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

Year 2009, Volume: 26 Issue: 2, 72 - 76, 06.12.2010

Özgür Olukman Füsun Atlıhan Gamze Gülfidan Şebnem Çalkavur İsmail Cengiz Öztürk

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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