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

Year 2017, Volume: 20 Issue: 2, 121 - 124, 01.08.2017

Aysu Türkmen Karaağaç

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

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