Yenidoğan yoğun bakım ünitesinde çok ilaca dirençli Gram-negatif bakteri oranı ve risk faktörleri: Tek merkezli on yıllık deneyim

Year 2023, , 228 - 235, 22.06.2023

Hatice Mine Çakmak , Dilek Yekenkurul , Zehra Şengün , Selvi Yener , Pelin Duran , Fatih Davran , Kenan Kocabay

https://doi.org/10.18521/ktd.1265336

Abstract

Amaç: Gram-negatif yenidoğan enfeksiyonlarında çoklu ilaç direncinin (ÇİD) yönetimi zordur ve risk faktörleri farklı çalışmalar arasında farklılık göstermektedir. Bu çalışmanın amacı, gram-negatif izolatların demografik özelliklerini, mortalitesini, ÇİD durumunu ve ÇİD gram-negatif enfeksiyonlar için risk faktörlerini araştırmaktır.
Metod: Düzce Üniversitesi Hastanesi'nde Ocak 2012-Ocak 2022 tarihleri arasında yenidoğanlarda ÇİD gram-negatif enfeksiyonlarla ilgili retrospektif tek merkezli bir çalışma yapıldı. Bu çalışmada ÇİD gram-negatif enfeksiyonu olan yenidoğanların risk faktörleri ve klinik özellikleri değerlendirildi. Tüm analizler IBM SPSS V23 kullanılarak gerçekleştirildi. Ayrıca, ÇİD risk faktörlerini belirlemek için tek değişkenli analizler ve çok değişkenli lojistik regresyon modelleri incelenmiştir.
Bulgular:
Yüzyedi gram-negatif bakterinin 41'ini (%38,3) Enterobacter, 30'unu (%28) Klebsiella pneumonia ve 22'sini (%20,6) Escherichia coli oluşturmuştur. Ayrıca, 61'i (%56,5) ÇİD mikroorganizmalardır. Seçilen izolatlar için yapılan duyarlılık testleri sonucunda 41'inde (%77,4) piperasilin, 57'sinde (%75) amoksiklav ve 16'sında (%72,7) sefoksitin direnci tespit edilmiştir. Ayrıca, 24'ünde (%43,6) karbapenemaz direnci ve 13'ünde (%36,1) meropenem direnci tespit edilmiştir. Kolistin, aztreonam ve tigesiklin dirençleri en az görülen dirençlerdi. Aşağıdaki bağımlı risk faktörleri gram-negatif enfeksiyonlarda çoklu ilaç direnci riskini arttırmıştır; geç başlangıçlı sepsis 3. 547 kat (p=0. 005), mekanik ventilasyon kullanımı 3. 143 kat (p=0. 007), kan kültürü pozitifliği 3. 587 kat (p=0. 013), bronkopulmoner displazi 6. 702 kat, (p=0. 015) ve total parenteral beslenme 5. 591 kat (p=0. 001), düşük gebelik yaşı 1. 122 (1/0. 891) kat (p=0. 026) ve doğum ağırlığı 1. 001 (1/0. 999) kat, (p=0. 013). Benzer şekilde, antibiyoterapi süresi ÇİD grubunda ÇİD olmayan gruba göre anlamlı derecede daha yüksekti.
Sonuçlar: Gram-negatif yenidoğan enfeksiyonlarında ÇİD için bildirilen risk faktörlerinin tümü bağımlı risk faktörleridir. Bu nedenle klinisyenler tüm potansiyel risk faktörleri çoklu ilaç direncini öngörmekte önem taşımaktadır.

Keywords

gram negatif bakteriyel enfeksiyonlar, yenidoğanlar, çoklu ilaç direnci

Supporting Institution

YOK

Project Number

YOK

Thanks

YOK

Multidrug-resistant Gram-negative bacteria rate and risk factors in the neonatal intensive care unit: A single-center ten-year experience

Abstract

Objective: Multidrug resistance (MDR) in gram-negative neonatal infections is difficult to manage, and the risk factors differ among different studies. We aim to investigate the demographics, mortality, MDR status of gram-negative isolates, and risk factors for MDR gram-negative infections.
Material-Methods:
We conducted a retrospective single-center study about MDR gram-negative infections in neonates between January 2012-January 2022 at Duzce University Hospital in Turkey. This study evaluates neonates with MDR gram-negative infections' risk factors and clinical features. All analyses were performed using IBM SPSS V23. Univariate analyses and multivariate logistic regression models were studied to determine MDR's risk factors.
Results: Of 107 gram-negative bacteria, 41 (38.3%) accounted for Enterobacter, 30 (28%) for Klebsiella pneumonia, and 22 (20.6%) for Escherichia coli. Additionally, 61 (56.5%) were MDR microorganisms. Among the susceptibility tests performed for selected isolates, 41 (77.4%) had resistance to Piperacillin, 57 (75%) showed resistance to amoxiclav, and 16 (72.7%) had cefoxitin resistance. In addition, carbapenemase resistance was found in 24 (43.6%) and meropenem resistance in 13 (36.1%). Colistin, aztreonam, and tigecycline resistances were the least frequent. The following dependent risk factors increased the multidrug resistance risk in gram-negative infections; late-onset sepsis 3.547 fold (p=0.005), use of mechanical ventilation 3.143 fold (p=0.007), blood culture positivity 3.587-fold (p=0.013), bronchopulmonary dysplasia 6.702 fold, (p= 0.015) and total parenteral nutrition 5.591 fold (p=0.001), lower gestational age 1.122 (1/0.891) fold (p=0.026), and birth weight 1.001 (1/0.999) fold, (p=0.013). Similarly, anti-biotherapy duration was significantly higher in the MDR group than in the non-MDR group.
Conclusions: The reported risk factors for MDR in gram-negative neonatal infections are all dependent risk factors. Hence clinicians must be alert to all potential risk factors.

Keywords

gram negative bacterial infections, neonates, multidrug resistance

Project Number

YOK

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