Pediyatrik Palyatif Bakım Ünitesindeki Enfeksiyon Ajanlarının Değerlendirilmesi

Year 2024, Volume: 3 Issue: 4, 152 - 160, 20.12.2024

Nilgün Harputluoğlu , Yakup Yaman Derşan Onur , Miray Yılmaz Mustafa Gülderen Tanju Çelik , Ünsal Yılmaz

https://doi.org/10.57221/izmirtip.1494548

Abstract

Amaç: Geniş spektrumlu antibiyotiklerin kullanımı, hasta profilindeki değişiklikler, yaşam süresinin uzaması, kateterler, damar içi sıvılar, gastrostomi ve trakeostomi gibi tıbbi cihaz ve teknoloji kullanımının artması enfeksiyonlar ve kültürlerden izole edilen mikroorganizmaların sayısında ve türünde değişikliğe neden olmuştur. Pediyatrik palyatif bakımda görülen enfeksiyonlara dair veri bulunmamaktadır. Bu çalışmada amaç enfeksiyon sıklığını ve kültürde üretilen patojenleri saptamak, üreme yerlerini bulmak ve yapılması gerekenleri gözden geçirmektir.
Yöntem: Çalışma 18.11.2018-01.09.2023 tarihleri arasında kesitsel, retrospektif bir çalışma olarak planlandı. Sosyodemografik veriler, yatış nedeni, yatış sayısı, primer tanıları, komorbid durumları, kullandıkları tıbbi cihaz ve teknoloji, kültür alınma yeri ve zamanı, kültür sayısı, üreyen mikroorganizmalar ve kültür üremesiyle ilişkili faktörler incelendi. İstatistiksel analiz SPSS 18.0 prog¬ramı ile yapıldı. p<0,05 değeri anlamlı kabul edildi. Yerel etik kurul onayı alındı (14/09/2023-176).
Bulgular: toplam 414 hastadan 218’i çalışmaya dahil edildi. 392 yatıştan alınan 1209 kültür tetkiki değerlendirildi. Yaş ortalaması=5,68±5,33 (SD) yıl, %56,9’u (n=124) erkekti. Yatış nedeni enfeksiyon ve enfeksiyon dışı olarak gruplandırıldığında kültür üremesi açısından fark saptanmadı (p=0,778). Medikal komorbiditeler ile kültür üremesi arasında anlamlı fark saptandı (p=0,008) ve Post hoc analizi ile değerlendirildiğinde kardiovasküler hastalıklar ve konjenital hastalıklar ile ilişkili anlamlı fark bulundu (sırasıyla p=0,001 ve p=0,018).
Sonuç: Bu sonuçlar, pediyatrik palyatif bakımdaki ilk veriler olup yaklaşık yarısında kültürde üreme olduğunu, kardiovasküler sistem hastalıkları ve konjenital hastalıklarla ilişkili olduğunu göstermiştir. Uzun süreli tedavi ve izlem gerektiren hasta profilimiz için aile eğitiminin, bakım ve enfeksiyonların önlenmesine yönelik eğitimlerin belirli aralarla tekrarlanmasının enfeksiyon sıklığını düşürebilir.

Keywords

çocuk, pediatrik, palyatif bakım, enfeksiyon

Evaluation of Infectious Agents in the Pediatric Palliative Care Unit

Abstract

Aim: The use of broad-spectrum antibiotics, changes in patient profile, prolonged life expectancy, increased use of medical devices and technologies such as catheters, intravenous fluids, gastrostomy and tracheostomy have led to changes in the number and types of microorganisms isolated from infections and cultures. There are no data on infections seen in pediatric palliative care. The aim of this study was to determine the frequency of infections and the pathogens produced in culture, to identify the sites of growth and to review what should be done.
Materials and Methods: This was planned as a cross-sectional, retrospective study between 11/18/2018 and 09/01/2023. Sociodemographic data, reason for hospitalization, number of hospitalizations, primary diagnoses, comorbid conditions, medical devices and technology used, time and place of culture, number of cultures, microorganisms grown and factors associated with culture growth were examined. Statistical analysis was performed with the SPSS 18.0 program. p<0.05 was considered significant. Local ethics committee approval was obtained (14/09/2023-176).
Results: A total of 218 of 414 patients were included in the study. A total of 1209 culture examinations from 392 hospitalizations were evaluated. The mean age was 5.68±5.33 (SD) years, and 56.9% (n=124) were male. When the reasons for hospitalization were grouped as infection and non-infection, no difference was found in terms of culture growth (p=0.778). There was a significant difference between medical comorbidities and culture growth (p=0.008) and when evaluated by post hoc analysis, a significant difference was found in relation with cardiovascular diseases and congenital diseases (p=0.001 and p=0.018, respectively).
Conclusion: These results are the first data in pediatric palliative care and show that approximately half of the patients had culture growth and were associated with cardiovascular diseases and congenital diseases. For our patient profile requiring long-term treatment and follow-up, family education, care and education on the prevention of infections should be repeated at regular intervals to reduce the frequency of infection.

Keywords

pediatric, palliative care, infection

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