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Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis

Yıl 2019, Cilt: 9 Sayı: 1, 37 - 42, 27.03.2019
https://doi.org/10.16899/gopctd.490920

Öz

Amaç: Yenidoğan Yoğun Bakım Ünitesi (YYBÜ)'ndeki
prematüre bebeklerde nozokomiyal sepsis gelişme oranını, risk faktörlerini ve
en sık görülen mikroorganizmaları saptamayı amaçladık

Gereç ve Yöntem: Nozokomiyal sepsis grubunda (NSG)
46, kontrol grubunda (KG) ise 124 hasta olarak toplam 170 prematüre çalışma
kapsamına alınmıştır. Tüm hastaların cinsiyet, doğum ağırlığı (DA), gestasyon
yaşı (GY), doğum ağırlığı (DA), yatış süresi ve doğum şekilleri, klinik ve
labaratuar bulguları kaydedilmiştir. Sepsis düşünülen hastalarda kan, Beyin
Omirilik Sıvısı (BOS) Endo Trakeal Aspirat (ETA), boğaz, idrar ve göbek
kültürleri alınmıştır.

Bulgular: Sepsis risk faktörlerini
belirlemek için yapılan lojistik regresyon analizi sonucunda yatış süresi, düşük DA, emmeme, mama ile
beslenme, ventilatör tedavisi, kan transfuzyonu, prematürelerde nozokomiyal sepsisi
istatiksel olarak anlamlı olarak artırdığı saptamıştır. Ayrıca klinik
bulgulardan kusma, ateş, apne, konvülziyon, menenjit ve hipoterminin
nozokomiyal sepsis gelişmesi bakımından anlamlı risk faktörleri olduğu tespit
edilmiştir (p<0.05). CRP, MPV

ve TG (+) NSG daha fazla olup istatiksel olarak anlamlı bulunmuştur
(p=0.00000).   Nozokomiyal sepsisli
hastaların %50 de kan, %20.37 de idrar kültüründe üreme gözlenmiş. 46 hastanı 11 de klebsiella pneumonia (%40.74)
izole edilirken sırasıyla S.Aureus (%18.51),
pseudomonas ve E.coli (%11.11) üremesi görülmüştür.

Sonuç: Nozokomiyal sepsis YD de önemli
morbidite ve mortalite nedeni olduğu için risk faktörlerinin ve enfeksiyon
etkenlerinin saptanarak gerekli önlemlerin alınmasının morbidite ve mortaliteyi
azaltacağını düşünüyoruz.









 

