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Yenidoğan yoğun bakım ünitesinde Klebsiella pneumoniae sepsisin risk faktörleri, laboratuvar bulguları, mortalite oranları ve zaman içindeki antibiyotik dirençlerinin araştırılması

Year 2018, Volume: 15 Issue: 3, 140 - 144, 12.12.2018

Abstract

Amaç: Yenidoğan yoğun bakım ünitelerindeki (YYBÜ) gelişmeler yenidoğanların yaşam oranlarının artışını sağlamıştır. Bununla birlikte nazokomiyal enfeksiyonlarda da (NE) artış görülmektedir. Bu çalışmada, hastanemiz YYBÜ’deki Klebsiella pneumoniae bağlı neonatal sepsisteki predispozan faktörleri, bu olguların klinik ve laboratuvar özelliklerini, mortalite oranlarını ve antibiyotik dirençlerini araştırmayı amaçladık.

Materyal ve Metod: 2015-2017 yılları arasında, yenidoğan yoğun bakım ünitesinde yatırılarak izlenmiş olan ve kanıtlanmış K. pneumoniae sepsisi tanısı alan olgular incelendi. Hastaların demografik, laboratuvar ve klinik özellikleri ile mikrobiyolojik sonuçları kaydedildi.

Bulgular: K. pneumoniae sepsisi tespit edilen 59 kan kültür örneğinin 55’i (%93,2) geç başlangıçlı neonatal sepsis (GNS) ve 4'ü (%6,8) erken başlangıçlı neonatal sepsis (ENS) idi. Çalışmaya alınan 59 olgunun 25’i (%42,4) kız, 34’ü (%57,6) erkekti. Olguların 47’si (%79,7) preterm doğmuştu. Hastaların primer en sık tanıları preterm ve respiratuar distres sendromu olup (n:47, %79,7), sık görülen ek patolojileri ise preterm + nekrotizan enterokolit (n:9, %15,3), intrakraniyal kanama+hidrosefali (n:5,%8,5), omfalosel veya gastroşizis (n:7,%11,9), intestinal atrezi (n:4,%6,8), ciddi konjenital kalp hastalığı (n:1, %1,7) idi. Olguların 23’ünde (%39) ek patoloji yoktu. Bakteriyemi gelişmeden önce, olguların 53’üne (%89,8) ikiden fazla invaziv girişim uygulanmıştı. K. pneumoniae enfeksiyonuna bağlı mortalite oranının %30,5 olduğu saptandı. K. pneumoniae karşı en etkili antibiyotikler: Kolistin (%87), Meropenem (%50,8) ve Siprofloksasin (%44,1) idi. Direnç oranları: Piperasiline karşı %86, Seftazidime karşı %85, Seftriaksona karşı %91, Sefaperozona karşı ise %95 olduğu tespit edildi. K. pneumoniae %67,8’i Gentamisine dirençli, yaklaşık %68’i ise Amikasin ve Trimetoprim-Sulfametoksazole dirençliydi.

Sonuç: Neonatal sepsis ile ilişkili Klebsiella enfeksiyonlarına, başlıca K. pneumoniae neden olmaktadır. Düşük doğum ağırlığı, erken gebelik haftalarında doğum, invaziv girişimler ve altta yatan ciddi hastalıklar yenidoğanda Klebsiella enfeksiyonlarına zemin oluşturmaktadır. Günümüzde çoklu ilaç direnci önemli bir sorun olmaktadır. Mortalite, sepsis ile beraber altta yatan primer hastalık ile ilişkilidir.

