Nosocomial infections and risk factors in intensive care unit of a university hospital

Abstract

Objective: The aim of this study is to evaluate nosocomial infections (NIs) in intensive care unit (ICU) in terms of site of infection, distribution of pathogens and risk factors for developing infection.

Methods: 80 patients staying for more than 48 hours in the ICU were included in the study. Epidemiologic characteristics of the patients, invasive procedures and other risk factors were noted. Cultures, identification of isolates and antibiotic susceptibility tests were made by standard microbiologic methods.

Results: Of 56 patients who have developed NIs, 26 (50%) had pneumonia, 15 (28.8%) had bloodstream infections and 6 (11.5%) had urinary tract infections. Klebsiella pneumoniae (23.5%), Pseudomonas aeruginosa (19.6%), and Acinetobacter spp. (15.6%) were the most frequently isolated microorganisms, respectively. For Klebsiella pneumoniae isolates, extended spectrum beta lactamase (ESBL) rate was 91.6%, carbapenem resistance rate was 15.6% and for Pseudomonas aeruginosa and Acinetobacter spp. carbapenem resistance rates were 60% and 100% respectively. Hemodialysis, enteral nutrition, total parenteral nutrition and prolonged hospitalization for more than 10 days were determined as independent risk factors for developing NI. Additionally Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of ICU stay and lenght of hospital stay before ICU were found to be high in the NI group.

Conclusion: Pneumonia is the most common NI and carbapenem resistance in Gram-negative bacilli was remarkably high in our ICU. It was considered that infection control measures must be applied carefully, invasive procedures should be used in correct indications and we should avoid long-term hospitalization if unnecessary. J Clin Exp Invest 2015; 6 (3): 233-239

Key words: Intensive care unit, nosocomial infections, carbapenem resistance

Keywords

• Intensive care unit, nosocomial infections, carbapenem resistance

Bir üniversite hastanesi yoğun bakım ünitesindeki hastane enfeksiyonları ve risk faktörleri

Öz

Amaç: Bu çalışmada yoğun bakım ünitesindeki (YBÜ) hastane enfeksiyonlarının (HE) enfeksiyon odağı, patojenlerin dağılımı ve risk faktörleri açısından değerlendirilmesi amaçlandı.Yöntemler: YBÜ’de 48 saatten fazla kalan 80 hasta çalışmaya dahil edildi. Hastaların epidemiyolojik özellikleri, invaziv girişimler ve diğer risk faktörleri kaydedildi. Kültürler, patojenlerin tanımlanması ve antibiyotik duyarlılık testleri standart mikrobiyolojik yöntemlerle yapıldı.Bulgular: HE gelişen 56 hastanın 26 (%50)’sında pnömoni, 15 (%28,8)’inde kan dolaşımı enfeksiyonu ve 6 (%11.5)’sında üriner sistem enfeksiyonu saptandı. Klebsiella pneumoniae (%23.5), Pseudomonas aeruginosa (%19,6) ve Acinetobacter spp. (%15,6) sırasıyla en sık saptanan etken mikroorganizmalar idi. Klebsiella pneumoniae izolatlarında genişlemiş spektrumlu beta laktamaz (GSBL) oranı %91,6, karbapenem direnci %15,6, Pseudomonas aeruginosa ve Acinetobacter spp. izolatları için de karbapenem direnci sırasıyla %60 ve %100 olarak saptandı. Hemodiyaliz, enteral beslenme, total parenteral beslenme, 10 günden uzun süreli yatış HE gelişimi açısından bağımsız risk faktörleri olarak saptandı. “Acute Physiology and Chronic Health Evaluation” (APACHE) II skoru, YBÜ’de yatış süresi ve YBÜ öncesi hastanede yatış süresi de HE gelişen grupta daha yüksek bulundu.Sonuç: Hastanemiz YBÜ’de pnömoni en sık görülen HE olarak saptandı ve Gram-negatif basillerdeki karbapenem direnci dikkat çekici ölçüde yüksek bulundu. Enfeksiyon kontrol önlemlerinin dikkatli bir şekilde uygulanması, invaziv girişimlerin doğru endikasyonlarda uygulanması ve gereksiz uzun dönem yatışlardan kaçınılması gerektiği düşünüldü

Anahtar Kelimeler

• Yoğun bakım ünitesi, hastane enfeksiyonları, karbapenem direnci

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