Üçüncü basamak bir yenidoğan yoğun bakım ünitesinde metisilin dirençli Staphylococcus aureus kan dolaşımı enfeksiyonlarının görülme sıklığı ve risk faktörleri

Year 2019, Volume: 13 Issue: 4, 263 - 269, 30.07.2019

Ferit Kulalı , Ahmet Yagmur Bas , Sara Erol , Husniye Yucel , Deniz Yaprak , İlter Arifoglu Nihal Demirel

https://doi.org/10.12956/tchd.542092

Abstract

Giriş:
Metisilin dirençli Staphylococcus Aureus
(MRSA) infeksiyonları, yenidoğan yoğun bakım ünitesi (NICU)’ndeki hastalar için
önemli bir morbidite ve motalite nedenidir. MRSA enfeksiyonlarının gelişimine
zemin hazırlayan risk faktörlerinin belirlenmesi, enfeksiyonların önlenmesi
açısından son derece önemlidir.

Bu çalışmada, MRSA
enfeksiyonlarına ait risk faktörlerini saptamayı amaçladık.

Gereç
ve Yöntemler: Bu retrospektif çalışma,
1 Ocak 2011 – 31 Aralık 2015 takvim yılları arasında üçüncü basamak bir NICU’da
yapıldı. Çalışmaya, kan kültürülerinde Staphylococcus
Aureus (S. aureus) izole edilen tüm hastalar alındı. Antibiyogram sonucuna
göre, hastalar iki gruba ayrıldı: MRSA ve metisilin duyarlı S. aureus (MSSA). Hastaların demografik
özellikleri ile klinik ve laboratuvar bulguları dökümente edildi.

Bulgular:
NICU’ya kabul edilen 9864 hastanın 54’ünde S.
aureus enfeksiyonu saptandı. S.
aureus enfeksiyonları, 1500 gr altındaki infantlarda (35 of 1542 infants),
1500 gr ve üzerindeki infantlara (19 of 8322 infants) göre daha sık görülmekte
idi [p<0.001 IRR=9.94 CI=(5.69 - 17.39)]. Olguların % 79.6 (43 of 54)’ında
MSSA, % 20.4 (11 of 54)’ünde ise MRSA suşları tespit edildi. MRSA
enfeksiyonları 1500 gr ve altındaki bebeklerde 1500 gr ve üstü bebeklerden daha
sık görülmesine rağmen, MRSA enfeksiyonları ile doğum ağırlığı arasında
istatistiksel olarak anlamlı bir ilişki saptanmadı. Doğum ağırlığı, gebelik
yaşı, cinsiyet, SNAPPE skoru, tedavi yöntemleri (santral venöz kateter, total
parenteral beslenme, yardımlı ventilasyon) ve kullanılan antibiyotikler (prenatal
veya ampirik) metisilin direnci açısından anlamlı bir fark oluşturmadı.

Tartışma:
S. aureus enfeksiyonları için en
önemli risk faktörü, çok düşük doğum ağırlığına (<1500 gr) sahip olmaktır.

Keywords

Metisilin direnci, antibakteriyel ilaçlar, NICU, çok düşük doğum ağırlığı, santral venöz kateter

Incidence of and risk factors for methicillin-resistant Staphylococcus aureus bloodstream infections in a level III neonatal intensive care unit

Abstract

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) infections
are significant causes of morbidity and mortality for the patients in neonatal
intensive care unit (NICU). The identification of risk factors that lead up to
the development of MRSA infections is of utmost importance in terms of preventing
infections.

In this study, we
aim to determine the risk factors of MRSA infections.

Material and Methods: This retrospective study
was conducted in a tertiary NICU between 1^stJanuary 2011 and 31^stDecember
2015. All patients with S. aureus
isolated from blood cultures were included in the study. According to the
antibiogram pattern, the patients were separated into two groups: MRSA and
methicillin-susceptible Staphylococcus aureus
(MSSA).

Results: S.
aureus infections were more frequent in infants
under 1500 g (2.27%) than in infants of 1500 g and above (0.23%) [OR=10.149,
CI: 5.790-17.790, p<0.001]. MSSA was identified in 79.6% (43 of 54) of
cases, and MRSA strains were identified in 20.4% (11 of 54) of cases. Although,
MRSA infections were more frequent in infants under 1500 g than in infants of
1500 g and above, there was no statistically significant association between
MRSA and birth weight [OR=1.580, CI: 0.366-6.831, p=0.728]. We found that birth
weight, gestational age, sex, SNAPPE score, therapeutic procedures (central
venous catheter, total parenteral nutrition, assisted ventilation) and
antibiotics used (prenatal or empirical) did not make a significant difference
in terms of methicillin resistance.

Conclusion: Very low birth weight is
the most important risk factor for both S.
aureus infections.

Keywords

Methicillin resistance, anti-bacterial agents, NICU, very low birth weight, central venous catheters

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