Kardiyovasküler Girişimler için Kullanılan Santral Venöz Kateterlerden İzole Edilen Patojenlerin Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı kardiyovasküler girişimler nedeniyle santral venöz kateterizasyon uygulanan hastalarda izole edilen patojenleri değerlendirmektir. Materyal ve Metot: Hastalar, kateter ilişkili infeksiyonların gelişimi için günlük olarak izlendi. Nisan 2017 ile Temmuz 2019 tarihleri arasında, kateterizasyondan sonra akıntı, ateş, ağrı, lenfadenopati ve kaşıntı gibi infeksiyon semptomları gösteren hastalar geriye dönük çalışmaya dahil edildi. Hastaların kateter tipleri, kateter yerleştirme bölgeleri, toplam kateterizasyon süreleri, kültür sonuçları, patojenlerin antimikrobiyal ilaçlara karşı duyarlılıkları ve dirençleri kaydedildi ve analiz edildi. Bulgular: Çeşitli endikasyonlar nedeniyle santral venöz kateterizasyon uygulanan 86 hasta çalışmaya alındı. Hastaların ortalama yaşı 52,70±17,82 yıl idi. Hastaların %62,79'unda bakteri üremesi mevcuttu. En sık kateter yerleştirme yerleri sağ subklavyen ven, sağ juguler ven ve sağ femoral venlerdi. En sık izole edilen mikroorganizma %25,58 ile S.aureus idi ve onu E. coli (%6,98), S. haemolyticus (%5,81) ve K. pneumonia (%5,81) izlemekte idi. S. aureus'un vankomisin ve linezolide duyarlı olduğu tespit edildi. Sonuç: Bu infeksiyonların insidansını etkileyen faktörler arasında kateter yerleştirme bölgesi, kateterizasyon süresi, kateter seçimi ve uygulayıcıların becerileri bulunur. Literatürdeki kateterle ilişkili infeksiyonlarda izole edilen patojenler ve bunların antimikrobiyal ajanlara duyarlılığı ve direnci hakkındaki veriler çoğunlukla eskidir. Bu konuda daha kapsamlı, çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• kateterizasyon
• patojenler
• kateterle ilişkili kan dolaşımı infeksiyonları
• S. aureus

Evaluation of Pathogens Isolated from Central Venous Catheters Used for Cardiovascular Interventions

Abstract

Objective: To evaluate the isolated pathogens in patients who underwent central venous catheterization due to cardiovascular procedures. Materials and Methods: Patients were monitored daily for the development of catheter related infections. Between April 2017 and July 2019, patients who exhibited infection symptoms like discharge, fever, pain, lymphadenopathy and itching after the catheterization were included in this retrospective study. Patients’ catheter types, catheter insertion sites, total catheterization durations, culture results, sensitivities and resistances of pathogens against antimicrobial drugs were recorded and analyzed. Results: Eighty-six patients who underwent central venous catheterization due to various indications were included. Mean age of patients was 52.70±17.82 years. Bacterial growth was found in 62.79% of patients. The most common catheter insertion sites were right subclavian vein, right jugular vein and right femoral vein. The most commonly isolated microorganism was S. aureus by 25.58% followed by E.coli (6.98%), S. haemolyticus (5.81%) and K.pneumonia (5.81%). S. aureus was detected to be sensitive to vancomycin and linezolid. Conclusion: Factors affecting incidence of these infections include catheter insertion site, catheterization duration, catheter selection and skills of the practitioners. Data in literature about the pathogens isolated in catheter-related infections and their sensitivity and resistance to antimicrobial agents are mostly old. Further comprehensive, multicenter studies are needed on this issue.

Keywords

• catheterization
• pathogens
• catheter related bloodstream infections
• S.aureus

References

1. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124(23):574-651.
2. Raingruber B, Kirkland-Walsh H, Chahon N, Kellermann M. Using the Mehran risk scoring tool to predict risk for contrast medium-induced nephropathy in patients undergoing percutaneous angiography. Crit Care Nurse. 2011;31(1):17-22.
3. Shah H, Bosch W, Thompson KM, Hellinger WC. Intravascular catheter-related bloodstream infection. Neurohospitalist. 2013;3(3):144-151.
4. Cantón-Bulnes ML, Garnacho-Montero J. Practical approach to the management of catheter-related bloodstream infection. Rev Esp Quimioter. 2019;32(Suppl 2):38-41.
5. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-2732.
6. Warren DK, Quadir WW, Hollenbeak CS, Elward AM, Cox MJ, Fraser VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006;34(8):2084-2089.
7. Duguid JP, Collee JG, Fraser, AG. Laboratory strategy in the diagnosis of infective syndromes. In: Mackie and McCartney. Practical Medical Microbiology. 1st ed. New York, PA: Churchil Livingstone; 1989:00-649.
8. https://www.eucast.org/ast_of_bacteria/. Access Date May 05, 2020.

9. Dreesen M, Foulon V, Spriet I, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr. 2013;32:16-26.
10. Peng S, Lu Y. Clinical epidemiology of central venous catheterrelated bloodstream infections in an intensive care unit in China. J Crit Care. 2013;28:277-283.
11. Horvath R, Collignon P. Controlling intravascular catheter infections. Aust Prescr. 2003;26:41-43.
12. Mozaffari K, Bakhshandeh H, Khalaj H, Soudi H. Incidence of catheter-related infections in hospitalized cardiovascular patients. Res Cardiovasc Med. 2013;2(2):99-103.
13. Heiselman D. Nosocomial bloodstream infections in the critically ill. JAMA. 1994;272(23):1819-1820.
14. Turken M, Toker AK, Zincirlioglu C, Kose S. Risk factors and incidence of catheter-related bloodstream infections in a tertiary hospital ICU. EJMI. 2019;3(1):32-36.
15. Sadoyama G, Gontijo Filho PP. Comparison between the jugular and subclavian vein as insertion site for central venous catheters: microbiological aspects and risk factors for colonization and infection. Braz J Infect Dis. 2003;7(2):142-148.
16. Eggimann P, Sax H, Pittet D. Catheter-related infections. Microbes Infect. 2004;6(11):1033-1042.
17. Mermel LA, Farr BM, Sherertz RJ, et al. Guidelines for the management of intravascular catheter-related infections. J Intraven Nurs. 2001;24:180-205.
18. Mohan U, Jindal N, Aggarwal P. Species distribution and antibiotic sensitivity pattern of coagulase negative staphylococci isolated from various clinical specimens. Indian J Med Microbiol. 2002;20(1):45-46.
19. Mjalawi BSA, Hamil ARH, Imam AL. Isolate and identification some of the pathogens of cardiac catheterization patients in the city of Karbala. Int J Res Dev Pharm L Sci. 2016;14(2):1-9.
20. Gecgel SK, Demircan N. The epidemiology of pathogen microorganisms in hospital acquired infections. Int J Clin Exp Med. 2016;9(11):22310-22316.
21. Tavares AL. Community-associated methicillin-resistant staphylococcus aureus (CA-MRSA) in Portugal: origin, epidemiology and virulence. Ph.D. Thesis, Universidade Nova de Lisboa. Lisbon, Portugal. 2014.
22. Phatak J, Udgaonkar U, Kulkarni RD, Pawar SG. Study of coagulase negative staphylococci and their incidence in human infections. Indian J Med Microbiol. 1994;12:90-95.
23. Goel MM, Singh AV, Mathur SK, Singh M, Singhal S, Chaturvedi UC. Resistant coagulase negative staphylococci from clinical samples. Indian J Med Res. 1991;93:350-352.