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Yenidoğan Yoğun Bakım Ünitesindeki Nozokomiyal Pseudomonas İnfeksiyonlu Olgularımız

Yıl 2009, Cilt: 3 Sayı: 4, 16 - 22, 01.04.2009

Öz

Amaç: Yenidoğan bebeklerin bakım ve tedavisindeki gelişmeler yaşam sürelerini artırmıştır. Düşük doğum ağırlıklı yenidoğan bebeklerin yaşam sürelerinin uzamasına paralel olarak nozokomiyal enfeksiyon sıklığıda artmıştır.Gereç ve Yöntem: Bu çalışmada, Eylül 2003-Ağustos 2004 tarihleri arasında hastanemiz yenidoğan yoğun bakım ünitesinde nozokomiyal Pseudomonas infeksiyonu gelişen olgular ve bu mikroorganizmaların antibiyotik duyarlılıkları retrospektif olarak değerlendirildi.Bulgular: Bu dönemde yatırılan 978 hastanın 17’sin den alınan 146 kültürden 38’inde Pseudomonas spp üredi. Olguların postnatal yaş ortalaması 45.0±83.7 saatti. Onbir olgu (%64.7) preterm, 6’sı (%35.3) term bebekti. Ortalama gestasyon yaşı 33.2±4.9(26-37) hafta olarak bulundu. Ortalama doğum ağırlığı 1807.4±826.9 (1345-3200 gr) gramdı. Hastanede kalış süresi ortalama 43±31.5 gün idi. Üreme öncesi tüm vakalar antibiyotik almıştı. Pseudomonas suşlarının en fazla imipenem (%94) ve siprofloksasine (%86) duyarlı olduğu saptandı. Kültürlerin %82’si amikasin, %80’i piperasillin, %50’si netilmisine duyarlıydı.Sonuç: Uygun antibiyotik seçimi ve hijyen önlemleri ile nozokomiyal infeksiyonlarda başarılı olunacağı düşünüldü.