References

  • 1. Waliullah MS, Islam MN, Siddika M, Hossain MK, Hossain MA. Risk factors, clinical manifestation and bacteriological profile of neonatal sepsis in a tertiary level pediatric hospital. Mymensingh Med J 2009; 18: S66-S72.
  • 2. Iregbu KC, Elegba OY, Babaniyi IB. Bacteriological profile of neonatal septicaemia in a tertiary hospital in Nigeria. Afr Health Sci 2006; 6: 151-4.
  • 3. Shitaye D, Asrat D, Woldeamanuel Y, Worku B. Risk factors and etiology of neonatal sepsis in Tikur Anbessa University Hospital, Ethiopia. Ethiop Med J 2010; 48: 11-21.
  • 4. Mahieu L, Buitenweg N, Beutels P, De Dooy JJ. Cost of nosocomial infection in a neonatal intensive care unit. Clin Microbiol Infect. 1999;5:S170.
  • 5. Leroyer A, Bedu A, Lombrail P, Desplanques L, Diakite B, Bingen E, et al. Prolongation of hospital stay and extra cost due to hospital-acquired infection in a neonatal unit. J Hosp Infect. 1997;35:37–45.
  • 6. Gladstone IM, Ehrenkranz RA, Edberg SC, Baltimore RS. A tenyear review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J. 1990;9:819–25.
  • 7. Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Tolson JS, Martone WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1996;98:357–361.
  • 8. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128-140.
  • 9. de Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, et al. The neutrophil-lymphocyte count ratio in patients with community acquired pneumonia. PLoS One 2012;7:e46561.
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  • 12. Turkish Neonatal Society, Nosocomial Infections Study Group. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr. 2010;52(1):50.
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  • 14. Shitaye D, Asrat D, Woldeamanuel Y, Worku B. Risk factors and etiology of neonatal sepsis in Tikur Anbessa University Hospital, Ethiopia. Ethiop Med J 2010; 48: 11-21.
  • 15. Lai M. Y., Tsai M. H., Lee C. W., Chiang M. C., Lien R., Fu, R. H., ... & Hsu, J. F.. Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L). BMC Infectious Diseases 2015;15:320
  • 16. IMC Ree, SF Fustolo-Gunnink, V Bekker, Karin J. Fijnvandraat, Sylke J. Steggerda,Enrico Lopriore Published Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS ONE 2017;12(10):e0185581
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  • 18. Kayange, N., Kamugisha, E., Mwizamholya, D. L., Jeremiah, S., & Mshana, S. E.. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza-Tanzania. BMC pediatrics, 2010, 10.1: 39.
  • 19. Livermore DM. Beta-Lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995; 8:557-84.
  • 20. Hakan N., Aydın M., Zenciroğlu A., Tanır, G., & Okumuş, N. Klebsiella Sepsisinin Klinik Özellikleri ve Antibiyotik Duyarlılık Paterni: Üçüncü Düzey Bir Yenidoğan Yoğun Bakım Ünitesindeki 8 Yıllık Deneyimlerimiz. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 2017, 14.3.
  • 21. European Centre for Disease Prevention and Control. "Summary of the Latest Data on Antibiotic Resistance in the European Union." (2016).

The investigation of risk factors, laboratory findings, mortality rates and antibiotic resistance of Klebsiella pneumoniae sepsis in neonatal intensive care unit

Year 2018, Volume: 15 Issue: 3, 140 - 144, 12.12.2018

Abstract

Background: The developments in neonatal intensive care units (NICUs) have led to an increase in the survival rate of newborns. However, there is also an increase in nosocomial infections (NE). In this study, we aimed to investigate the predisposing factors in the neonatal sepsis due to Klebsiella strains in the NICU, clinical and laboratory features, mortality rates and antibiotic resistance of these cases.

Material and Methods: The patients hospitalized in the neonatal intensive care unit were within 2015-2017 years. They were proven sepsis cases due to Klebsiella pneumoniae and retrospectively analyzed. Demographic, laboratory and clinical features and microbiological results of the patients were recorded.

Results: Of the 59 blood culture samples with K. pneumoniae sepsis, 55 (93.2%) had late-onset neonatal sepsis (LNS) and 4 (6.8%) had early-onset neonatal sepsis (ENS). 47 (79.7%) of the cases were preterm. The primary diagnoses of the patients were preterm and respiratory distress syndrome (n: 47, 79.7%), common pathologies include preterm + necrotizing enterocolitis (n: 9, 15.3%), intracranial hemorrhage + hydrocephalus (n: 5, 8.5%), onfalocele or gastroschisis (n: 7, 11.9%), intesttinal atresia (n: 4, 6.8%), severe congenital heart disease (n: 1, 1.7%). More than two invasive procedures were performed in 53 (89.8%) cases before bacteremia developed. The most effective antibiotics against K. pneumoniae strains were colistin (87.3%), meropenem (51.7%) and ciprofloxacin (49.1%). The mortality rate of K. pneumoniae infection was found to be 30%. Resistance rates were 86% against piperacillin, 85% against ceftazidime, 91% against ceftriaxone and 95% against cefaperozone. The percentages of Klebsiella strains resistant to gentamycin, were 67.8% and 68% to both amikacin and trimethoprim-sulfamethoxazole.

Conclusion: Klebsiella infections associated with health care are mainly caused by K. pneumoniae. Low birth weight, birth at early gestational weeks, invasive procedures and underlying serious diseases predispose to Klebsiella infections in the newborn. Today, multidrug resistance is a major problem. Mortality is associated with sepsis and underlying primary disease.

