Yoğun bakım ünitelerinde santral venöz kateter ilişkili kan dolaşımı infeksiyonu sıklığı, mikrobiyolojik etkenleri, antibiyotiklere duyarlılıkları ve risk faktörlerinin belirlenmesi

Year 2021, Volume: 12 Issue: 4, 404 - 408, 22.12.2021

Nuran Sarı , Çiğdem Erol , Kenan Hızel

https://doi.org/10.18663/tjcl.1004105

Abstract

Amaç: Santral venöz kateterler (SVK), yoğun bakım ünitelerinde hastaların tedavisi ve izlemi için sık kullanılan aletlerdir. Santral venöz kateter ilişkili infeksiyonları belirlemek, uygun ampirik antibiyotik tedavisi açısından yol gösterici olmak ve sonraki çalışmalar için karşılaştırılabilir veri sağlamak amaçlanmıştır.
Gereç ve Yöntemler: Yoğun bakım ünitelerinde, aktif prospektif sürveyans kapsamında takip edilen ve Centers for Disease Control and Prevention (CDC) kriterlerine göre SVK ilişkili kan dolaşımı infeksiyonu tanısı konulan hastaların, retrospektif olarak SVK kullanım oranları, kateter ilişkili kan dolaşımı infeksiyon (KİKDİ) hızları, mikrobiyolojik etkenleri, antibiyotiklere duyarlılık sonuçları ve risk faktörleri değerlendirilmiştir. Veriler SPSS 17.0 istatistik paket programına kaydedilerek, analiz edilmiştir.
Bulgular: Santral kateter kullanım oranı %48 ve infeksiyon hızı 8,07 olarak saptanmıştır. . İzole edilen 72 patojenin, 28’ i gram pozitif (% 28,9), 31’i gram negatif ( % 43,6), 13’ ü mantar (%18,5) olup, koagülaz negatif stafilokok (%22), Candida spp. (%18,8) Acinetobacter spp. (%16,6) en sık saptanan etkenler olmuştur. Koagülaz negatif stafilokoklarda metisilin direnci %75, S. aureus’ da %67 saptanmıştır.
Sonuç: Gereksiz santral kateter kullanımından kaçınılması, endikasyon kalkınca çıkarılması ve altta yatan hastalıkların tedavi edilmesi ile KİKDİ oranlarında azalma sağlanabileceği düşünülmektedir.

Keywords

Santral venöz kateter;, infeksiyon;, yoğun bakım ünitesi

Supporting Institution

Bu yazıdaki hiçbir yazarın herhangi bir çıkar çatışması yoktur. Yazının herhangi bir finansal desteği yoktur

Project Number

189

Determination of incidence, causative agents, antimicrobial susceptibilities, and risk factors of central venous catheter-related bloodstream infections in intensive care units

Abstract

Aim: Central venous catheters (CVCs) are widely utilized for patient therapy and monitoring in intensive care units . Its goal is to identify infections caused by central venous catheters, to recommend appropriate empirical antibiotic therapy in intensive care units, and to offer comparable data for future investigations.
Material and Methods:Patients who were followed up in intensive care units as part of an active prospective surveillance program and were found to have CVC-related bloodstream infections according to Centers for Disease Control and Prevention (CDC) criteria were spared. Retrospectively, the rates of catheter-related bloodstream infections (CRBSI), CVC use, microbiological agents, antibiotic sensitivity, and risk factors were evaluated. The data was analyzed and recorded using the SPSS 17.0 statistical package application.
Results: The rate of central venous catheter use was 0.48 and the rate of central catheter-related infection was determined as 8.07. The 72 pathogens identified were 28 gram-positive (28.9%), 31 gram-negative (43.6%) and 13 fungi (18.5%) and coagulase-negative staphylococci (22%), Candida spp. (18.8%), Acinetobacter spp. (16.6%) were the most commonly found agents. The methicillin resistance was detected in 75% of coagulase-negative staphylococci and 67% of S. aureus strains.
Conclusion: It is believed that reducing the incidence of CRBSI can be achieved by avoiding needless CVCs use, removing it when the indication is no longer needed, and treating the underlying medical conditions.