Kaynakça

  • Peter G ,Cashore JW. Infections acquired in the nursery. Epide- miology and control. In: Remington JS, Klein JO (eds). Infectious Disease of the Fetus and Newborn Infant. W.B. Sounders Phila- dephia 1990:1000-1019.
  • Grisaru-soon G, Lerner-geva L, Keller N, Berger H, Passwell JH, Barzilai A. Pseudomonas aeruginosa bacteremia in children: analysis of trends in prevalance, antiobiotic resistence and prog- nostic factor. Pediatr Infect Dis 2000;19: 959-963.
  • Akalın H, Özakın C, Sütçü Ş, Helvacı S, Ener B, Gedikoğlu S. Uludağ Üniversitesi Tıp Fakültesi Hastanesi’nde Hastane İnfeksi- yonları. Klimik Dergisi 1999;12:55-57.
  • Cordero L, Sananes M, Ayers LW. Bloodstream infections in ne- onatal intensive-care unit :12 years’experience with an antiobiotic control program. Infec Control Hosp Epidemiol 1996; 20:242
  • Ovalı F. Bakteriyel infeksiyonlar. Dağoğlu T, Ovalı F, Samancı N Eds. Neonatoloji. İstanbul Nobel Tıp Kitabevleri 2000:679-707.
  • Molina-Cabrillana J, Santana-Reyes C, Hernandez J, Lopez I, Dor- ta E. Incidence of nosocomial infections at a neonatal intensive care unit: a six-year surveillance study. Enferm Infec Microbial Clin 2006;24: 307-312.
  • Trotman H, Bell Y. Neonatal sepsis in very low birthweight infants at the University Hospital of the West Indies. West Indian Med J. ;55:165-169. Grudmann H., Kropec A, Hartung D, Berner R., Daschner F. Pse- udomonas aeruginosa in neonatal intensive care unit : reservoirs and ecology of the nasocomial pathojen. J Infect Dis 1993;168: 947.
  • Trotman H, Bell Y, Thame M,Nicholsan AM, Barton M. Predic- tors of poor outcome in neonates with bacterial sepsis admitted to the University Hospital of the West Indies. West Indian Med J. 2006;55:80-84.
  • Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy- five years of neonatal sepsis at Yale: 1928-2003. Pediatrics ;116:595-602.
  • Aliaga L, Mediavilla JD, Cobo F. A clinical index predicting mor- tality with Pseudomonas aeroginosa bacteraemia. J Med Microbiol ; 51: 615-619. Vidal F, Mensa J, Almela M, Martínez JA, Marco F, Casals C, Gatell JM, Soriano E, Jimenez de Anta MT. Epidemiology and outcome of Psödomonas aeruginasa bacteremia, with special emphasis on the influence of antiobiotic treatment.Analysis of 189 episodes. Arch Intern Med 1996; 156: 121-26.
  • Foca M, Jakob K, Whittier S, Della Latta P, Factor S, Rubenstein D, Saiman L. Endemic Psödomonas aeruginosa infection in a ne- onatal intensive care unit. N Engl J Med 2000;343: 695-700.
  • Chacko B, Sohi I. Early onset neonatal sepsis. Indian J Pediatr ;72:23-26
  • Lodha R, Natchu UC, Nanda M, Kabra SK. Nazocomial infection in pediatric intansive care units. Indian J Pediatr 2000;68:1063
  • Lee NC, Chen SJ, Tang RB, Hwang BT. Neonatal bacteremia in a neonatal intansive care unit: analysis of causative organisms and antimicrobial suspectibility. J Chin Med Assoc 2004 ;67:15-20.
  • Kapoor L, Randhawa VS, Deb M. Microbiological profile of ne- onatal septicemia in a pediatric care hospital in Delhi. J Commun Dis 2005 ;37:227-232.
  • Tekeli E. Yoğun bakım infeksiyonlarının dünü, bugünü, yarını (de- ğişen profili). Yoğun Bakım Dergisi 2002;2: 14-34.
  • Linder N, Dagan R, Kuint J,Keler G, Reichman B. Ventriculitis ca- used by klebsiella pnemoniea successfully treated with perfloxacin in a neonate.Infection 1994;22:210-212.
  • Ayyıldız A, Kocazeybek B, Arıtürk S. Değişik klinik örneklerden izole edilen Acinobacter ve Pseudomonas suşlarının antibiyotik duyarlılıkları. Ankem Dergisi 2002;16: 1-3.
  • EL Armari EB, Chamat E, Auckenthaler R, Pechere JC, Van Del- den C. Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates. Clin Infect Dis 2001; 33: 1859-1864.
  • Tunçbilek S, Tezeren D, Balaban N, Öztürk S, Işılak İ. Hastane in- feksiyonu etkeni Pseudomonas aeruginoso’ların in vitro antibiotik duyarlılıkları.İnfeksiyon Dergisi 1998; 12: 361.
  • Çolak D, Erdinç Ç, Öğünç D,Öngüt G, Demirgiller D, Mutlu G. Klinik örneklerden izole edilen Pseudomonas türlerine karşı çeşit- li antibiotiklerin in vitro etkinliği. Türk Mikrobiyol Cem Dergisi ; 26: 48-51. Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, Rosenzweig R, Gutmann L, Safar M, Acar J. Nazocomial acqui- sition of multiresistant Acinetobacter baumannii : risk factor and prognosis. Clin Infect Dis 1995;20:790-796.
  • Yalaz M, Cetin H, Akisu M, Aydemir S, Tunger A, Kültürsay N. Neonatal nosocomial sepsis in a level-III NICU: evaluation of the causative agents and antimicrobial susceptibilities. Turk J Pediatr. ;48:13-18. Molina-Cabrillana J, Santana-Reyes C, Hernandez J, Lopez I, Dor- ta E. Incidence of nosocomial infections at a neonatal intensive care unit: a six-year surveillance study. Enferm Infecc Microbiol Clin 2006;24:307-312.
  • Parry GJ, Tucker JS, Tarnow-Mordi WO; UK Neonatal Staffing Study Group. Relationship between probable nosocomial bacte- raemia and organisational and structural factors in UK neonatal intensive care units.Qual Saf Health Care 2005;14:264-269.

NOSOCOMIAL PSEUDOMONAS INFECTIONS IN OUR NEONATAL INTENSIVE CARE UNIT

Yıl 2009, Cilt: 3 Sayı: 4, 16 - 22, 01.04.2009

Öz

Aim: Improvement in the care and treatment of neonates has contributed to increased survival. In the last few years, nosocomial infection frequency has risen up owing to the increased survival rates in the neonates. Material and Method: In this study, we retrospectively assessed the prevalence of Pseudomonas infection and antibiotic sensitivity of these microorganism in our neonatal intensive care unit between September 2003-August 2004. Results: A total of 978 neonates were hospitalized during this period. 146 cultures were collected from 17 patients and Pseudomonas was isolated in 38 of these cultures. Of these 17 patients, 11(64.7%) were premature and 6(35.3%) were mature.The average birth weight was 1807.47±826.9 g(1345-3200 gr), average gestational age was 33.2±4.9 weeks and average postnatal age was 45.05±83.7 hours. Mean hospitalization time was 43±31.5 days. Antibiotics were administered to all cases before Pseudomonas isolation. The best antimicrobial sensitivity was observed with Imıpenem (94%) and Ciprofloxacin (86%) which were the most effective antibiotics for Pseudomonas infections. Of this 38 cultures, 82% were sensitive to amicasin, 80% to piperasilin, 50% to netilmycin. Conclusion: Appropiate antibiotic selection and improvements in hygiene are required to reduce the incidence of nosocomial infections in neonatal intensive care unit

