Nöroloji yoğun bakımda mekanik ventilatörde takip edilen hastaların enfeksiyon etkenleri ve demografik özelliklerinin değerlendirilmesi: Retrospektif tek merkezli gözlemsel çalışma

Yıl 2018, , 262 - 264, 01.09.2018

Yılmaz İnanç , Yusuf İnanç

https://doi.org/10.28982/josam.427084

Cited By: 3

Öz

Amaç: Yoğun bakım üniteleri hastane geneline göre invazif girişimlerin daha sık uygulandığı dirençli mikroorganizmaların daha çok izole edildiği yerlerdir ve bu nedenle buralarda hastane enfeksiyonları daha sıktır. Ventilatör ilişkili pnömoniler mortalitesi en yüksek nozokomiyal enfeksiyonlardır. Bu çalışmada nöroloji yoğun bakımda mekanik ventilatörde takip edilen hastaların demografik özellikleri, endotrakeal aspirat kültürleri yönünden değerlendirilmesi amaçlandı.

Yöntemler: Çalışmamız retrospektif, kesitsel, tanımlayıcı olarak dizayn edildi. Son 6 ayda mekanik ventilatöre bağlı ve trakeal aspirat kültürü alınan 51 hasta retrospektif olarak değerlendirildi. Endotrakeal aspirat örnekleri; steril şartlarda, örnek almak için tasarlanmış özel kateterler kullanılarak, entübasyon tüpünün içinden serum fizyolojik verilip aspire edilmesi yöntemiyle elde edildi. Üreme saptanan hastaların trakeal aspirat örnekleri ile eş zamanlı gönderilen kan kültür sonuçları da geriye dönük olarak değerlendirildi. Hastaların demografik özellikleri, yoğun bakıma yatış tanıları, risk faktörleri, trakealaspirat kültür mikrobiyal üremeleri kaydedildi.

Bulgular: İlk kültürde 22 (%43,1) hastada üreme yoktu, 14 (%27,5) hastada Acinetobacter baumanii, 3 (%5,9) hastada Pseudomonas aeruginosa, 3 (%5,9) hastada Klebsiella pneumonia,2 (%3,9) hastada Staphylococcus aureus, 2 (%3,9) hastada Corynebacterium striatum, 2 (%3,9) hastada Acinetobacter baumanii + Pseudomonas aeruginosa, 2 (%3,9) hastada Acinetobacter baumanii + Klebsiella pneumonia, 1 (%2,0) hastada Acinetobacter baumanii+ Escherichia coli saptandı. Hastaların ikinci kültür alınma süresi ortalama 11. gün idi. İkinci kültürde 3 (%10,7) hastada üreme yoktu. 15 (%53,6) hastada Acineto bacterbaumanii, 3 (%10,7) hastada Pseudomonas aeruginosa, 2 (%7,1) hastada Klebsiella pneumonia, 1 (%3,6) hastada Escherichia coli, 1 (%3,6) hastada Corynebacterium striatum, 3(%10,7) hastada Acinetobacter baumanii + Pseudomonas aeruginosa saptandı.

Sonuç: Yaptığımız çalışmada nörolojik nedenlerle yatan hastalarda da literatürle uyumlu olarak benzer kültür sonuçları izlenmiştir. Büyük çoğunluğunu iskemik inmeli hastaların oluşturduğu yoğun bakım hastalarımızda mortalite oranımız %64,7 gibi yüksek oranda idi. Bu duruma hem nöroloji yoğun bakım hastalarının nörolojik bulgularına bağlı ağır tablosunun olması hem de Acinetobacter baumanii ve Pseudomonas aeruginosa gibi etkenlerin birlikte katkısı olduğu düşüncesindeyiz.

Anahtar Kelimeler

Nazokomial enfeksiyon, Nörolojik yoğun bakım ünitesi, Mekanik ventilatör

An evaluation of the infection agents and the demographic characteristics of patients followed up on a mechanical ventilator in neurology intensive care: A retrospective, single center, observational study

Öz

Aim: The incidence of nosocomial infections is higher than other sites of the hospitals at intensive care units (ICU) because of high frequency of invasive interventions and multidrug resistant microorganism’s prevalence. Ventilator-related pneumonia cases have the highest mortality risk among the nosocomial infections. The aim of this study was to evaluate the endotracheal aspirate cultures and the demographic characteristics of patients followed up on mechanical ventilation in Neurology Intensive Care.

