Defining the Risk Factors for the Evolution of Pan-Drug Resistance (PDR) Acinetobacter baumanni Infections in Intensive Care Units

Öz

ABSTRACT Intorductıon:Acinetobacter baumannii is one important nosocomial pathogenes. Acinetobacter infections causes long in hospital stay, mortality and morbidity. The aim of this study is to define the risk factors of PDR A. baumannii caused health care related(HCR) infections. Materyal and Methods:In the study of Cumhuriyet University Hospital between 01.01.201231.12.2013 is a case-control study was performed retrospectively. 49 PDR A. baumannii caused ventilator associated pneumonia and bacteraemia, 71 other bacteria caused ventilator associated pneumonia and bacteraemia patients were involved in this study. The PDR A. baumannii infection observed cases and the cases irrelevant to PDR A. baumannii infections are compared in terms of risk factors. Result:As a result of the Univariate Analysis, it was found that DM, traumas, CCI>4, steroid use, hospitalization history in the last 3 months, and antibiotic use in the last 3 months were statistically and significantly higher in the PDR A. baumannii Group. Multivariate analysis was used to determine the risk factors with a p value of 0.1 and below by univariate analysis. In this respect, traumas (OR=93.32, p=0.011), steroid use (OR=21.09, p<0.001) and antibiotic use in the last 3 months. (OR=26.97, p=0.001) were determined as independent risk factors in the development of PDR A. baumannii VAP and bloodstream infection. Dıscussıon:All risk factors for health care related PDR. Acinetobacter infections were modifiable. The control of these factors may decrease the ratio of PDR A. baumannii. In case of detection of PDR A. baumannii infection in hospitals, control measures should be applicated,hospital staff should be educated and inappropriate antibiotic use should be prohibited. ÖZET Giriş:Acinetobacter baumannii önemli nozokomiyal patojenlerden biridir. Acinetobacter enfeksiyonları hastanede kalış süresinin uzamasına,mortalite ve morbiditeye neden olur. Bu çalışmanın amacı PDR A. baumannii nedenli sağlık bakımı ilişkili (SBİ) enfeksiyonlar için risk faktörlerinin belirlenmesidir. Gereç ve yöntemler:Çalışma Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi’nde 01.01.201231.12.2013 tarihleri arasında retrospektif olarak gerçekleştirilmiş bir vaka-kontrol çalışmasıdır. Çalışmaya PDR A. baumannii ile oluşan 49 ventilatör ilişkili pnömoni ve bakteriyemi, 71 A. baumannii dışı etkenlerle oluşan ventilatör ilişkili pnömoni ve bakteriyemi hastası alınmıştır. PDR A. baumannii enfeksiyonu saptanan olgularla saptanmayan olgular risk faktörleri yönünden karşılaştırılmıştır. Sonuç:Univariate analiz sonuçları sonucunda PDR A.baumannii grubunda DM, travma, CCI>4 olması, steroid kullanımı, son 3 ay hastanede yatış öyküsü ve son 3 ay antibiyotik kullanımı istatiksel anlamlı olarak daha yüksek olduğu bulundu.Univariate analiz ile p değeri 0.1 ve altında saptanan risk faktörleri bağımsız risk faktörlerinin belirlenmesi için multivariate analiz uygulandı.Buna göre travma (OR=93.32, p=0.011), steroid kullanımı (OR=21.09, p<0.001) ve son 3 ay antibiyotik kullanımı’nın (OR=26.97, p=0.001) PDR A.baumannii VİP ve kan dolaşımı infeksiyon gelişiminde bağımsız risk faktörleri olarak tespit edildi. Tartışma:PDR Acinetobacter nedenli sağlık bakımı ilişkili enfeksiyonlarda çoğu risk faktörleri düzeltilebilir özelliktedir. Bu risk faktörlerinin kontrolü PDR.A. baumannii oranlarını düşürebilir. Hastanelerde PDR Acinetobacter enfeksiyonu tespit edilmesi durumunda rehberler eşliğinde kontrol önlemleri alınmalı, hastane personeli eğitilmeli ve uygunsuz antibiyotik kullanımının önüne geçilmelidir.

Anahtar Kelimeler

• rısk factors
• control precautıons
• Acınetobacter baumannıı

Kaynakça

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