Üçüncü Basamak Bir Hastanenin İki Farklı Yoğun Bakım Ünitesinde Gelişen Ventilatör İlişkili Pnömonili Hastaların Karşılaştırılması

Yıl 2022, Cilt: 6 Sayı: 3, 358 - 367, 27.12.2022

İlken Uguz , Derya Karasu , Canan Yılmaz , Gul Durmus , Ezgi Ünal Asan , Seyda Efsun Ozgunay , Mehmet Gamlı

https://doi.org/10.29058/mjwbs.1117289

Öz

Amaç: Amacımız üçüncü basamak bir hastanede iki farklı yoğun bakım ünitesi (YBÜ)’nde gelişen ventilatör ilişkili pnömoni (VİP) hastalarının özelliklerini ve 30 günlük mortalitelerini karşılaştırmaktır.
Gereç ve Yöntemler: Hastanemizin iki farklı YBÜ’nde iki yıllık süreçte VİP gelişen 18 yaş üstü hastalar çalışmaya dahil edildi. Hastaların Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II (APACHE II), Sepsis İlişkili Organ Yetmezliği Değerlendirmesi (SOFA), Glasgow Koma Skoru (GKS), Klinik Pulmoner Enfeksiyon Skoru (KPES) ve enfeksiyon belirteçleri ve 30 günlük mortaliteleri değerlendirildi. Grup 1 ve Grup 2’nin fiziksel koşulları, YBÜ’deki el hijyen oranları, hemşire eğitim düzeyi ve yoğun bakım ünitelerinin hasta yatış hızı karşılaştırıldı.
Bulgular: Grup 1’de 48 ve Grup 2’de 56 hasta olmak üzere toplam 104 hastaya analiz yapıldı. İki grup arasında yatış günü, tanı aldığı gün, tanı aldıktan 3, 7 ve 30 gün sonra GKS, SOFA ve KPES skorları açısından anlamlı fark saptanmadı. Her 2 grupta da en çok Acinetobacter baumanni etkeni tespit edildi. Hasta yatış hızı Grup 2’de anlamlı yüksek saptandı. 30 günlük mortalite Grup 1’de %45.8 ve Grup 2’de %48.2 olarak saptandı. SOFA ortalama skorundaki 1 birimlik artışın 30 günlük mortalite riskini 2.214 kat arttırdığı, yatış süresindeki artışın 30 günlük mortalite riskini azalttığı saptandı (OR=0.891). Grup 2’de yaş oranının 1 birimlik artışı 30 günlük mortalite riskini 1.085 kat arttırdığı, tüm hastalarda ve Grup 1’de SOFA ortalama skorundaki artışın yatış süresini azalttığı saptandı.
Sonuç: VİP tanısı alan hastalarda 30 günlük mortaliteyi %47.1 olarak saptadık. SOFA skorundaki artış 30 günlük mortalite riskini arttırırken yatış süresindeki uzama mortalite riskini azaltmaktadır.

Anahtar Kelimeler

Yoğun Bakım, Mortalite, Ventilatör İlişkili Pnömoni

Comparison of Patients with Ventilator-Associated Pneumonia Developed in Two Different Intensive Care Units of a Tertiary Hospital

Öz

Aim: Our purpose is to compare the characteristics and 30-day mortality of ventilator-associated
pneumonia (VAP) patients that developed in two different intensive care units (ICUs) in a tertiary hospital.
Material and Methods: Patients who were over the age of 18 who developed VAP in two different
ICUs of our hospital over two years were included in the study. Acute Physiology and Chronic Health
Assessment II (APACHE II), Sepsis-Related Organ Failure Assessment (SOFA), Glasgow Coma Score
(GCS), Clinical Pulmonary Infection Score (CPIS), infection markers, and 30-day mortality of the
patients were evaluated. Physical conditions of Group 1 and Group 2, hand hygiene rates in ICU, nurse
education level, and hospitalization rate in intensive care units were compared.
Results: A total of 104 patients, 48 being in Group 1 and 56 being in Group 2, were analyzed. There
was no significant difference between the two groups with regards of GKS, SOFA and CPIS scores.
Acinetobacter baumanni was the most common agent in both groups. The hospitalization rate was
found to be significantly higher in Group 2. 30-day mortality was 45.8% in Group 1 and 48.2% in Group
2. It was found that a one unit increase in the SOFA hospitalization period reduced the risk of 30-day
mortality. It was determined that a one unit increase in the age ratio in Group 2 increased the risk of
30-day mortality 1.085 times, and the increase in the mean SOFA score in all patients and Group 1
decreased the length of the hospitalization period.
Conclusion: We found a 30-day mortality rate of 47.1% in patients diagnosed with VAP. An increase in
SOFA score increases the risk of 30-day mortality, while a prolonged hospitalization period decreases
the risk of mortality.

