Complicated Intraabdominal Infections; Epidemiology of Microorganisms, Resistance Profiles ans Risk Factors Associated with Mortality

Yıl 2024, Cilt: 57 Sayı: 3, 99 - 104, 22.01.2025

Sengül Üçer , Nurcan Baykam

https://doi.org/10.20492/aeahtd.1421424

Öz

Aim: The threat of antimicrobial resistance has been identified as one of the major challenges in the management of complicated intra-abdominal infections(cIAIs). In this study, we aimed to describe the clinical, microbiological and resistance profiles of complicated intra-abdominal infections and to assess the risk factors related to resistance and mortality.
Material and Method: Seventy-nine patients undergoing surgery or interventional drainage for cIAIs with a positive microbiological culture were documented.
Results: Among these patients 79,7% were affected by health care associated IAIs while remaining 20,3% cases were identified as cIAI in the community. In 79 cases, 143 microorganisms were isolated and the leading microorganism was E.coli (34.9%) followed by Enterococcus spp. (17.4%). Among Enterobacteriaceae (n:96), 53.6% of the strains had ESBL and 36.8% were Multi Drug Resistant (MDR) bacteria. The overall mortality rate was 22.8%. According to univariate analysis, the use of broad spectrum antibiotics between initial intervention and re-operation was a significant risk factor for presence of ESBL. By multivariate analysis of the data; isolation of MDR bacteria, Enterococcus spp as an etiologic agent and presence of chronic obstructive pulmonary disease were statistically significant indicators for mortality.
Discussion: These data indicate that local community and nosocomial resistance patterns should guide empiric antimicrobial therapy.
Conclusion: To have the efficient data for resistance patterns, culture of the materials should not be neglected in either hospital or community acquired IAIs.Due to the increase in the prevalence of ESBL positive and MDR bacteria, demonstration of the epidemiological data in populations and each hospital is crucially important for accurate selection of initial empirical antibiotherapy

Anahtar Kelimeler

intraabdominal infection, resistance, mortality

Komplike İntraabdominal Enfeksiyonlar; Mikroorganizmaların Epidemiyolojisi, Direnç Profilleri ve Mortalite ile İlişkili Risk Faktörleri

Öz

Amaç: Antimikrobiyal direnç tehdidi, komplike intraabdominal enfeksiyonların(cIAI) tedavisindeki en büyük zorluklardan biridir.Bu çalışmada komplike intraabdominal enfeksiyonların klinik ve mikrobiyolojik özelliklerin, etkenlerin direnç profillerinin tanımlanması, direnç ve mortalite ile ilişkili risk faktörlerinin belirlenmesi amaçlandı.
Gereç ve Yöntem: Komplike intraabdominal enfeksiyon tanısıyla takip edilen, perkutan drenaj ya da açık cerrahi ile alınan mikrobiyolojik kültürleri pozitif olan 79 hasta dökümente edildi.
Bulgular: Hastaların %79,7’si sağlık hizmeti ilşkili intraabdominal enfeksiyon ve geri kalan %20,3’ü toplumda edinilmiş intraabdominal enfeksiyon olarak sınıflandırıldı. 143 mikroorganizma izole edildi. En sık izole edilen mikroorganizma E.coli (34.9%), sonrasında Enterococcus spp.(17.4%) olduğu görüldü. Enterobacteriaceae (n:96) türleri içerisinde %53.6 ESBL pozitif ve %36.8 çoklu ilaca dirençli (MDR) bakteri olarak saptandı. Mortalite oranı %22.8’di.Tek değişkenli analizlere göre iki cerrahi girişim arasında geniş spektrumlu antibiyotiklerin kullanımı ESBL varlığı için risk faktörüydü. Verilerin çok değişkenli analizlerine göre ise MDR bakteri izolasyonu, etkenin Enterococcus spp. olması ve kronik obstrüktif akciğer hastalığı varlığı istatistiksel olarak anlamlı mortalite belirleyicisiydi.
Tartışma: Bu veriler bölgesel toplumsal ve nozokomiyal direnç paternlerinin, ampirik antibiyotik tedavisini yönlendirmesi gerektiğine işaret etmektedir.
Sonuç: Yeterli verinin sağlanabilmesi için toplum kökenli ya da sağlık hizmeti ilişkili intraabdominal enfeksiyonlarda kültür alınmalıdır.ESBL pozitif ve MDR bakteri sıklığındaki artış nedeniyle, toplumda ve hastanede epidemiyolojik verilerin bilinmesi başlangıç ampirik antibiyotik tedavisinin seçiminde önemlidir.

Anahtar Kelimeler

intraabdominal enfeksiyon, direnç, mortalite

Destekleyen Kurum

yok

Kaynakça

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