Kaynakça

  • Referans1 Allen U, Ford-Jones EL. Nosocomial infections in the pediatric patient: an update. Am J Infect Control 1990;18(3):176-93.
  • Referans2 Jacob J, Pfenninger J, Davis RF, Hulman S. The next challenge for newborn intensive care in Alaska: improving the survival of the larger neonate. Alaska Med 1997;39(4):111-6.
  • Referans3. Starr SE. Antimicrobial therapy of bacterial sepsis in the newborn infant. J Pediatr 1985;106(6):1043-8.
  • Referans4. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16(3):128-40.
  • Referans5. Simon C, Schroder H, Beyer C, Zerbst T. Neonatal sepsis in an intensive care unit and results of treatment. Infection 1991;19(3):146-9.
  • Referans6. Mullett MD, Cook EF, Gallagher R. Nosocomial sepsis in the neonatal intensive care unit. J Perinatol 1998;18(2):112-5.
  • Referans7. Gayvallet-Montredon N, Sauvestre C, Bergeret M, Gendrel D, Raymond J. [Bacteriologic surveillance of nosocomial septicemia and bacteremia in a pediatric hospital]. Arch Pediatr 1998;(11):1216-20.
  • Referans8. Kotloff KL, Blackmon LR, Tenney JH, Rennels MB, Morris JG, Jr. Nosocomial sepsis in the neonatal intensive care unit. South Med J 1989; 82(6):699-704.
  • Referans9. Gerdes JS. Clinicopathologic approach to the diagnosis of neonatal sepsis. Clin Perinatol 199118(2):361-81.
  • Referans10. Perez EM, Weisman LE. Novel approaches to the prevention and therapy of neonatal bacterial sepsis. Clin Perinatol 1997;24(1):213-29.
  • Referans11. Wolach B. Neonatal sepsis: pathogenesis and supportive therapy. Semin Perinatol 1997;21(1):28-38.
  • Referans12. Maguire GC, Nordin J, Myers MG, Koontz FP, Hierholzer W, Nassif E. Infections acquired by young infants. Am J Dis Child 1981;135(8):693-8.
  • Referans13. Coovadia YM, Johnson AP, Bhana RH, Hutchinson GR, George RC, Hafferjee IE. Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks. J Hosp Infect 1992;22(3):197-205.
  • Referans14. Nataro JP, Corcoran L, Zirin S, et al. Prospective analysis of coagulase-negative staphylococcal infection in hospitalized infants. J Pediatr 1994;125(5 Pt 1):798-804.
  • Referans15. St Geme JW, 3rd, Polin RA. Neonatal sepsis. Progress in diagnosis and management. Drugs 1988;36(6):784-800.
  • Referans16. Tessin I, Trollfors B, Thiringer K. Incidence and etiology of neonatal septicaemia and meningitis in western Sweden 1975-1986. Acta Paediatr Scand 1990;79(11):1023-30.
  • Referans17. Campins M, Vaque J, Rossello J, et al. Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. EPINE Working Group. Am J Infect Control 1993;21(2):58-63.
  • Referans18. Samanci N, Ovali F, Akdoğan Z, Dağoğlu T. Neonatal septicemia in a neonatal intensive care unit. Results of four years. The Turkish journal of pediatrics 1997;39(2):185-93.
  • Referans19. Hemming VG, Overall JC, Jr., Britt MR. Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. N Engl J Med 1976;294(24):1310-6.
  • Referans20. Witek-Janusek L, Cusack C. Neonatal sepsis: confronting the challenge. Crit Care Nurs Clin North Am 1994;6(2):405-19.
  • Referans21. Ng SP, Gomez JM, Lim SH, Ho NK. Reduction of nosocomial infection in a neonatal intensive care unit (NICU). Singapore Med J 1998;39(7):319-23.
  • Referans22. el-Mohandes AE, Picard MB, Simmens SJ, Keiser JF. Use of human milk in the intensive care nursery decreases the incidence of nosocomial sepsis. J Perinatol 1997;17(2):130-4.
  • Referans23. Poland RL, Watterberg KL. Sepsis in the newborn. Pediatr Rev 1993;14(7):262-3.
  • Referans24. Shortland DB, MacFadyen U, Elston A, Harrison G. Evaluation of C. reactive protein values in neonatal sepsis. J Perinat Med 1990;18(3):157-63.
  • Referans25. Boyle RJ, Chandler BD, Stonestreet BS, Oh W. Early identification of sepsis in infants with respiratory distress. Pediatrics 1978;6 2(5):744-50.
  • Referans26. Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr 1988;112(5):761-7.
  • Referans27. Benuck I, David RJ. Sensitivity of published neutrophil indexes in identifying newborn infants with sepsis. J Pediatr 1983;103(6):961-3.
  • Referans28. Prasertsom W, Horpaopan S, Ratrisawadi V, Puapondh Y, Thanasophon Y, Trakulchang K. Early versus late onset neonatal septicemia at Children's Hospital. J Med Assoc Thai 1990;73(2):106-10.
  • Referans29. Bhutta ZA, Naqvi SH, Muzaffar T, Farooqui BJ. Neonatal sepsis in Pakistan. Presentation and pathogens. Acta Paediatr Scand 1991;80(6-7):596-601.

Nosocomial Sepsis in Premature İnfants at Neonatal İntensive Care Unit.

Yıl 2019, Cilt: 9 Sayı: 1, 37 - 42, 27.03.2019
https://doi.org/10.16899/gopctd.490920

Öz

Aim: We aimed to establish the
nosocomial sepsis development rate, risk factors, and most frequently found
microorganisms in premature infants observed in Neonatal Intensive Care Units
(NICU).

