Kliniğimizde Yatarak İzlenen Kateter İlişkili Kan Dolaşımı İnfeksiyonu Tanılı Hastaların Değerlendirilmesi

Öz

Giriş: Santral venöz kateterizasyonun en sık görülen, ölümcül ve maliyetli komplikasyonlarından olan kateter ilişkili kan dolaşımı infeksiyonu aynı zamanda nozokomiyal bakteremilerin en sık nedenidir. Kateter ilişkili kan dolaşımı enfeksiyonları (KİKDE), hemodiyaliz hastalarında kardiyovasküler hastalıktan sonra ikinci önde gelen ölüm nedenidir. Bu infeksiyonlar infektif endokardit, spondilodiskit, paravertebral apse gibi birçok metastatik komplikasyona neden olabilir. Çalışmamızda KİKDE’nin ve metastatik komplikasyonların değerlendirilmesi amaçlanmıştır. Materyal-Metod: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji kliniğinde tedavi gören KİKDE olan hastalardaki infeksiyon epizodları retrospektif olarak değerlendirildi. Hastaların demografik verileri, klinik semptomları, eşlik eden hastalıkları, kateter özellikleri, fizik muayene bulguları, izole edilen mikroorganizma ve antibiyotik duyarlılığı, inflamasyon parametreleri, metastatik komplikasyonları kaydedildi. Bulgular: Belirlenen zaman aralığında toplam 51 hastada 63 KİKDE epizodu saptandı. Hastaların %54,9’u erkek olup yaş ortalaması 60,7±16,2 yıl olarak bulundu. Hastaların %82,4’ü diyaliz kateteri ile hemodiyalize alınan olgulardı. Toplam 63 epizodun %85,7’si hemodiyaliz alan olgularda saptandı. Elli bir hastanın %37,3’ünde toplam 20 komplikasyon saptandı. İlk üç sırada görülen komplikasyonlar diskit, infektif endokardit ve psoas apsesi olarak bulundu. Bu komplikasyonlarından en sık sorumlu olan etken metisilin duyarlı Staphylococcus aureus (MSSA) idi. Sonuç: Hemodiyaliz alan olgularda KİKDE’nin yanısıra infeksiyonla ilişkili komplikasyonlar da daha sıktır. Kateter bakımı ve kişisel hijyen konularında olguların eğitimi, hastanelerde KİKDE’yi önleme demetlerinin uygulanması ve hemodiyaliz olgularını mümkün olan durumlarda fistül seçeneğine yönlendirme bu komplikasyonların görülme oranını azaltabilir.

Anahtar Kelimeler

• Kateter
• Kan dolaşımı infeksiyonu
• Metastatik komplikasyon

Evaluation of Hospitalized Diagnosed with Catheter-Related Primary Bloodstream Infection in Our Clinic

Öz

Introduction: Catheter related bloodstream infection (CRBSIs), among the most common, fatal and costly complications of central venous catheterization, are the leading cause of nosocomial bacteraemia. In hemodialysis patients, CRBSIs are the second most common cause of death after cardiovascular disease. These infections may cause metastatic complications such as infective endocarditis, spondylodiscitis and paravertebral abscess. The objective of this study was to evaluate CRBSIs and metastatic complications. Material and Methods: A retrospective evaluation included CRBSIs patients treated at the Department of Infectious Diseases and Clinical Microbiology. Demographic data, clinical symptoms, comorbidities, catheter characteristics, physical examination findings, isolated microorganisms and antibiotic susceptibility, inflammatory parameters and metastatic complications were recorded. Results: During the study period, a total of 63 episodes of CRBSIs were recorded in 51 patients. Of these, 54.9% were male, with a mean age of 60.7±16.2 years. In 82.4% of patients were received haemodialysis with dialysis catheter. All episodes, 85.7% were reported in patients on hemodialysis. Twenty complications were detected in 37.3% of the 51 patients. The most common complications were spondylodiscitis, infective endocarditis and psoas abscess. Gram-positive microorganisms were responsible for 85% of these complications and the most common pathogen was methicillin-susceptible Staphylococcus aureus. Conclusion: In addition to CRBSIs, infection-related complications were also more frequently observed in hemodialysis patients. Educating patients on catheter care and personal hygiene, implementing CRBSIs prevention packages in hospitals, and referring haemodialysis patients to the fistula option when possible may reduce the incidence of these complications.

Anahtar Kelimeler

• Catheter
• Bloodstream infection
• Metastatic complication

Kaynakça

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