per day in 17910 patients over the course of two years. The patient's urine catheter day was 17470 days. At the time of the study, a total of 85 patients were diagnosed with 116 HIV. The urine kateter use rate was 0.97, and the urine system infection rate associated with the kateter was 6.63. In 2019 the Ministry of Health Education and Research Hospitals ARYBÜ compared with the surveillance data; it was found that our hospital’s ARYBÜ urine kateter use rate is consistent with 25% per cent, and the KI-USSE rate is above 90% per cent. 47 (55%) of patients were female, 38 (45%) male, and the average age was 66. All patients had an urine catheter. Comorbid diseases observed in patients; 44 (51.8) patients with neurological diseases (cerebrovascular events, dementia, etc.)40 (%47.1) patients were diagnosed with hypertension, 28 (%32.9) patients with diabetes mellitus, 20 (%23.5) patients with KOAH and two (%2.4) patients with chronic kidney disease. 72 of the patients (84.7 percent) were enthusiast and 19 (22.4 percent) had decubite ulcers. When the distribution of the CIS factors was studied, 27 (31.8%) patients found more than one factor being isolated. Urinary system factors 18 (21.2%) in patients with Klebsiella types (spp.), 10 (%11.8) patients with Escherichia coli, nine (%10.6) patients with Enterococcus spp., eight (%9.4) patients with Pseudomonas spp., eaten seven (%8. 2) Proteus spp., Acinetobacter spp. in four patients (4.7 percent), Staphylococcus aureus in one (1.2 percent) and Enterobacter spp. in one (1.2 percent). It was determined. Of the 85 patients diagnosed with HIV, 19 were isolated by the same factor in the blood culture. The factors isolated from the blood culture, respectively; more than one factor in six cases, seven Klebsiella spp., two E. coli and two Enterococcus spp., one Acinetobacter spp., one Proteus spp. It was determined. The result: a good determination of the indications of urine catheter installation to reduce the rates of catheter-related urine system infection in intensive care units will be a suitable approach to pay attention to catheter withdrawal and infection control measures when the need disappears. The identification of hospitalized infection factors in patients in the intensive care unit will also contribute to the reduction of mortality and morbidity rates, as it will be a guide in empiric treatment.
Aim: The aim of this study is to retrospectively evaluate the rates and infectious factors of healthcare-associated urinary tract infections in patients with Ankara Training and Research Hospital, Anesthesia and Reanimation intensive care unit. Material and Methods: Patients hospitalized in the Anesthesia and Reanimation intensive care unit (ICU) between January 1, 2018 and December 31, 2019 and diagnosed with healthcare-related urinary tract infection were included in the study. Patient data were obtained from the daily visits of infection control nurses and daily consultation records of infectious diseases, while laboratory data were obtained from the Microbiology laboratory. The rate of infection associated with urinary catheter, distribution of infectious agents, and presence of comorbid conditions in patients were recorded. Results: Totaly 1243 patients were followed up for 17,910 patient days in the Anesthesia and Reanimation intensive care unit for two years .The urinary catheter day of the patients was 17470 days. A total of 85 patients were diagnosed with 116 urinary catheter-related urinary tract infections. Forty- seven of the patients (55%) were female, 38 (45%) were male, age median value was 66.During the period of the study, it was found that the rate of urinary catheter use was 0.97, and the rate of catheter-related urinary tract infection (CI-UTI) was 6.63.When the rate of urinary catheter use in the Anesthesia and Reanimation intensive care unit in our hospital is compared with the 2019 Ministry of Health Education and Research Hospitals Anesthesia ICU surveillance data; it was found that the rate of urinary catheter use was consistent with the 25th percentile (0.97), and the rate of CI-UTI was above the 90th percentile (3.8).The most common comorbid diseases in patients were at least one neurological disease (cerebrovascular event, dementia, etc.) in 44 (51.8%) patients, hypertension in 40 (47.1%), diabetes mellitus in 28 (32.9%), chronic obstructive pulmonary diseases in 20 (23.5%) patients and 2.4% of the patients were identified as chronic kidney disease. All patients had urinary catheters. 72 (84.7%) of the patients were intubated and 19 (22.4%) had decubitus ulcers.Distribution of agents causing urinary tract infection; multiple agents in 27 (31.8) patients, Klebsiella species (spp.) in 18 (21.2%) patients, E.coli in 10 (11.8%) patients, Enterococcus spp. in nine (10.6%) patients, Pseudomonas spp in eight (9.4%) patients, Proteus spp. in seven (8.2%) patients, Acinetobacter spp. in four (4.7%) patients, Staphylococcus aureus in one (1.2%) patient, Enterobacter spp. in one (1.2%) patient were determined.In 19 of 85 patients with urinary system infection, the agent was also isolated from the blood culture. The most common factors isolated from blood culture are; 36.8% Klebsiella spp., 31.6% multiple agents, 10.5% E.coli and 10.5% Enterococcus spp. was determined. Conclusion: As a result, it would be an appropriate approach to determine the indications for urinary catheter insertion well and withdraw the catheter when the necessity is eliminated in order to reduce the urinary system infection rates associated with healthcare in the ICU. Determining the factors of nosocomial infection in patients hospitalized in the intensive care unit will contribute to the reduction of mortality and morbidity rates as it will be a guide in empirical treatment.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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