Materials and Method: A total of 170 premature infants
with 46 from nosocomial sepsis group (NSG) and 124 premature infants from the
control group (CG) were included in this study. Gender, birth weight (BW),
gestational age (GA) hospital stay and birth types, the laboratory and clinical
findings of all patients were recorded. Blood, cerebrospinal fluid(CSF),
endotracheal aspirate (ETA), throat, urine, and umbilical culture samples of
the patients believed to have sepsis were obtained.

Results: As a result of the logistic
regression analysis conducted to establish sepsis risk factors, hospital stays,
low BW, lack of sucking, ventilation treatment, and blood transfusion were
established to statistically significantly increase nosocomial sepsis. In
addition, vomiting, fever, apnoea, convulsion, meningitis, and hypothermia that
are among clinical symptoms were found as the significant risk factors in terms
of sepsis development. CRP, MPV

and TG(+) were higher in NSG and were found as statistically significant. Of
the nosocomial sepsis patients, growth was observed in the blood of 50%, and in
urine of 20.37%. While klebsiella pneumonia was isolated in 11 of the 46
patients (40.74%), also observed were S. Aureus(18.51%), pseudomonas, and E.
coli(11.11%) growth, respectively.

Conclusion: Since nosocomial sepsis
constitutes a significant cause of morbidity and mortality in infants, we
believe that establishing risk factors and infection factors and taking
necessary precautions would lower morbidity and mortality.









 

Kaynakça

  • Referans1 Allen U, Ford-Jones EL. Nosocomial infections in the pediatric patient: an update. Am J Infect Control 1990;18(3):176-93.
  • Referans2 Jacob J, Pfenninger J, Davis RF, Hulman S. The next challenge for newborn intensive care in Alaska: improving the survival of the larger neonate. Alaska Med 1997;39(4):111-6.
  • Referans3. Starr SE. Antimicrobial therapy of bacterial sepsis in the newborn infant. J Pediatr 1985;106(6):1043-8.
  • Referans4. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16(3):128-40.
  • Referans5. Simon C, Schroder H, Beyer C, Zerbst T. Neonatal sepsis in an intensive care unit and results of treatment. Infection 1991;19(3):146-9.
  • Referans6. Mullett MD, Cook EF, Gallagher R. Nosocomial sepsis in the neonatal intensive care unit. J Perinatol 1998;18(2):112-5.
  • Referans7. Gayvallet-Montredon N, Sauvestre C, Bergeret M, Gendrel D, Raymond J. [Bacteriologic surveillance of nosocomial septicemia and bacteremia in a pediatric hospital]. Arch Pediatr 1998;(11):1216-20.
  • Referans8. Kotloff KL, Blackmon LR, Tenney JH, Rennels MB, Morris JG, Jr. Nosocomial sepsis in the neonatal intensive care unit. South Med J 1989; 82(6):699-704.
  • Referans9. Gerdes JS. Clinicopathologic approach to the diagnosis of neonatal sepsis. Clin Perinatol 199118(2):361-81.
  • Referans10. Perez EM, Weisman LE. Novel approaches to the prevention and therapy of neonatal bacterial sepsis. Clin Perinatol 1997;24(1):213-29.
  • Referans11. Wolach B. Neonatal sepsis: pathogenesis and supportive therapy. Semin Perinatol 1997;21(1):28-38.
  • Referans12. Maguire GC, Nordin J, Myers MG, Koontz FP, Hierholzer W, Nassif E. Infections acquired by young infants. Am J Dis Child 1981;135(8):693-8.
  • Referans13. Coovadia YM, Johnson AP, Bhana RH, Hutchinson GR, George RC, Hafferjee IE. Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks. J Hosp Infect 1992;22(3):197-205.
  • Referans14. Nataro JP, Corcoran L, Zirin S, et al. Prospective analysis of coagulase-negative staphylococcal infection in hospitalized infants. J Pediatr 1994;125(5 Pt 1):798-804.
  • Referans15. St Geme JW, 3rd, Polin RA. Neonatal sepsis. Progress in diagnosis and management. Drugs 1988;36(6):784-800.
  • Referans16. Tessin I, Trollfors B, Thiringer K. Incidence and etiology of neonatal septicaemia and meningitis in western Sweden 1975-1986. Acta Paediatr Scand 1990;79(11):1023-30.
  • Referans17. Campins M, Vaque J, Rossello J, et al. Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. EPINE Working Group. Am J Infect Control 1993;21(2):58-63.
  • Referans18. Samanci N, Ovali F, Akdoğan Z, Dağoğlu T. Neonatal septicemia in a neonatal intensive care unit. Results of four years. The Turkish journal of pediatrics 1997;39(2):185-93.
  • Referans19. Hemming VG, Overall JC, Jr., Britt MR. Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance. N Engl J Med 1976;294(24):1310-6.
  • Referans20. Witek-Janusek L, Cusack C. Neonatal sepsis: confronting the challenge. Crit Care Nurs Clin North Am 1994;6(2):405-19.
  • Referans21. Ng SP, Gomez JM, Lim SH, Ho NK. Reduction of nosocomial infection in a neonatal intensive care unit (NICU). Singapore Med J 1998;39(7):319-23.
  • Referans22. el-Mohandes AE, Picard MB, Simmens SJ, Keiser JF. Use of human milk in the intensive care nursery decreases the incidence of nosocomial sepsis. J Perinatol 1997;17(2):130-4.
  • Referans23. Poland RL, Watterberg KL. Sepsis in the newborn. Pediatr Rev 1993;14(7):262-3.
  • Referans24. Shortland DB, MacFadyen U, Elston A, Harrison G. Evaluation of C. reactive protein values in neonatal sepsis. J Perinat Med 1990;18(3):157-63.
  • Referans25. Boyle RJ, Chandler BD, Stonestreet BS, Oh W. Early identification of sepsis in infants with respiratory distress. Pediatrics 1978;6 2(5):744-50.
  • Referans26. Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr 1988;112(5):761-7.
  • Referans27. Benuck I, David RJ. Sensitivity of published neutrophil indexes in identifying newborn infants with sepsis. J Pediatr 1983;103(6):961-3.
  • Referans28. Prasertsom W, Horpaopan S, Ratrisawadi V, Puapondh Y, Thanasophon Y, Trakulchang K. Early versus late onset neonatal septicemia at Children's Hospital. J Med Assoc Thai 1990;73(2):106-10.
  • Referans29. Bhutta ZA, Naqvi SH, Muzaffar T, Farooqui BJ. Neonatal sepsis in Pakistan. Presentation and pathogens. Acta Paediatr Scand 1991;80(6-7):596-601.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Çalışma
Yazarlar

