Risk Factors For Mortality of Nosocomial Sepsis in Intensive Care Unit of Firat University Hospital

Abstract

Objective: Several problems are present nosocomial sepsis which still remains an important health problem in Turkish intensive care units (ICUs). The aim of the study is to decrease the mortality rate of nosocomial sepsis in ICUs. This study sought to find mortality – related risk factors in ICUs. Material and Methods: The prospective study was performed with following of one year in the ICUs of Firat University Hospital. The patients who were followed in the ICUs for at least 48 hours were enrolled in the study. Nosocomial infections were defined according to the Center for Disease Control and Prevention (CDC) criteria and were categorised by specific infection site. Results: Among the 470 patients, 81 had ICU- acquired sepsis episodes. In- ICUs nosocomial was sepsis rate 17.2% (81/470) and mortality rate 63% (51/81). Needs for mechanical ventilation, entubation, nasogastric catheter, urinary catheters episodes of sepsis were significantly associated with fatalities. Respiratory failure, used of H2 receptor antagonist was associated with a fatal outcome. The most frequent primary sources of nosocomial sepsis were lungs 38.3%, urinary 29.7% and intra-abdominal 12.4%. Cultures were positive of the patients with common microorganisms were Pseudomonas spp. 22.3% (14.5% P.aeruginosa), E.coli 17.1%, S.aureus 17% (including 9% methicillin-resistant), Acinetobacter spp. 13.1%. Conclusion: The most important risk factors of mortality were observed older age, high APACHE II score, mechanical ventilation, intubation, nasogastric catheterization, urinary catheterization, respiratory failure and used H2 receptor antagonist.

Keywords

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Fırat Üniversitesi Hastanesi Yoğun Bakım Ünitelerinde Gelişen Nozokomiyal Sepsiste Mortalite İçin Risk Faktörleri

Öz

Amaç: Nozokomiyal sepsis, yoğun bakım ünitelerinde (YBÜ) önemli bir sorun olmaya devam etmektedir. Klinik çalışmanın amacı, yoğun bakım ünitelerindeki nozokomiyal sepsiste mortaliteyle ilişkili risk faktörlerinin tespitidir. Bu çalışmada yoğun bakım ünitelerinde mortaliteyle ilişkili risk faktörleri bulunmaya çalışıldı. Gereç ve Yöntem: Bu prospektif çalışma Fırat Üniversitesi Hastanesi Yoğun Bakım Üniteleri'nin bir yıllık izlemi ile yapıldı. YBÜ'ne kabul edilen hastalar en azından 48 saat izlendikten sonra çalışmaya dahil edildi. Nozokomiyal infeksiyonların tanısı CDC (Center for Disease Control and Prevention) kriterlerine göre kondu ve spesifik infeksiyon alanlarına göre sınıflandırıldı. Bulgular: 470 hastadan 81'inde YBÜ kaynaklı sepsis atağı gelişti. YBÜ'nde nozokomiyal sepsis oranı %17.2 (81/470) ve mortalite oranı %63 (51/81) idi. Sepsis atağında gereksinim duyulan mekanik ventilasyon, entübasyon, nazogastrik tüp, üriner kateter mortaliteyi önemli ölçüde artırıyordu. Solunum yetmezliği, H2 reseptör antagonisti kullanımı mortaliteyi artırıyordu. Nozokomiyal sepsisin en sık primer kaynağı pulmoner %38.3, üriner % 29.7 ve intra-abdominal infeksiyonlar %12.4 idi. Kültür pozitif hastalardaki en sık mikroorganizmalar Pseudomonas spp. %22.3 (%14.5 P.aeruginosa), E.coli %17.1, S.aureus %17 (%9 metisilin-rezistans), Acinetobacter spp. %13.1 idi. Sonuç: Mortaliteyle ilişkili en önemli risk faktörleri yaş, APACHE II skoru yüksekliği, mekanik ventilasyon, entübasyon, nazogastrik tüp, üriner kateterizasyon, solunum yetmezliği, H2 reseptör antagonisti kullanımı ve H2 reseptör antagonisti kullanma süresi olarak gözlemlendi.

Anahtar Kelimeler

• Yoğun Bakım Ünitesi, nozokomiyal sepsis, sürveyans, mortalite, risk faktörleri

Kaynakça

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12. Gönderilme Tarihi: 06.01.2011