References

  • 1. Waliullah MS, Islam MN, Siddika M, Hossain MK, Hossain MA. Risk factors, clinical manifestation and bacteriological profile of neonatal sepsis in a tertiary level pediatric hospital. Mymensingh Med J 2009; 18: S66-S72.
  • 2. Iregbu KC, Elegba OY, Babaniyi IB. Bacteriological profile of neonatal septicaemia in a tertiary hospital in Nigeria. Afr Health Sci 2006; 6: 151-4.
  • 3. Shitaye D, Asrat D, Woldeamanuel Y, Worku B. Risk factors and etiology of neonatal sepsis in Tikur Anbessa University Hospital, Ethiopia. Ethiop Med J 2010; 48: 11-21.
  • 4. Mahieu L, Buitenweg N, Beutels P, De Dooy JJ. Cost of nosocomial infection in a neonatal intensive care unit. Clin Microbiol Infect. 1999;5:S170.
  • 5. Leroyer A, Bedu A, Lombrail P, Desplanques L, Diakite B, Bingen E, et al. Prolongation of hospital stay and extra cost due to hospital-acquired infection in a neonatal unit. J Hosp Infect. 1997;35:37–45.
  • 6. Gladstone IM, Ehrenkranz RA, Edberg SC, Baltimore RS. A tenyear review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J. 1990;9:819–25.
  • 7. Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Tolson JS, Martone WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1996;98:357–361.
  • 8. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128-140.
  • 9. de Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, et al. The neutrophil-lymphocyte count ratio in patients with community acquired pneumonia. PLoS One 2012;7:e46561.
  • 10. Stanworth SJ, Clarke P, Watts T, Ballard S, Choo L, Morris T, et al. Prospective, observational study of outcomes in neonates with severe thrombocytopenia. Pediatrics 2009;124:826–34.
  • 11. Uslu S, Bolat F, Can E, Comert S, Nuhoğlu A. Yenidoğan yoğun bakım ünitelerinde hastane enfeksiyonlarını önleme çalışmaları. Bakırköy Tıp Dergisi. 2010;6(1):1-7.
  • 12. Turkish Neonatal Society, Nosocomial Infections Study Group. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr. 2010;52(1):50.
  • 13. Babazono A, Kitajima H, Nishimaki S, Nakamura T, Shiga S, Hayakawa M, et al. Risk factors for nosocomial infection in the neonatal intensive care unit by the Japanese Nosocomial Infection Surveillance (JANIS). Acta Med Okayama. 2008;62:261-8.
  • 14. Shitaye D, Asrat D, Woldeamanuel Y, Worku B. Risk factors and etiology of neonatal sepsis in Tikur Anbessa University Hospital, Ethiopia. Ethiop Med J 2010; 48: 11-21.
  • 15. Lai M. Y., Tsai M. H., Lee C. W., Chiang M. C., Lien R., Fu, R. H., ... & Hsu, J. F.. Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L). BMC Infectious Diseases 2015;15:320
  • 16. IMC Ree, SF Fustolo-Gunnink, V Bekker, Karin J. Fijnvandraat, Sylke J. Steggerda,Enrico Lopriore Published Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS ONE 2017;12(10):e0185581
  • 17. Ozdemir SA, Ozer EA, Ilhan O, Alkan Ozdemir, S., Arun Ozer, E., Ilhan, O., & Sutcuoglu S.. Can neutrophil to lymphocyte ratio predict late-onset sepsis in preterm infants? J Clin Lab Anal. 2017;e22338.
  • 18. Kayange, N., Kamugisha, E., Mwizamholya, D. L., Jeremiah, S., & Mshana, S. E.. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza-Tanzania. BMC pediatrics, 2010, 10.1: 39.
  • 19. Livermore DM. Beta-Lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995; 8:557-84.
  • 20. Hakan N., Aydın M., Zenciroğlu A., Tanır, G., & Okumuş, N. Klebsiella Sepsisinin Klinik Özellikleri ve Antibiyotik Duyarlılık Paterni: Üçüncü Düzey Bir Yenidoğan Yoğun Bakım Ünitesindeki 8 Yıllık Deneyimlerimiz. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 2017, 14.3.
  • 21. European Centre for Disease Prevention and Control. "Summary of the Latest Data on Antibiotic Resistance in the European Union." (2016).
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Hüseyin Gümüş 0000-0002-9326-2194

Halil Kazanasmaz 0000-0003-4671-4028

Publication Date December 12, 2018
Submission Date October 30, 2018
Acceptance Date November 23, 2018
Published in Issue Year 2018 Volume: 15 Issue: 3

Cite

Vancouver Gümüş H, Kazanasmaz H. Yenidoğan yoğun bakım ünitesinde Klebsiella pneumoniae sepsisin risk faktörleri, laboratuvar bulguları, mortalite oranları ve zaman içindeki antibiyotik dirençlerinin araştırılması. Harran Üniversitesi Tıp Fakültesi Dergisi. 2018;15(3):140-4.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty