Karbapenem Dirençli Enterobacteriacae Enfeksiyonları: Risk Faktörleri

Öz

Amaç: Enterobacteriaceae ailesi ve özellikle Klebsiella pneumoniae tedavisi zor ve artan direnç durumu ile birlikte tedavi seçenekleri daha da sınırlı hale gelen enfeksiyon etkenleridir. Çalışmamızda karbapenem dirençli Enterobacteriaceae KDE ile enfekte olan hastaların demografik özelliklerinin ve enfeksiyon risk faktörlerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Ocak 2010 – Nisan 2014 tarihleri arasında hastanemizde KDE’nin etken olduğu enfeksiyon tanısı alan 25 hasta olgu grubu olarak çalışmaya dahil edildi. Olgu grubu hastalar ile aynı dönemde ve aynı klinikte yatan toplam 71 hasta kontrol grubu olarak belirlendi. Her iki grup için de hastaların demografik özellikleri ve sağlık bakımı ilişkili karakteristikleri değerlendirildi.Bulgular: Hastaların 20 %80 ’sinde K. pneumoniae, 2 %8 ’sinde Escherichia coli, 2 %8 ’sinde Enterobacter cloaca, 1 %4 ’inde Enterobacter aerogenes izole edildi. Tek değişkenli analizde SAPS II, YBÜ’de yatış öyküsü ve son 3 ayda antibiyotik kullanımı anlamlı risk faktörleri olarak bulundu p≤0,05 . Lojistik regresyon analizinde SAPS II OR 0,95; %95 GA 0,90-0,99, p=0,03 , YBÜ’de yatış öyküsü OR 8,5; %95 GA 2,25-32,51, p=0,04 ve son 3 ayda antibiyotik kullanımı OR 0,01; %95 GA 1,3-1,7, p=0,01 kolistin dirençli mikroorganizma enfeksiyonu için risk faktörü olma açısından bağımsız değişkenler olarak saptandı. On üç hastanın tedavisinde monoterapi, 10 hastanın tedavisinde kombine antibiyotik tedavisi kullanıldı. KDE izolatlarının en duyarlı olduğu antibiyotik grubu aminoglikozidler olarak tespit edildi.Sonuç: KDE’nin neden olduğu enfeksiyonlar artmış morbidite ve mortalite ile ilişkili olmaları ve sınırlı tedavi alternatifleri nedeni ile sıkı kontrol önlemleri alınması gereken bir sağlık bakım sorunudur. Bu amaçla, daha çok sayıda hastayı içeren çalışmalar ile risk faktörlerinin irdelenmesi gerekmektedir

Anahtar Kelimeler

• Karbapenem, Direnç, Enterobacteriaceae, K. pneumoniae, Risk faktörleri

Carbapenem-resistant Enterobacteriaceae Infections: Risk Factors

Abstract

Objective: Increasing antibiotic resistance has become an important problem for the Enterobacteriaceae family and particularly for Klebsiella pneumonia. The aim of this study was to determine the demographic features of patients with carbapenem-resistant Enterobacteriaceae CRE infections and the relevant risk factors.Material and Methods: A total of 25 patients were included between January 2010 and April 2014 in the study as the case group infected with CRE. For the control group, 71 patients were chosen from the same clinics and concurrently hospitalised patients. All the patients’ demographic features and health care associated characteristics were evaluated in terms of possible risk factors.Results: Twenty 80% of the isolates were K. pneumoniae, 2 8% Esherichia coli, 2 8% Enterobacter cloaca, and 1 4% Enterobacter aerogenes. On univariate analysis, a high SAPS II score, history of ICU admissions, and antibiotic use within the last 3 months were found to be risk factors p≤0.05 . Logistic regression analysis revealed that the SAPS II score OR 0.95;CI 0.90-0.99,p=0.03 , history of ICU admissions OR 8.5;CI 2.25-32.51,p=0.04 and antibiotic use within the last 3 months OR 0.01;CI 1.3-1.7,p=0.01 were independent risk factors for CRE infection. Monotherapy was used for 13 patients and combination therapy for 10 patients. Aminoglycosides were the antibiotic group the CRE isolates were most commonly sensitive to.Conclusion: CRE infections are associated with increased morbidity and mortality. Treatment alternatives for these infections are limited and strict precautions are needed for this health care problem. The risk factors should therefore be evaluated with studies including more patients

Keywords

• Carbapenem, Resistance, Enterobacteriaceae, K. pneumoniae, Risk factor

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