Keywords

Central venous catheter;, infection;, intensive care unit

Project Number

189

References

• 1. Centers for Disease Control and Prevention. Vital signs:central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. 11; 60: 243-8.
• 2. Mermel LA, Allon M, Bouza E et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49: 1-45.
• 3. Rosenthal VD, Maki DG, Rodrigues et al. Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive care units of 15 developing countries. Infect Control Hosp Epidemiol 2010; 31: 1264-72.
• 4. O’Grady NP, Alexander M, Burns LA et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52: 1-32.
• 5. Beekman SE, Hendersan DK. Infections caused by percutaneous ıntravascular devices. In: Bennett JE, Dolin R, Blaser MJ (Eds): Mandell, Dauglas, and Bennetts Principles and Practice of Infectious Disease, Eighth Edition, Philadephia, Elsevier Saunders 2015: 3309-24
• 6. Glaver S, Brun-Buisson C, Infectious associated with ıntravascular lines, grafts and diveces. In: Cohen J, Powderly WG, Opal SM.Infectious Disease Third Edition. China: Mosby Elsevier 2010: 491-300.
• 7. Cox E, Thom KA. Infectious Involving Intravascular catheters. In: Wright WF . Essentials of Clinical Infectious Diseases. New York, Demos, 2013: 70-79.
• 8. Weber DJ, Rutala WA. Central line-associated bloodstream infections: prevention and management. Infect Dis Clin North Am 2011; 25: 77–102.
• 9. Karabey S, Kaptı H. Hastane infeksiyonlarının izlemi: Sürveyans. Hastane İnfeksiyonları Kontrolü El Kitabı. Bilimsel Tıp Yayınevi Ankara 2005; 101-25.
• 10. Willke A, Ateş B. Hastane infeksiyonlarının sürveyansı ve Amerikan ulusal hastane infeksiyon sürveyans sistemi. Hastane İnfeksiyonları Kontrolü El Kitabı .Bilimsel Tıp Yayınevi , Ankara 2005: 67-78.
• 11. Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related Infection. N Engl J Med 1977; 296: 1305-9
• 12. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices; a systematic review of 200 published prospective studies. Mayo Clin Proc 2006; 81: 1159-71
• 13. Clinical and Laboratory Standarts Institute. Performance Standarts for Antimicrobial Susceptibility Testing; 18th Informational Supplement: CLSI document M100-S18 (ISBN 1-56238-556-9). Clinical and Laboratory Standarts Wayne, Pennsylvania 2008; 1897-8.
• 14. Leblebicioğlu H, Rosenthal V.D, Arıkan A et al. Device-associated hospital acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INICC). J Hosp Infect 2007; 65: 251-7.
• 15. Rupp ME. Nosocomial bloodstream infections. Epidemiology and prevention of nosocomial infections of organ systems. Hospital Epidemiology and Infection Control. C.Glen Mayhall (ed) Third ed. Philadelphia 2004; 253-65.
• 16. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32: 470-85.
• 17. İnan D, Saba R, Yalçın AN et al. Device-associated nosocomial infection rates in Turkish medical-surgical intensive care units. Infect Control Hosp Epidemiol 2006; 27: 343-8.
• 18. Tacconelli E, Smith G, Hieke K, Lafuma A, Bastide P. Epidemiology medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries literature and registry-based estimate. J Hosp Infect 2009; 72: 97-103.
• 19. O'Grady NP, Alexander M, Burns LAet al. Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheterrelated infections. Am J Infect Control 2011; 39: 1-34.
• 20. Şardan YÇ, Güner R, Çakar N, Ağalar F. Damar İçi Kateter İnfeksiyonlarının Önlenmesi Kılavuzu. Hastane İnfeksiyonları Dergisi 2013; 17: 233-79.
• 21. Rosenthal VD, Bijie H, Maki DG, Mehta Y, Apisarnthanarak A, Medeiros EA. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am J Infect Control 2012; 40: 396-407.
• 22. Hekimoğlu CH, Oku FC, Batır E. Ulusal Sağlık Hizmeti İlişkili İnfeksiyonlar Sürveyans Ağı. Etken ve Dağılımı ve Antibiyotik Direnç Raporu 2016. Ed. Şencan İ Ankara 2017. 1-38.
• 23. Labelle A, Micek ST, Roubinian N, M Kollef. Treatment-related risk factors for hospital mortality in Candida bloodstream infections. Crit Care Med 2008; 36: 2967-72.
• 24. Rupp ME, Majorant D. Prevention of Vascular Catheter-Related Bloodstream Infections. Infect Dis Clin North Am 2016; 30: 853-68.
• 25. Ciccia M, Chakrokh R, Molinazzi D, Zanni A, Farruggia P, Sandri F. Skin antisepsis with 0.05% sodium hypochlorite before central venous catheter insertion in neonates: A 2-year single-center experience. Am J Infect Control 2018; 46: 169-72.