EVDE PARENTERAL NÜTRİSYON HASTALARINDA KATETER İLİŞKİLİ KAN DOLAŞIMI ENFEKSİYONLARINDA TEDAVİ YAKLAŞIMI

Öz

Kronik bağırsak yetmezliğinde (KIF) evde parenteral nütrisyon (HPN) hayati öneme sahiptir. HPN alan hastalarda kateter ilişkili kan dolaşımı enfeksiyonları (KİKDE) önemli bir morbidite ve mortalite kaynağıdır. HPN hastalarında KİKDE tedavisinde sistemik antibiyotik tedavisi, Kilit tedavileri, kateter kurtarma prosedürleri rehberler ışığında yürütülmelidir. KİKDE yönetiminde etken ajanlar, antibiyotik direnci, kateterin yapısı ve kullanma süresi, HPN tedavi sıklığı önemli rol oynamaktadır. Ayrıca kateterin kurtarılması da önemli bir yere sahiptir. Ancak bazı durumlarda kateterin çıkarılmasında gecikme kliniğin kötüleşmesine ve metastatik enfeksiyon gelişimine yol açabilmektedir. KİKDE şüphesi durumunda kateter ve periferik kan kültürleri alınmalı ve hemodinamik stabilite durumuna göre antibiyotik seçimi yapılarak ampirik antibiyotik başlanmalıdır. Antibiyotik direnci SAT seçiminde gözönüne alınmalıdır. Kateterin kurtarılması prensipleri gözden geçirilmeli ve gerekirse kilit tedavileri değerlendirilmelidir. Ancak komplike durum varsa ve hemodinamik durum stabil değilse kateter çıkarılması geciktirilmemelidir. Kültür negatifliği elde edilmeden yeni kateter girişimi uygulanmamalıdır. Hijyen ve eğitim önlemleri KİKDE gelişimi riskini azaltmak için gözönünde bulundurulmalıdır. Bu derleme de son yıllarda sıklığı artan HPN hastalarında KİKDE tedavi yönetimi konusunda literatürlerin gözden geçirilmesi amaçlanmıştır.

Anahtar Kelimeler

• EPN;
• KİKDE;
• TEDAVİ;

TREATMENT APPROACH IN CATHETER RELATED BLOODSTREAM INFECTIONS IN HOME PARENTERAL NUTRITION PATIENTS

Öz

Home parenteral nutrition (HPN) has vital significance in chronic intestinal failure (CIF). Catheter-related bloodstream infections (CRBSI) are an important source of mortality and morbidity in HPN patients. While treating CRBSI in HPN patients, the procedures of systemic antibiotherapy, lock therapies, and catheter rescue should be done in light of guidelines. Causative microorganisms, antibiotic resistance, the composition and time of usage of the catheter, and HPN treatment frequency play an important role in CRBSI management. Another point of importance is rescuing the catheter. But, in some cases, delays in removing the catheter can cause clinical deterioration and the development of metastatic infections. If CRBSI is suspected, catheter and peripheral blood cultures should be drawn and empirical antibiotherapy should begin with choosing an antibiotic according to hemodynamic stability. Antibiotic resistance should be considered when choosing an empirical agent. The principles of catheter rescue should be reviewed, and if necessary, lock therapies should be considered. However, if there is a complicated situation and the hemodynamic situation is unstable, catheter removal should not be delayed. A new catheter insertion should not be performed without obtaining a negative culture. Hygiene and educational measures should be considered to reduce the risk of developing CRBSI.

Anahtar Kelimeler

• HPN;
• CRBSI;
• THERAPY;

Kaynakça

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