Öz
Incidence of nosocomial infections gradually increase in patients over 65 years age population. There is a significant relationship between increased age and predisposition to nosocomial infections. Predisposition to infections in this age group is a result of impaired host defense, underlying chronic diseases, long-term hospitalization, steroids and immunosuppressive therapies and malnutrition. Nevertheless there is not much data about the incidence and risk factors of nosocomial infections in elderly population. In this study we aimed to investigate the incidence and risk factors for nosocomial infections and the factors affecting mortality rates in elderly patients in the medical intensive care units. Nosocomial infection is an important factor causes increased mortality rate and length of hospital stay. Mortality rates and time interval between admission and discharge is significantly higher in nosocomially infected group than others. There are several known independent risk factors for increased mortality rates include increased age and length of hospital stay, impaired conscious levels, co-morbidities, nosocomial infections, immunsupresive conditions such as malnutrition, malignancies, mechanic ventilation and/or central venous catheter usage. As a result nosocomial infection is an important and partially preventable risk factor for mortality among patients treated in intensive care units. Mechanical ventilation, central venous and/or urinary catheterizations are such invasive interventions that may cause higher nosocomial infection rates. In terms of decreasing nosocomial infection rates; less frequently used invasive interventions can help in achieving this purpose of treatment.
Anahtar Kelimeler
Nosocomial infection elderly intensive care unit mortality risk factors
Kaynakça
- Uzun O. Hospital Infections Definitions. Doğanay M, Unal S (Ed). Hospital Infections. Ankara: Bilimsel Tıp Yayınevi 2003;35-37.
- Blot S, Koulenti D, Dimopoulos G, et al. EU-VAP Study Inves- tigators. Prevalence, risk factors, and mortality for ventilator- associated pneumonia in middle-aged, old, and very old criti- cally ill patients. Crit Care Med. 2014;42:601-609.
- Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nos- ocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-644.
- National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;22:470-485.
- Ylipalosaari P, Ala-Kokko TI, Laurila J, et al. Epidemiol- ogy of intensive care unit (ICU)-acquired infections in a 14-month prospective cohort study in a single mixed Scan- dinavian university hospital ICU. Acta Anaeesthesiol Scand 2006;50:1192-1197.
- Leblebicioğlu H. Katater ilişkili üriner sistem infeksiyonları. Köksal İ, Çakar N, Arman D (Ed). Yoğun Bakım İnfeksiyonla- rı. Ankara. Bilimsel Tıp Yayınevi 2005;345-356.
- Palabıyıkoğlu I. Yoğun bakım ünitesi infeksiyonlarında patoge- nez. Türkiye Klinikleri J Int Med Sci 2006;2:11-22.
- Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-332.
- Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attrib- utable cost of ventilator-associated pneumonia among in- tensive care unit patients in a suburban medical center. Crit Care Med 2003;31:1312-1317
- Ozdemir K, Dizbay M, Dikmen A. Incidence and risk factors of nosocomial infections in elderly patients in intensive care units. Turkish Journal of Geriatrics 2013;16:155-160.
- Strausbaugh LJ. Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 2001;7:268-271.
- Htwe TH, Mushtaq A, Robinson SB, et al.: Infection in the elderly. Infect Dis Clin N Am 2007;21:711-743.
- Liang SY, Mackowiak PA. Infections in the Elderly. Clin Geri- atr Med 2007;23:441-456.
- Rhyn RL, Roche RJ. Infection in the elderly. In: Brilman JC, Quenze RW eds. Infectious Disease in Emergency Medi- cine. 2nd ed. Philadelphia: Lippincott Raven, 1998;291-316.
- Sen P, Middleton JR, Perez G, et al. Host defense abnormali- ties and infections in older persons. Highlights from Infec- tions in Medicine 1996;11:17-22.
- Ulutan F. Yaşlılıkta infeksiyonu kolaylaştıran Faktörler ve yaş- lılıkta Sık Görülen İnfeksiyonların Özellikleri. Klimik Dergisi 2004;17:139-141.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosoco- mial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-892.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosoco- mial Infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510-515.
