Yenidoğan Yoğun Bakım Ünitesinde Nozokomiyal İnfeksiyon Etkenleri ve Antibiyotik Direnç Özellikleri : Son Bir Yıllık Deneyim

Abstract

Nozokomiyal infeksiyonlar (NKİ) yenidoğanlarda anlamlı mortalite ve morbidite nedenidir. Özellikle düşük doğum tartılı yenidoğanlar NKİ’lar açısından yüksek riskli olduklarından etkenlerin ve antimikrobiyal direnç özelliklerinin bilinmesi ampirik tedavi seçimleri açısından önemlidir. Çalışmamızda ünitemizde NKİ’a yol açan mikroorganizmaların ve antibiyotik duyarlılıklarının saptanması amaçlanmıştır. Ünitemizde Ocak 2008-Ocak 2009 tarihleri arasında hastaya dayalı aktif sürveyans yöntemiyle saptanan NKİ’lar, üreyen etkenler ve antibiyotik duyarlılıkları prospektif olarak değerlendirildi. Ünitemizde yatan 372 hastanın 4’ü term, 12’si preterm olmak üzere toplam 16’sında (%4,3) 30 NKİ atağı saptandı. Hastane infeksiyon hızımız %8,07 idi. NKİ sıklığı termlerde %25, pretermlerde %75’di. Kan dolaşımı infeksiyonu %43’le ilk sıradaydı. En sık izole edilen etkenler Pseudomonas aeruginosa (%20), Klebsiella pneumoniae (%20) ve Candida türleriydi (%20). Gram negatif etkenler %44, gram pozitifler %36, Candida türleri %20 oranındaydı. Gram negatif etkenlerde ampisilin ve aminoglikozid direnci %100, sefalosporin direnciyse %92 bulundu. Gram negatif enterik basillerde genişletilmiş spektrum betalaktamaz (GSBL) pozitifliği %.100’dü. Gram pozitif etkenlerden stafilokok türlerinde metisilin direnci % 80’iken, glikopeptid direnci görülmedi. Genel ölüm hızı %1,8’di. Ölen term bebeklerde hipoksik iskemik ensefalopati, pretermlerdeyse respiratuar distres sendromu, nekrotizan enterokolit ve pnömotoraks tanıları mevcuttu. Sonuç olarak başta el yıkama olmak üzere infeksiyon kontrol kurallarına tam olarak uyulması, aktif sürveyans çalışmaları ve akılcı antibiyotik kullanımıyla dirençli NKİ sıklığının azaltılabileceği düşünülmektedir. Nosocomial infection agents and antibiotic resistance profiles in neonatal intensive care unit : An experience of one year Nosocomial infections are responsible for significant mortality and morbidity in hospitalized newborns. Especially very low birth weight infants are accepted to be under high risk. For this reason it is important to know the pathogenic agents and their antimicrobial resistance profiles in a neonatal intensive care unit when choosing an empiric antibiotic treatment. In this study we aimed to determine the nosocomial pathogens and their antibiotic sensitivity patterns in our unit. Between January 2008 and January 2009 we performed a prospective study to determine hospital-acquired infections in our unit, to assess pathogenic culture results and to evaluate antibiotic susceptibility patterns by using patient-based active surveillance system. During the study period we hospitalized 372 newborn babies in our unit and we ascertained 30 nosocomial infection attacks in 16 (4.3%) infants. Our overall hospital infection rate was 8.07%. Premature infants had a nosocomial infection rate of 75%, whereas mature infants had an infection rate of 25%. Most nosocomial infections were bloodstream infections (43%). Most common causitive pathogens were Pseudomonas aeruginosa (20%), Klebsiella pneumonia (20%) and Candida species (20%). We found that gram negative agents were responsible for 44%, gram positive agents were responsible for 36% and candida species were responsible for 20% of nosocomial infections. Ampicilline and aminoglycoside resistance ratios were 100% in gram negative agents. On the other hand cephalosporine resistance ratio was found to be 92%. Expanded spectrum betalactamase positivity was detected as 100% in gram negative enteric bacilli. Methycilline resistance ratios in coagulase-negative staphylococci was 80%. There was no apparent resistance against glycopeptides among gram positive agents. The overall mortality rate was calculated as 1.8%. In mature infants hypoxic ischemic encephalopathy, in premature infants respiratory distress syndrome, necrotising enterocolitis and pneumothorax were the underlying causes which led to death. In conclusion hand hygiene standing first on the list, all nursery personnel should strictly obey preventive principles against nosocomial infections. Active surveillance and rational antibiotic usage may be helpful in decreasing the frequency of resistant nosocomial infections.

Keywords

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