Pediatrik Kardiyovasküler Cerrahi Yoğun Bakım Ünitesinde Görülen Nozokomiyal İnfeksiyonların Özellikleri, Patojenler ve Mortalite ile İlgili Risk Faktörleri Açısından Değerlendirilmesi

Abstract

Giriş: Bu çalışmanın amacı, pediatrik kardiyovasküler cerrahi yoğun bakım ünitesinde görülen nozokomiyal infeksiyonları (Nİ) özellikleri, patojenler, mortaliteyle ilgili risk faktörleri ve mortalite sıklığı açısından değerlendirmektir.

Hastalar ve Yöntem: Bu retrospektif çalışmada, yaşları 1 ay ila16 yıl arasında değişen, Kartal Koşuyolu Eğitim ve Araştırma Hastanesinde Ocak 2014-Ocak 2016 tarihleri arasında  kardiyovasküler cerrahi geçirmiş 838 çocuğun dosyaları değerlendirilmiştir. Hastalık kontrol merkezi kriterlerine göre Nİ tespit edilmiş hastalar çalışmaya alınmıştır. Nİ  prevalansı ve çeşitli risk faktörleriyle Nİ arasındaki ilişkiler istatistiksel olarak analiz edilmiştir. 

Bulgular: Toplam 838 hastadan 54 (%6.4)’ünde Nİ [(solunum sistemi (%53.9), idrar yolu (%24.8), bakteremi (%15.7) ve yara yeri infeksiyonları (%5.6)] mevcuttu. İzole edilen patojenler: Klebsiella pneumoniae (%20.4), Pseudomonas aeruginosa (%18.6), Candida albicans (%18.6), Stenotrophomonas maltophilia (%13.8), Acinetobacter baumannii (%10.5), koagülaz negatif stafilokok (9.1%), metisilin dirençli Staphylococcus aureus (MRSA) (3.6%), Serratia  marcescens (1.8%), Citrobacter freundii (%1.8)  ve  Providencia rettgeri (1.8%) ve Nİ nedeniyle  mortalite  oranı %13.7 (11/80) bulunmuştur. Çocukların yaşı ve mekanik ventilasyon süresi ile Nİ arasında anlamlı bir ilişki saptanmış (p< 0.05); cinsiyet, nazogastrik beslenme ve eşlik eden anomaliler ile Nİ  arasında anlamlı bir ilişki bulunamamıştır (p> 0.05).

Sonuç: PKVC sonrası Nİ sıklığı %6.4 ve en sık Nİ morbidite ve mortalite etkeni gram-negatif bakteriler olmuştur. Yoğun bakımda takip edilen hastalarda endotrakeal aspirat,  kan, idrar ve yara kültürlerinin gönderilmesi ve NKİ ile ilişkili  risk faktörlerinin zamanında değerlendirilmesi, gerekli infeksiyon kontrol önlemlerinin alınarak postoperatif morbidite ve mortalitenin azaltılmasını sağlayacaktır.

Keywords

• Nozokomiyal infeksiyon
• çocuklar
• kardiyovasküler cerrahi
• yoğun bakım

Evaluation of Properties, Pathogens, and Mortality-Related Risk Factors of Nosocomial Infections in Pediatric Cardiovascular Surgery Intensive Care Unit

Abstract

Introduction: The aim of this study was to evaluate the properties, pathogens, mortality-related risk factors, and mortality rates of nosocomial infections (NIs) in the pediatric cardiovascular surgery intensive care unit.

Patients and Methods: The files of 838 children, aged 0-16 years, who underwent cardiovascular surgery between January, 2014 and January, 2016 in Kartal Koşuyolu Research Hospital were evaluated in this retrospective study. NI was diagnosed according to the Center for Disease Control criteria. The correlations between several risk factors and NI were statistically analyzed.

