Yoğun Bakım Hastalarında Hastane Kaynaklı Pnömoni Olgularının Değerlendirilmesi ve Sık Görülen Bakteriyel Etkenlerin Antimikrobiyallere Dirençlerinin Araştırılması

Abstract

Amaç: Bu çalışmanın amacı; hastanemiz yoğun bakım üniteleri YBÜ ’nde yatmakta olan hastalardan alınan alt solunum yolu örneklerinden izole edilen hastane kaynaklı pnömoni HKP etkenlerinin tür dağılımlarını, direnç paternlerini ve etken-kolonizasyon oranlarını saptamaktır.Yöntem:Çalışmada 11.06.2012-01.01.2014 tarihleri arasında üreme saptanan 96 balgam ve 1023 endotrakeal aspirat ETA olmak üzere 1119 alt solunum yolu örneği retrospektif olarak incelenmiştir. ETA örnekleri kantitatif kültür, balgam örnekleri ise kalitatif kültür yöntemleri ile değerlendirilmiştir. Üreyen mikroorganizmaların ayrımı hastanemiz Enfeksiyon Kontrol Komitesi tarafından CDC kriterlerine göre yapılmıştır. İdentifikasyon ve antibiyotik duyarlılık testleri Vitek-2 bioMerieux, France otomatize sistemiyle çalışılmıştır.Bulgular: Toplam 678 hastadan alınan 1119 örnekten 1309 mikroorganizma izole edilmiştir. Bu mikroorganizmalardan 401 hastaya ait 962 mikroorganizma kolonizasyon, 277 hastaya ait 347 mikroorganizma ise etken olarak kabul edilmiştir. Etken mikroorganizmaların 338’i ETA, dokuzu balgam materyalinden üretilmiştir. En sık görülen etken microorganisms in ETA samples were 208 Acinetobacter baumannii 61.5% , 53 Pseudomonas spp. 15.6% , 20 Klebsiella pneumoniae 5.9% , 18 Staphylococcus aureus 5.3% , and 9 Escherichia coli 2.6% , those that are in sputum samples were 6 A. baumannii 66.6% , 2 Pseudomonas spp. 22.2% , 1, K. pneumoniae 11.1% . The microorganisms regarded as colonization were 272 A. baumannii 28.3% , 228 Enterobacteriaceae spp. 23.7% , 131 Pseudomonas spp. 13.6% , and 138 Candida spp. 14.3% . The most frequently isolated A. baumannii, Pseudomonas spp. and K. pneumoniae were found to be multiple antimicrobial resistance. Of patients with nosocomial pneumonia HAP , 235 were considered as ventilator-associated pneumonia VAP , but 63 were nonConclusion: HAP is a nosocomial infection with a high mortality rate, which is frequently seen in ICUs. Determining the microorganisms causing HAP in ICUs, and monitoring their antimicrobial susceptibilities is also important to reduce mortality and morbidity as well as to guide empirical therapy. The fact that most of the cases are late-onset displays that that duration of hospital stay is an important risk factor in terms of HAP. The most frequent causative agent was detected A. baumannii, and colistin for this microorganism was seen as the only treatment option. It should be kept in mind that colonized microorganisms may be causative infectious agents eventually, and the patients should be monitored

Keywords

• hastane kökenli pnömoni, ventilatör ilişkili pnömoni, antimikrobiyal direnç, kolonizasyon

Analysis of Nosocomial Pneumonia and Antimicrobial Resistance of Frequently Encountered Bacterial Isolates in Intensive Care Unit Patients

Abstract

Objective: The aim of the study is to investigate the distributions of species, resistance patterns and infectioncolonization rates of hospital acquired pneumoniae HAP agents which isolated from lower respiratory tracts of the patients hospitalized in intensive care units ICU .Method: In the study, it was retrospectively evaluated 1119 lower respiratory tract samples [96 sputum, 1023 endotracheal aspirates ETA ] with positive culture results, and obtained between June 11, 2012 January 01, 2014. Quantitative cultures were done in ETA samples, and qualitative cultures were done in sputum samples. Separation of growing microorganism on culture was done by Infection Control Committee of our hospital, in accordance with CDC criteria. Identification and antibiotic susceptibility tests were performed by Vitek-2 bioMerieux, France automated system. Results: One thousand three hundred and nine microorganisms were isolated from 1119 samples obtained from a total of 678 patients. Of those microorganisms, 962 isolates from 401 patients were considered as colonization, while 347 microorganisms isolated from 277 patients were accepted as causative agents. Of causative microorganisms, 338 were from ETA, nine were produced from sputum materials. The most frequently isolated microorganisms in ETA samples were 208 Acinetobacter baumannii 61.5% , 53 Pseudomonas spp. 15.6% , 20 Klebsiella pneumoniae 5.9% , 18 Staphylococcus aureus 5.3% , and 9 Escherichia coli 2.6% , those that are in sputum samples were 6 A. baumannii 66.6% , 2 Pseudomonas spp. 22.2% , 1, K. pneumoniae 11.1% . The microorganisms regarded as colonization were 272 A. baumannii 28.3% , 228 Enterobacteriaceae spp. 23.7% , 131 Pseudomonas spp. 13.6% , and 138 Candida spp. 14.3% . The most frequently isolated A. baumannii, Pseudomonas spp. and K. pneumoniae were found to be multiple antimicrobial resistance. Of patients with nosocomial pneumonia HAP , 235 were considered as ventilator-associated pneumonia VAP , but 63 were nonConclusion: HAP is a nosocomial infection with a high mortality rate, which is frequently seen in ICUs. Determining the microorganisms causing HAP in ICUs, and monitoring their antimicrobial susceptibilities is also important to reduce mortality and morbidity as well as to guide empirical therapy. The fact that most of the cases are late-onset displays that that duration of hospital stay is an important risk factor in terms of HAP. The most frequent causative agent was detected A. baumannii, and colistin for this microorganism was seen as the only treatment option. It should be kept in mind that colonized microorganisms may be causative infectious agents eventually, and the patients should be monitored

Keywords

• hospital acquired pneumonia, ventilatorassociated pneumonia, antimicrobial resistance, colonization

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