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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

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.

References

  • 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. 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. Bozaykut A, Ipek IO, Kiliç BD. Predicting neonatal sepsis in ventilated neonates. Indian J Pediatr 2008;75:39-42.
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. Ramirez P, Bassi GL, Torres A. Measures to prevent nosocomial infections during mechanical ventilation. Curr Opin Crit Care 2012;18:86-92.
  • 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. 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. 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.

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

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

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.

References

  • 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. 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. Bozaykut A, Ipek IO, Kiliç BD. Predicting neonatal sepsis in ventilated neonates. Indian J Pediatr 2008;75:39-42.
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. Ramirez P, Bassi GL, Torres A. Measures to prevent nosocomial infections during mechanical ventilation. Curr Opin Crit Care 2012;18:86-92.
  • 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. 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. 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.
There are 16 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Aysu Türkmen Karaağaç

Publication Date August 1, 2017
Published in Issue Year 2017 Volume: 20 Issue: 2

Cite

Vancouver Türkmen Karaağaç A. Evaluation of Properties, Pathogens, and Mortality-Related Risk Factors of Nosocomial Infections in Pediatric Cardiovascular Surgery Intensive Care Unit. Koşuyolu Heart Journal. 2017;20(2):121-4.