Yenidoğan Yoğun Bakım Ünitesinde Gelişen Sağlık Bakım İlişkili Enfeksiyonlar: Son 6 Yılın Değerlendirilmesi

Abstract

Amaç:  Sağlık bakım ilişkili enfeksiyonlar  (SBİE) yenidoğan yoğun bakım ünitelerinde  (YDYBÜ) önemli morbidite ve mortalite nedenidir.  Bu çalışmada, bir üçüncü basamak YDYBÜ’nde gelişen SBİE değerlendirildi.

Gereç ve yöntem: Çalışma Sakarya Üniversitesi Eğitim ve Araştırma Hastanesi merkez kampüsü YDYBÜ’nde 1 Ocak 2013-31 Aralık 2018 arasında yapıldı. YDYBÜ’de gelişen SBİE retrospektif olarak değerlendirildi. YDBÜ günlük aktif sürveyans yöntemiyle takip edildi ve SBİE tanısı Center for disease controle (CDC)’nin 2014 rehberine göre koyuldu. YDYBÜ’de yatan hasta sayısı, hasta günü, gelişen SBİE, invaziv alet kullanımı, izole edilen etkenler ve antibiyotik direnç oranları hesaplandı. Elde edilen veriler bilgisayar ortamında değerlendirildi.

Bulgular: Toplam 2196 hasta, 33652 hasta günü, 4157 ventilatör günü, 3343 umbilikal kateter günü, 5210 santral venöz kateter günü ve 92 üriner kateter günü izlendi. SBİE hızı %4,78 (105/2196) ve insidans dansitesi ‰ 3,12 (105/33652) idi. SBİE alt dağılımlarına göre değerlendirildiğinde kan dolaşımı enfeksiyonları (KDE) %96,1 (101/105) ilk sıradaydı. SBİE etkenlerinin %59,0 (62/105)’si gram negatif (GNB) %41,0 (43/105)’i gram pozitif etkenlerdi. En sık izole edilen GNB Klebsiella spp. (%34,2) ve Enterobacter spp. (%12,3) idi. Gram pozitif etkenler ise koagülaz negatif stafilokoklar (%26,6) ve Staphylococcus aureus (%10,4) idi. İnvaziv alet ilişkili enfeksiyon hızları değerlendirildiğinde; santral venöz kateter ilişkili kan dolaşımı enfeksiyon hızı   ‰ 0,95 umbilikal kateter ilişkili kan dolaşımı enfeksiyon hızı ‰ 2,09 idi ve ventilatör ilişkili pnömoni ile üriner kateter ilişkili üriner sistem enfeksiyonu gelişmedi. 

Tartışma: KDE’nin en sık görülen SBİE olduğu tespit edildi. Ünitede hastaların uzun süre izlenmesi, invaziv girişimler, düşük doğum ağırlığı, erken doğum, total parenteral beslenme ve doğumsal anomaliler enfeksiyon riskini artıran faktörlerdir. SBİE gelişme oranı bebeğin gestasyon yaşı ve vücut ağırlığı ile ters orantılı idi. SBİE en fazla ≤ 750 gr ağırlığında ki bebeklerde görülürken, en az > 2500 gr ağırlığındaki bebeklerde görülmüştür. Doğum ağırlığı düşük olan yenidoğanlarda enfeksiyon kontrol önlemleri hassas bir şekilde uygulanmalıdır.

Keywords

• Sağlık bakım ilişkili enfeksiyonlar,invaziv alet kullanımı,yenidoğan yoğun bakım ünitesi

Healthcare-associated ınfections in the neonatal intensive care unit: Review of the last 6 years

Abstract

Objective: Healthcare-associated ınfections (HAIs) are important causes of morbidity and mortality in neonatal intensive care units (NICUs). In this study we aimed to investigate  HAIs in a tertiary NICU was evaluated.

Materials and methods: The study was carried out between January 1, 2013 and December 31, 2018 in Sakarya University Training and Research Hospital. HAIs were evaluated retrospectively. The NICU was followed up with daily active surveillance and the diagnosis of HAIs was established according to the 2014 guidelines of the Center for Disease Control (CDC). The number of inpatients in the NICU, day of the patient, developing HAIs, invasive device use, isolated agents and antibiotic resistance rates were calculated. The data obtained were evaluated by computer.

Results: A total of 2196 patients, 33652 patient days, 4157 ventilator days, 3343 umbilical catheter days, 5210 central venous catheter days, and 92 urinary catheter days were observed. The HAIs rate was 4.78% (105/2196) and the incidence density was 3.16 (105/33652). Blood circulation infections (BCI) were in the first place in 96.1% (101/105) when evaluated according to the subscale of HAIs. 59.0% (62/105) of the HAIs agents were gram negative (GNB) 41.0% (43/105) were gram positive bacteria. The most frequent isolated GNB Klebsiella spp. (34.2%) and Enterobacter spp. (12.3%). Gram positive bacteria were coagulase negative staphylococci (26.6%) and Staphylococcus aureus (10.4%). When invasive device-related infection rates were evaluated; The rate of central venous catheter-related bloodstream infection was 5 0.95 umbilical catheter-related bloodstream infection rate ‰ 2.09, and ventilator-associated pneumonia and urinary catheter-related urinary tract infection did not develop.

Discussion: BCI was found to be the most common HAIs. Long-term follow-up of patients in the unit, invasive procedures, low birth weight, preterm birth, total parenteral nutrition and congenital anomalies are factors that increase the risk of infection. The rate of development of HAIs was inversely proportional to gestational age and body weight of the baby. HAIs was seen in infants weighing at least gr 750 g, whereas it was seen in infants weighing at least> 2500 g. Infection control measures should be applied precisely in newborns with low birth weight.

Keywords

• Healthcare-associated ınfections,use of invasive devices

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