Eyüp Sarı

Yayımlanma Tarihi 27 Mart 2019
Kabul Tarihi 16 Ocak 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 9 Sayı: 1

Kaynak Göster

APA Sarı, E. (2019). Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis. Çağdaş Tıp Dergisi, 9(1), 37-42. https://doi.org/10.16899/gopctd.490920
AMA Sarı E. Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis. J Contemp Med. Mart 2019;9(1):37-42. doi:10.16899/gopctd.490920
Chicago Sarı, Eyüp. “Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis”. Çağdaş Tıp Dergisi 9, sy. 1 (Mart 2019): 37-42. https://doi.org/10.16899/gopctd.490920.
EndNote Sarı E (01 Mart 2019) Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis. Çağdaş Tıp Dergisi 9 1 37–42.
IEEE E. Sarı, “Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis”, J Contemp Med, c. 9, sy. 1, ss. 37–42, 2019, doi: 10.16899/gopctd.490920.
ISNAD Sarı, Eyüp. “Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis”. Çağdaş Tıp Dergisi 9/1 (Mart 2019), 37-42. https://doi.org/10.16899/gopctd.490920.
JAMA Sarı E. Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis. J Contemp Med. 2019;9:37–42.
MLA Sarı, Eyüp. “Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis”. Çağdaş Tıp Dergisi, c. 9, sy. 1, 2019, ss. 37-42, doi:10.16899/gopctd.490920.
Vancouver Sarı E. Yenidoğan Yoğun Bakım Ünitesinde Prematürelerde Nozokomiyal Sepsis. J Contemp Med. 2019;9(1):37-42.