Bir Üniversite Hastanesinde Çoklu İlaca Dirençli Acinetobacter baumanii ile Oluşan Enfeksiyonların 15 Yıllık Ara ile Risk Faktörleri ve Prognoz Yönünden Araştırılması

Year 2024, , 149 - 163, 30.06.2024

Emel Azak , Aynur Karadenizli , Haluk Vahaboglu

https://doi.org/10.31832/smj.1430446

Abstract

Amaç: Sağlık bakımı ilişkili enfeksiyonlarda (SBİE) Acinetobacter baumannii (AB), yüksek antibiyotik direnç oranları nedeniyle önemli bir sorundur. Bu çalışmada, çoklu ilaca dirençli AB (ÇİDAB) SBİE’lerinin, risk faktörlerinin ve prognozun iki farklı zaman diliminde değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Mayıs 2002-Mayıs 2005 (Grup I) ve Ocak 2023-Aralık 2023 (Grup II) tarihleri arasında, ÇİDAB üremesi olan hastaların klinik ve mikrobiyolojik verileri, retrospektif olarak değerlendirildi. ÇİDAB SBİE’lerinin gelişimine ait risk faktörlerini değerlendirmek için, vaka ve kontrol grupları oluşturuldu. Bulgular: Grup I’de 37 vaka ve 26 kontrol hastası, Grup II’de 64 vaka ve 64 kontrol hastası değerlendirildi. En sık SBİE’ler, Grup I’de solunum yolu (%54), Grup II’de kan dolaşımı (%57) enfeksiyonlarıydı. Grup I’de diyabet (p=0,010), kronik akciğer hastalığı (p=0,007) ve hastanede uzun yatış süresi (p=0,004), Grup II’de ise nazogastrik tüp günü (p=0,044) risk faktörü olarak saptandı. Grup I’de kronik akciğer hastalığı, geçirilmiş cerrahi, cerrahi birimlerde yatış, üriner kateter ve nazogastrik tüp kullanımı Grup II’den; Grup II’de, altta yatan hastalık, malignite, YBÜ’ye yatış ve APACHE II skoru Grup I’den yüksekti. Grup I’den II’ye karbapenem kullanımının %43’ten %69’a (p=0,012) ve mortalitenin %30’dan %45’e (p=0,123) arttığı saptandı. Grup II’de %64 tigesiklin direnci ve %5,4 kolistin direnci vardı. Sonuç: Bu çalışmada, geçmişten günümüze ÇİDAB ilişkili kan dolaşımı enfeksiyonlarında belirgin artış, malignitesi olan ve YBÜ’ye yatan hastalarda ÇİDAB enfeksiyonu sıklığı dikkat çekicidir. SBİE öncesi karbapenem kullanımında artış, tigesiklin ve kolistine artan direnç ve yüksek doz tigesiklin kullanım onayının olmaması önemli sorunlardır. Günümüzde mortalite oranlarındaki artış da dikkate alındığında, ÇİDAB enfeksiyonlarına yönelik çok yönlü enfeksiyon kontrol müdahalelerine gereksinim duyulduğu aşikardır.

Keywords

Acinetobacter baumannii, Sağlık bakımı ilişkili enfeksiyon, Çoklu ilaca direnç, Risk faktörleri, Prognoz

Ethical Statement

Çalışmanın etik kurul onayı Kocaeli Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan (GOKAEK-2024/02.45, proje numarası: 2024/69) alındı.

Supporting Institution

Yok

Project Number

2024/69

An Investigation of Infections Caused by Multidrug Resistant Acinetobacter baumannii in a University Hospital: A 15-year Interval Study on Risk Factors and Prognosis

Abstract

Objective: Growing antibiotic resistance and limited treatment options make Acinetobacter baumannii (AB) in healthcare-associated infections (HAI) difficult. This study compares MDRAB-related HAI risk factors and prognosis in our hospital over two time periods. Materials and Methods: MDRAB growth patients’ clinical and microbiological data from May 2002–May 2005 (Group I) and January 2023–December 2023 (Group II) were retrospectively examined. MDRAB-caused HAI risk factors were assessed in case and control groups. Results: This study evaluated 37 cases and 26 controls in Group I and 64 cases and 64 controls in Group II. Most HAIs were respiratory tract infections (54%) in Group I and bloodstream infections (57%) in Group II. Diabetes (p=0.010), chronic lung disease (p=0.007), and prolonged hospital stay (p=0.004) were risk factors in Group I, while nasogastric tube days (p=0.044) were in Group II. Group I had more chronic lung disease, prior surgery, surgical unit admission, urinary catheter, and nasogastric tube use than Group II. Group II had higher underlying disease, malignancy, ICU admission, and APACHE II score than Group I. The mortality rate rose from 30% to 45% (p=0.123), and carbapenem use rose from 43% to 69% (p=0.012). Group II had 64% tigecycline and 5.4% colistin resistance. Conclusion: The study shows a significant rise in MDRAB-related bloodstream infections, especially in malignancy and ICU patients. High carbapenem use before HAI, rising tigecycline and colistin resistance, and the lack of high-dose tigecycline approval are major issues. The rise in mortality rates makes multifaceted infection control interventions for MDRAB infections necessary.

Keywords

Acinetobacter baumannii, Healthcare associated infection, Multidrug resistance, Risk factors, Prognosis

Project Number

2024/69

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