ÜRİNER SONDA UYGULANAN HASTALARDA HASTANE KÖKENLİ ÜRİNER SİSTEM ENFEKSİYONLARININ ARAŞTIRILMASI

Abstract

Amaç: Üriner sonda kullanımının en önemli dezavantajı, idrar yolu enfeksiyonuna (İYE) zemin hazırlamasıdır. Bu çalışma, acil ve elektif koşullarda üriner sonda uygulamalarının karşılaştırılması ve bunun sonucunda kateter ilişkili idrar yolu enfeksiyonu (Kİ-İYE) gelişiminin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışmamız, 1 Ağustos- 30 Aralık 2021 tarihleri arasında tek merkezli retrospektif bir vaka-kontrol çalışmasıdır. Vaka grubu, acil serviste (AS) üriner kateterizasyonu yapılan ve en az 48 saat hastanede yatan 18 yaş ve üzeri hastalardan oluşmaktadır. Kontrol grubu ise serviste elektif üriner kateterizasyonu yapılan ve en az 48 saat daha hastanede kalan hastalardan oluşmaktadır. İki grup, Kİ-İYE gelişimi, predispozan faktörler ve üriner kateter kullanma nedenleri açısından karşılaştırılmıştır. Bulgular: Hem vaka hem de kontrol gruplarında,106 hasta bulunmaktadır. En sık üriner kateterizasyon nedeni, sırasıyla %82.1ve %77.4 oranlarıyla genel durum bozukluğu olarak belirlenmiştir. Vaka ve kontrol gruplarında üriner kateterizasyon süresi sırasıyla 8,4 ve 11,17 gün olarak bulunmuştur (p<0.0001). Üriner kateter takma işlemi vaka grubunda daha çok intern doktorlar, kontrol grubunda ise asistan doktorlar tarafından yapılmıştı (p=0.001). Kİ-İYE gelişme oranı vaka ve kontrol gruplarında sırasıyla 1000 kateter günü başına 0.078 ve 0.064 idi ve vaka grubunda daha yüksek olmasına rağmen anlamlı bir fark yoktu (p>0.005). Sonuç: Acilde üriner kateter uygulanım süreci Kİ-İYE gelişimi açısından serviste üriner kateter uygulanımına göre ek bir risk faktörü olarak saptanmamıştır. Kateter uygulayıcısı açısından da farklılık saptanmamıştır. Toplam olgu sayısının azlığı, kontrol grubunda kateterizasyon süresinin daha uzun olması ve çalışmada Kİ-İYE prevalansının düşük olması ile ilişkili olabilir.

Keywords

• acil servis
• önleme
• idrar kateteri
• İdrar yolu enfeksiyonu

Investigation of Nosocomial Urinary Tract Infections in Patients with Urinary Catheters

Abstract

Aim: The most significant adverse outcome of urinary catheter use is the development of a urinary tract infection (UTI). This study evaluates the role of urinary catheterization in emergencies compared to elective conditions in wards, focusing on the development of catheter-associated urinary tract infections (CA-UTI). Methods: Our study is a single-center retrospective case-control study between August 1 and December 30, 2021. The case group consists of patients aged 18 years and older, who underwent urinary catheterization in the emergency department (ED) and were hospitalized for at least 48 hours. The control group consisted of patients who underwent elective urinary catheterization in the wards and continued to be hospitalized for at least 48 hours. Two groups were compared in terms of development, predisposing factors of CA-UTI and reasons of using urinary catheter. Results: The most reason for urinary catheterization in case and control groups, each of consisted of 106 patients, is for patients’ unstable medical conditions with ratios of 82.1% and 77.4%, respectively. The duration of urinary catheterization in case and control groups was 8.4 and 11.17 days, respectively (p<0.0001). While majority of the urinary catheter insertions were performed by intern doctors in the ED; most of them were carried out by assistant doctors in the wards (p=0.001). The rate of development of CA-UTI in case and control groups, was 0.078 and 0.064 per 1000 catheter days, respectively, and although the case group was higher, there was no significant difference (p>0.005). Conclusion: The process of urinary catheterization in the emergency department has not been identified as an additional risk factor for the development of CA-UTI when compared to urinary catheterization in the ward. No difference was detected in terms of catheter practitioner. This may be related to the small total number of cases, the longer catheterization duration in the control group, and the low prevalence of CA-UTI in the study.

Keywords

• emergency department
• prevention
• urinary catheter
• Urinary tract infection

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