Methods: Our study was designed as a retrospective, cross-sectional and descriptive. Retrospective evaluation was made of 51 patients who were attached to a mechanical ventilator in the last 6 months and from whom a tracheal aspirate culture was taken. The endotracheal aspirate samples were taken under sterile conditions using a specifically designed catheter with the method of administering saline into the intubation tube and then aspiration. Blood culture results sent for analysis at the same time as the tracheal aspirate samples were also retrospectively evaluated in patients determined with positive production. A record was made of the demographic characteristics of the patients, diagnosis on admittance to ICU, risk factors, and microbial production in the tracheal aspirate culture.

Results: In the first culture, there was no production in 22 (43.1%) cases, and Acinetobacter baumanii was determined in 14 (27.5%) patients, Pseudomonas aeruginosa in 3 (5.9%), Klebsiella pneumonia in 3 (5.9%), Staphylococcus aureus in 2 (3.9%), Corynebacterium striatum in 2 (3.9%), Acinetobacter baumanii + Pseudomonas aeruginosa in 2 (3.9%), Acinetobacter baumanii + Klebsiella pneumonia in 2 (3.9%), and Acinetobacter baumanii + Escherichia coli in 1 (2.0%). The second culture was taken from patients on the mean 11th day. In 3 (10.7%) patients there was no production in the second culture and in the other patients, Acinetobacter baumanii was determined in 15 (53.6%) patients, Pseudomonas aeruginosa in 3 (10.7%), Klebsiella pneumonia in 2 (7.1%), Escherichia coli in 1 (3.6%), Corynebacterium striatum in 1 (3.6%), and Acinetobacter baumanii + Pseudomonas aeruginosa in 3 (10.7%).

Conclusion: The culture results in this study of patients admitted for neurological reasons were observed to be consistent with findings in literature. The high mortality rate of 64.7% in these ICU patients is due to the majority being ischemic stroke patients. This suggests that both the severe table associated with neurological findings and agents such as Acinetobacter baumanii and Pseudomonas aeruginosa contribute to Neurology ICU patients.

Anahtar Kelimeler

Nosocomial infection, Neurological intensive care unit, Mechanical ventilator

Kaynakça

• 1. Walaszek M, Rozanska A, Bulanda M, Wojkowska-Mach, J. Epidemiology of healthcare-associated infections in Polish intensive care. A multicenter study based on active surveillance. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018;72(1):33-44.
• 2. Küme G, Demirci M. Antimicrobial susceptibilities of nonfermentative gram negative bacteria isolated from lower respiratory tract samples of patients in intensive care units and risk factors associated with lower respiratory tract infection. DEÜ Faculty of Medicine Journal. 2012;26(1):37–4.
• 3. Hinduja A, Dibu J, Achi E, Patel A, Samant R, Yaghi S. Nosocomial infections in patients with spontaneous intracerebral hemorrhage. American Journal of Critical Care. 2015;24(3):227-31.
• 4. Inanc Y, Gokce M, Tuncel D, Inanc Y,Ozcekic Demirhan S, Bavli S. Percutaneous endoscopic gastrostomy in neurology intensive care unit. IJSM. 2018;4(1):33-5.
• 5. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilatorassociated pneumonia: a systematic review. Critical care med. 2005;33:2184.
• 6. Nseir S, Martin-Loeches I. Ventilator-associated tracheobronchitis: Where are we now? Rev Bras Ter Intensiva. 2014;26:212–4.
• 7. Bassetti M, Taramaso L, Giacobbe DR, Pelosi P. Management of ventilator-associated pneumonia: epidemiology, diagnosis and antimicrobial therapy. Expert Rev Anti Infect Ther, 2012;10:1405-23.
• 8. Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164(6): 637-44.
• 9. Ray U, Ramasubban S, Chakravarty C, Goswami L, Dutta S. A prospective study of ventilator-associated tracheobronchitis: incidence and etiology in intensive care unit of a tertiary care hospital. Lung India: official organ of Indian Chest Society. 2017;34(3):236.
• 10. Namıduru M, Güngör G, Karaoğlan I, Dikensoy O. Antibiotic resistance of bacterial ventilator associated pneumonia in surgical intensive care units. J Int Med Res. 2004;32:78-83.
• 11. Mi H, Li S, Li H, Hu W. The effects of infection on severe stroke patients in the neurological intensive care unit in China. Int J Neurosci. 2018 Aug;128(8):715-20.