- Leblebicioglu H, Rosenthal VD, Arikan OA, et al. Turkish Branch of INICC. Device-associated hospital-acquired in- fection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (IN- ICC). J Hosp Infect 2007;65:251-257.
- Ribas M, Gontijo Filho P. Comparing hospital infections in the elderly versus younger adults: An Experience in a Brazilian University Hospital. Braz J Infect Dis 2003;7:210-215.
- Leone M, Albanese J, Garnier F, et al. Risk factors of nosoco- mial catheter associated urinary tract infection in a polyvalent intensive care unit. Int Care Med 2003;29:23-41.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosoco- mial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-892.
- Meriç M, Wilke A, Çağlayan Ç, Toker K. Intensive care unit- acquired infections: incidence, risk factors and associated mortality in a Turkish University hospital. Jpn J Infect Dis 2005;58:297-302.
- Jarvis WR, Edwards JR, Culver DH, et al. Nosocomial infec- tion rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 1991;91:185-191.
- Rosenthal VD. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2002-2007, Am J Infect Control 2008;36:627-637.
- Toejada AA, Bello DS, Chacon VE. Risk factors for nosoco- mial pneumonia in critically ill trauma patients. Crit Care Med 2001;29:304-309.
- Torres A, El Ebiary M, Rano A. Respiratory infectious complications in the intensive care unit. Clin Chest Med 1999;20:287-301.
- Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect 2002;8:295-309.
- O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002;10:1-29.
- Laupland KB, Zygun DA, Davies HD, et al. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care 2002;17:50-57.
Öz
65 yaş üzerindeki hastalarda nozokomiyal infeksiyon sıklığı her geçen gün artmaktadır ve ilerlemiş hasta yaşı ile nozokomiyal infeksiyon arasında belirgin bir ilişki bulunmaktadır. Bu hastalarda konak savunmasının azalması, altta yatan kronik hastalıklar, hastanede uzun yatış süresi, malnutrisyon, steroid ve immunsupresif kullanımı infeksiyona zemin hazırlayan diğer faktörlerdir. Maalesef yaşlı hastalarda ortaya çıkan nozokomiyal infeksiyonlar ve risk faktörleri ile ilgili literatürde çok fazla çalışma bulunmamaktadır. Bu çalışmada yoğun bakım ünitelerinde yatan yaşlı hastalarda ortaya çıkan nozokomiyal infeksiyonların risk faktörlerini ve mortalite üzerine olan etkilerini göstermeyi amaçladık.Nozokomiyal infeksiyonlar hastanede kalış süresini uzatan ve mortaliteyi artıran önemli bir etkendir. Mortalite oranları ve hastaneye yatış ile taburculuk arasında geçen süre nozokomiyal infeksiyonu olan hastalarda belirgin olarak daha fazladır. Yoğun bakım ünitelerinde, ileri yaş, hastanede uzun yatış süresi, altta yatan hastalıklar, nozokomiyal infeksiyonlar, immunsupresif durumlar, uygulanan invaziv girisimler mortaliteyi artıran bağımsız risk faktörleridir.Sonuc olarak nozokomiyal infeksiyonlar yoğun bakım hastaları icin mortalite üzerinde önemli etkisi olan ve kısmen önlenebilir bir risk faktörüdür. Uygulanan invaziv işlemlerin azaltılması bu infeksiyonlardan korunmada önemli bir rol oynamaktadır
Anahtar Kelimeler
Nozokomiyal infeksiyon yaşlı yoğun bakım mortalite risk faktörleri
Kaynakça
- Uzun O. Hospital Infections Definitions. Doğanay M, Unal S (Ed). Hospital Infections. Ankara: Bilimsel Tıp Yayınevi 2003;35-37.
- Blot S, Koulenti D, Dimopoulos G, et al. EU-VAP Study Inves- tigators. Prevalence, risk factors, and mortality for ventilator- associated pneumonia in middle-aged, old, and very old criti- cally ill patients. Crit Care Med. 2014;42:601-609.
- Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nos- ocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-644.
- National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;22:470-485.
- Ylipalosaari P, Ala-Kokko TI, Laurila J, et al. Epidemiol- ogy of intensive care unit (ICU)-acquired infections in a 14-month prospective cohort study in a single mixed Scan- dinavian university hospital ICU. Acta Anaeesthesiol Scand 2006;50:1192-1197.
- Leblebicioğlu H. Katater ilişkili üriner sistem infeksiyonları. Köksal İ, Çakar N, Arman D (Ed). Yoğun Bakım İnfeksiyonla- rı. Ankara. Bilimsel Tıp Yayınevi 2005;345-356.
- Palabıyıkoğlu I. Yoğun bakım ünitesi infeksiyonlarında patoge- nez. Türkiye Klinikleri J Int Med Sci 2006;2:11-22.
- Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-332.
- Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attrib- utable cost of ventilator-associated pneumonia among in- tensive care unit patients in a suburban medical center. Crit Care Med 2003;31:1312-1317
- Ozdemir K, Dizbay M, Dikmen A. Incidence and risk factors of nosocomial infections in elderly patients in intensive care units. Turkish Journal of Geriatrics 2013;16:155-160.
- Strausbaugh LJ. Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 2001;7:268-271.
- Htwe TH, Mushtaq A, Robinson SB, et al.: Infection in the elderly. Infect Dis Clin N Am 2007;21:711-743.
- Liang SY, Mackowiak PA. Infections in the Elderly. Clin Geri- atr Med 2007;23:441-456.
- Rhyn RL, Roche RJ. Infection in the elderly. In: Brilman JC, Quenze RW eds. Infectious Disease in Emergency Medi- cine. 2nd ed. Philadelphia: Lippincott Raven, 1998;291-316.
- Sen P, Middleton JR, Perez G, et al. Host defense abnormali- ties and infections in older persons. Highlights from Infec- tions in Medicine 1996;11:17-22.
- Ulutan F. Yaşlılıkta infeksiyonu kolaylaştıran Faktörler ve yaş- lılıkta Sık Görülen İnfeksiyonların Özellikleri. Klimik Dergisi 2004;17:139-141.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosoco- mial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-892.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosoco- mial Infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510-515.
- Leblebicioglu H, Rosenthal VD, Arikan OA, et al. Turkish Branch of INICC. Device-associated hospital-acquired in- fection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (IN- ICC). J Hosp Infect 2007;65:251-257.
- Ribas M, Gontijo Filho P. Comparing hospital infections in the elderly versus younger adults: An Experience in a Brazilian University Hospital. Braz J Infect Dis 2003;7:210-215.
- Leone M, Albanese J, Garnier F, et al. Risk factors of nosoco- mial catheter associated urinary tract infection in a polyvalent intensive care unit. Int Care Med 2003;29:23-41.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosoco- mial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-892.
- Meriç M, Wilke A, Çağlayan Ç, Toker K. Intensive care unit- acquired infections: incidence, risk factors and associated mortality in a Turkish University hospital. Jpn J Infect Dis 2005;58:297-302.
- Jarvis WR, Edwards JR, Culver DH, et al. Nosocomial infec- tion rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 1991;91:185-191.
- Rosenthal VD. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2002-2007, Am J Infect Control 2008;36:627-637.
- Toejada AA, Bello DS, Chacon VE. Risk factors for nosoco- mial pneumonia in critically ill trauma patients. Crit Care Med 2001;29:304-309.
- Torres A, El Ebiary M, Rano A. Respiratory infectious complications in the intensive care unit. Clin Chest Med 1999;20:287-301.
- Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect 2002;8:295-309.
- O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002;10:1-29.
- Laupland KB, Zygun DA, Davies HD, et al. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care 2002;17:50-57.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Derleme |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Nisan 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 5 Sayı: 01 |