Results: Fifty-four children out of 838 (6.4%) had NI. 29 of them (53.9%) had respiratory tract infections, 14 (24.8%) had urinary tract infections, 8 (15.7%) had bacteremia and 3 (5.6%) had wound site infections. The isolated pathogens were Klebsiella pneumoniae (20.4%), Pseudomonas aeruginosa (18.6%), Candida albicans (18.6%), Stenotrophomonas maltophilia (13.8%), Acinetobacter baumannii (10.5%), coagulase-negative staphylococci (9.1%), methicillin-resistant Staphylococcus aureus (MRSA, 3.6%), Serratia marcescens (1.8%), Citrobacter freundii (1.8%), and Providencia rettgeri (1.8%). The mortality rate due to NI was 13.7% (11/80). There was a statistically significant relationship between NIs and age and duration of mechanic ventilation (p< 0.05), but not between NIs and gender, accompanying abnormalities, and nasogastric feeding (p> 0.05).

Conclusion: Gram-negative bacteria were the most common pathogens of NI, which caused mortality. Assessing the responsible pathogens and determining the risk factors will help us to develop effective infection control measures for reducing the morbidity and mortality rates.

Keywords

• Nosocomial infection
• pediatry
• cardiovascular surgery
• intensive care unit

References

1. 1. Urrea M, Pons M, Serra M, Latorre C, Palomeque A. Prospective incidence study of nosocomial infections in pediatric intensive care unit. Pediatr Infect Dis J 2003;22:490-4.
2. 2. Wisplinghoff H, Seifert H, Tallent S, Biscoff T, Wenzel R, Edmond M. Nosocomial blood stream infections in pediatric patients in United States Hospitals: Epidemiology, clinical features and susceptibilities. Pediatr Infect Dis J 2003;22:686-91.
3. 3. Bozaykut A, Ipek IO, Kiliç BD. Predicting neonatal sepsis in ventilated neonates. Indian J Pediatr 2008;75:39-42.
4. 4. Esteban E, Ferrer R, Urrea M, Suarez D, Rozas L, Balaguer M, et al. The Impact of a quality improvement intervention to reduce nosocomial infections in a PICU. Pediatr Crit Care Med 2013;14:525-32.
5. 5. Martinez JA, Pozo L, Almela M, Marco F, Soriano A, Lopez F, et al. Microbial and clinical determinants of time-to-positivity in patients with bacteraemia. Clin Microbiol Infect 2007;13:709-16.
6. 6. Asembergiene J, Gurskis V, Kevalas R, Valinteliene R. Nasocomial Infections in the Pediatric Intensive Care Units in Lithuania. Medicina (Kaunas) 2009;45:29-36.
7. 7. Abramczyk ML, Carvalho WB, Carvalho ES, Medeiros EAS. Nosocomial infection in a pediatric intensive care unit in a developing country. Brazilian J Infect Dis 2003;7:375-80.
8. 8. Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR, et al. Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units. Am J Infect Control 2006;29:152-7.

9. 9. Raymond J, Aujard Y. Nosocomial infections in pediatric patients: a European, multicenter prospective study. Europen Study Group. Infect Control Hosp Epidemiol 2000;21:260-3.
10. 10. Lee CY, Chen PY, Huang FL, Lin CF. Microbiologic spectrum and susceptibility pattern of clinical isolates from the pediatric intensive care unit in a single medical center-6 years’experience. J Microbiol Immunol Infect 2009;42:160-5.
11. 11. Koulenti D, Lisboa T, Brun-Buisson C, Krueqer W, Macor A, Sole-Violan J, et al. Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units. Crit Care Med 2009;37:2360-8.
12. 12. Feng Y, Amoateng-Adjepong Y, Kaufman D, Gheorghe C, Manthous CA. Age, duration of mechanical ventilation, and outcomes of patients who are critically ill. Chest J 2009;136:759-64.
13. 13. Ramirez P, Bassi GL, Torres A. Measures to prevent nosocomial infections during mechanical ventilation. Curr Opin Crit Care 2012;18:86-92.
14. 14. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the ıntensive care unit:Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med 2015;19:14-20.
15. 15. Kaoutar B, Joly C, L’Heriteau F, Barbut F, Robert J, Denis B, et al. Nosocomial infections and hospital mortality: a multicentre epidemiological study. J Hosp Infect 2004;58:268-75.
16. 16. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323-9.