Üçüncü Basamak Bir Hastanede Santral Venöz Kateter İlişkili İnfeksiyonların Sıklığı, Etken Mikroorganizmalar ve Risk Faktörlerinin Değerlendirilmesi

Year 2016, , 108 - 117, 01.05.2016

Ismail Necati Hakyemez Mustafa Taner Yıldırmak Gül Çetmeli Nur Efe Iris

https://doi.org/10.5505/abantmedj.2016.80388

Abstract

GİRİŞ ve AMAÇ: Santral venöz kateter SVK ilişkili kan dolaşımı infeksiyonları SVK-KDİ hastanede kalış süresini, maliyeti, morbidite ve mortaliteyi artırmaktadır. Bu çalışmada SVK-KDİ sıklığını, etkenleri ve risk faktörlerini değerlendirmeyi amaçladık.YÖNTEM ve GEREÇLER: Bu çalışma 1 Şubat 2007 - 1 Ağustos 2007 tarihleri arasındaki 6 aylık dönemde Sağlık Bakanlığı Okmeydanı Eğitim ve Arastırma Hastanesinde değişik ünitelerde yapıldı. Hastaların yaşı, cinsiyeti, yattığı klinik, altta yatan hastalıkları, çıkış durumu, total paranteral nütrisyon, TPN kan ürünü kullanımı, cerrahi yara tipi, APACHE II skoru, prediktif mortalite oranı, kateterin takıldığı ven, takılı kaldığı süre, takıldığı ünite, takılma durumu, kateter ucu ve kan kültürlerinde üreyen etkenler ve ünitelerin 1000 kateter günü başına SVK-KDİ hızları belirlendi.BULGULAR: Hastaların 48’i erkek, 52’si kadın olup yaş ortalaması 54.3 idi. Hastaların 46'sında steril- kontaminasyon, 39'unda kolonizasyon, 10'unda SVK-KDİ ve 5'inde lokal kateter infeksiyonu saptandı. Kateterlerin 32 %59.2 ’sinde Gram-pozitif kok, 17 %31.5 ’sinde Gram-negatif çomak, 5 %9.3 ’inde maya üredi. En sık metisiline dirençli S.aureus üredi. SVK-KDİ hızları tüm ünitelerde 6.9 olarak belirlenmiştir. TARTIŞMA ve SONUÇ: Kateterin 10 günden uzun süre takılı kalması, TPN ve kan ürünü kullanımı, kateterin takılı olduğu ven, APACHE II skoru ve prediktif mortalite oranı risk faktörleri olarak belirlendi. İnfeksiyon kontrol önlemleri ile risk faktörlerinin önlenebilir olması SVK-KDİ hızlarında önemli bir azalma sağlayabilecektir.

Keywords

Santral venöz kateter ilişkili infeksiyon, risk faktörleri, etken mikroorganizma, infeksiyon hızı

Prevalence, causative microorganisms, and risk factors of central venous catheter-related infections in a tertiary care hospital

Abstract

INTRODUCTION: Central venous catheter CVC –related blood stream infections CRBSIs increase duration of stay in hospital, costs, morbidity, and mortality. This study was conducted to find out the rate, microorganisms, and risk factors of CRBSIs. METHODS: This study was carried out in different units of Istanbul Okmeydanı Training and Research Hospital in a period of 6 months between February 1 and August 1, 2007. The followings were determined for each patient: age and gender, clinic of hospitalization, underlying disorders, patient’s condition at discharge, total parenteral nutrition TPN , use of blood products, type of surgical wound, APACHE II score, the vein where the catheter was placed, duration of catheterization, the hospital unit where the catheter was placed, isolated microorganisms, and the rate of CRBSIs per 1000 catheter days in each hospital unit.RESULTS: Of the patients 48 were males and 52 females, with a mean age of 54.3 ± 19.3. Forty-six catheters were found sterile or contaminated, 39 colonized, 10 with CRBSI, and 5 with local catheter infection. The catheter cultures yielded gram-positive cocci in 32 59.2% , gram-negative bacilli in 17 31.5% , and yeasts in 5 9.3% . The most frequently isolated microorganism was methicillin-resistant Staphylococcus aureus. The rates of CRBSI were found to be 6.9 in all units. DISCUSSION AND CONCLUSION: The risk factors for CRBSIs were catheter carried for longer than 10 days, total parenteral nutrition and use of blood products, the vein where CVC was placed, APACHE II score, and the predictive mortality rate. The prevention of risk factors with infection control measures may significantly decrease the rates of CRBSIs.

Keywords

Central venous catheter-related infection, risk factors, causative microorganism, infection rate

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