Anahtar Kelimeler

Intensive Care Unit, Mortality, Ventilator-associated pneumonia

Kaynakça

• 1. Nair GB and Niederman MS. Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med 2015; 41: 34-48.
• 2. Chastre J and Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165: 867-903.
• 3. Yüceer S and Demir SG. Prevention of nosocomial infections in intensive care unit and nursing practices. Dicle Med J 2009; 36: 226-232.
• 4. WHO Guidelines on Hand Hygiene in Health Care. 15 January 2009 Website https://www.who.int/publications/i/item/9789241597906. [accessed 29 May 2021]
• 5. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416.
• 6. Leblebicioglu H, Rosenthal VD, Arıkan ÖA, Özgültekin A, Yalcin AN, Koksal I, et al. Device-associated hospital-acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INICC). J Hosp Infect 2007; 65: 251-257.
• 7. Karasu D, Yılmaz C, Durmuş G, Özer D, Çağlayan Ü, Karaduman İ, et al. Evaluation of Healthcare-Associated Infections in Critically Ill Patients Receiving Long-Term Treatment in the Intensive Care Unit. KLİMİK J 2016; 29: 71-76.
• 8. Gursel G, Aydogdu M, Ozyilmaz E, Ozis T N. Risk factors for treatment failure in patients with ventilator-associated pneumonia receiving appropriate antibiotic therapy. J Crit Care 2008; 23: 34-40.
• 10. Yang GH and Wang GF. Value of the clinical pulmonary infection score for the prognosis of ventilator-associated pneumonia. Chin J Tuberc Respir Dis 2006; 29: 751-754.
• 11. Mathai AS, Phillips A, Kaur P, Isaac R. Incidence and attributable costs of ventilator-associated pneumonia (VAP) in a tertiary-level intensive care unit (ICU) in northern India. J Infect Public Health 2015; 8: 127-135.
• 12. Kundakcı A, Özkalaycı Ö, Zeyneloglu P, Arslan H, Pirat A. Risk factors for nosocomial infections in a surgical intensive care unit. J Turk Soc Intens Care 2014; 12: 25-35.
• 13. Palabıyık O, Öğütlü A, Toptaş Y. Ventilator-Associated Pneumonia and causative microorganisms in intensive care unit: A two year retrospective analysis. J Turk Soc Intens Care 2016; 14: 80-85.
• 14. Mirsaeidi M, Peyrani P, Ramirez JA, and Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators. Predicting mortality in patients with ventilator-associated pneumonia: The APACHE II score versus the new IBMP-10 score. Clin Infect Dis 2009; 49: 72-77.
• 15. Şengül A, Şengül E, Argun Barış S, Hayırlıoğlu N. Assesment of the factors associated with mortality in ventilator associated pneumonia of multidrug resistance Acinetobacter Baumannii. Kocaeli Med J 2013; 2: 1-6.
• 16. Blot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med 2014; 42: 601-609.
• 17. de Miguel-Díez J, López-de-Andrés A, Hernández-Barrera V, Jiménez Trujillo I, Méndez-Bailón M, Miguel-Yanes JM, et al. Decreasing incidence and mortality among hospitalized patients suffering a ventilator-associated pneumonia: Analysis of the Spanish national hospital discharge database from 2010 to 2014. Medicine (Baltimore) 2017; 96: e7625.
• 18. Song X, Chen Y, Li X. Differences in incidence and outcome of ventilator associated pneumonia in surgical and medical ICUs in a tertiary hospital in China. Clin Respir J 2014;8:262-8.Rocker G, Cook D, Sjokvist P, Weaver B, Finfer S, McDonald E, et al. Clinician predictions of intensive care unit mortality. Crit Care Med 2004; 32: 1149-1154.
• 19. Bonten MJM, Kollef MH, Hall JB. Risk factors for ventilator-associated pneumonia: From epidemiology to patient management. Clin Infect Dis 2004; 38: 1141-1149.
• 20. Uslu M, Öztürk DB, Kuşçu K, Aslan V, Gürbüz Y, Tütüncü EE ve ark. Risk factors affecting the development of Ventilator-Associated Pneumonia in patients hospitalized in the intensive care unit. KLİMİK J 2010; 23: 83-88. 21. Craven DE. Preventing ventilator-associated pneumonia in adults: sowing seeds of change. Chest 2006; 130: 251- 260.
• 22. Grisaru-Soen G, Paret G, Yahav D, Boyko V, Lerner-Geva L. Nosocomial infections in pediatric cardiovascular surgery patients: a 4-year survey. Pediatr Crit Care Med 2009; 10: 202-206.
• 23. Tarnow-Mordi WO, Hau C, Warden A, and Shearer AJ. Hospital mortality in relation to staff workload: A 4-year study in an adult intensive-care unit. Lancet 2000; 356: 185-189.
• 24. Kahveci F. Infection control principles in intensive care unit: International standarts. J Turk Soc Intens Care 2017; 5: 30-31.
• 25. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med 2005; 33: 2184-2193.
• 26. Bonten MJ. Infection in the intensive care unit: prevention strategies. Curr Opin Infect Dis 2002; 15: 401-405.
• 27. Rosenthal V D, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005; 33: 392-397.