Kaynakça

  • Peter G ,Cashore JW. Infections acquired in the nursery. Epide- miology and control. In: Remington JS, Klein JO (eds). Infectious Disease of the Fetus and Newborn Infant. W.B. Sounders Phila- dephia 1990:1000-1019.
  • Grisaru-soon G, Lerner-geva L, Keller N, Berger H, Passwell JH, Barzilai A. Pseudomonas aeruginosa bacteremia in children: analysis of trends in prevalance, antiobiotic resistence and prog- nostic factor. Pediatr Infect Dis 2000;19: 959-963.
  • Akalın H, Özakın C, Sütçü Ş, Helvacı S, Ener B, Gedikoğlu S. Uludağ Üniversitesi Tıp Fakültesi Hastanesi’nde Hastane İnfeksi- yonları. Klimik Dergisi 1999;12:55-57.
  • Cordero L, Sananes M, Ayers LW. Bloodstream infections in ne- onatal intensive-care unit :12 years’experience with an antiobiotic control program. Infec Control Hosp Epidemiol 1996; 20:242
  • Ovalı F. Bakteriyel infeksiyonlar. Dağoğlu T, Ovalı F, Samancı N Eds. Neonatoloji. İstanbul Nobel Tıp Kitabevleri 2000:679-707.
  • Molina-Cabrillana J, Santana-Reyes C, Hernandez J, Lopez I, Dor- ta E. Incidence of nosocomial infections at a neonatal intensive care unit: a six-year surveillance study. Enferm Infec Microbial Clin 2006;24: 307-312.
  • Trotman H, Bell Y. Neonatal sepsis in very low birthweight infants at the University Hospital of the West Indies. West Indian Med J. ;55:165-169. Grudmann H., Kropec A, Hartung D, Berner R., Daschner F. Pse- udomonas aeruginosa in neonatal intensive care unit : reservoirs and ecology of the nasocomial pathojen. J Infect Dis 1993;168: 947.
  • Trotman H, Bell Y, Thame M,Nicholsan AM, Barton M. Predic- tors of poor outcome in neonates with bacterial sepsis admitted to the University Hospital of the West Indies. West Indian Med J. 2006;55:80-84.
  • Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy- five years of neonatal sepsis at Yale: 1928-2003. Pediatrics ;116:595-602.
  • Aliaga L, Mediavilla JD, Cobo F. A clinical index predicting mor- tality with Pseudomonas aeroginosa bacteraemia. J Med Microbiol ; 51: 615-619. Vidal F, Mensa J, Almela M, Martínez JA, Marco F, Casals C, Gatell JM, Soriano E, Jimenez de Anta MT. Epidemiology and outcome of Psödomonas aeruginasa bacteremia, with special emphasis on the influence of antiobiotic treatment.Analysis of 189 episodes. Arch Intern Med 1996; 156: 121-26.
  • Foca M, Jakob K, Whittier S, Della Latta P, Factor S, Rubenstein D, Saiman L. Endemic Psödomonas aeruginosa infection in a ne- onatal intensive care unit. N Engl J Med 2000;343: 695-700.
  • Chacko B, Sohi I. Early onset neonatal sepsis. Indian J Pediatr ;72:23-26
  • Lodha R, Natchu UC, Nanda M, Kabra SK. Nazocomial infection in pediatric intansive care units. Indian J Pediatr 2000;68:1063
  • Lee NC, Chen SJ, Tang RB, Hwang BT. Neonatal bacteremia in a neonatal intansive care unit: analysis of causative organisms and antimicrobial suspectibility. J Chin Med Assoc 2004 ;67:15-20.
  • Kapoor L, Randhawa VS, Deb M. Microbiological profile of ne- onatal septicemia in a pediatric care hospital in Delhi. J Commun Dis 2005 ;37:227-232.
  • Tekeli E. Yoğun bakım infeksiyonlarının dünü, bugünü, yarını (de- ğişen profili). Yoğun Bakım Dergisi 2002;2: 14-34.
  • Linder N, Dagan R, Kuint J,Keler G, Reichman B. Ventriculitis ca- used by klebsiella pnemoniea successfully treated with perfloxacin in a neonate.Infection 1994;22:210-212.
  • Ayyıldız A, Kocazeybek B, Arıtürk S. Değişik klinik örneklerden izole edilen Acinobacter ve Pseudomonas suşlarının antibiyotik duyarlılıkları. Ankem Dergisi 2002;16: 1-3.
  • EL Armari EB, Chamat E, Auckenthaler R, Pechere JC, Van Del- den C. Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates. Clin Infect Dis 2001; 33: 1859-1864.
  • Tunçbilek S, Tezeren D, Balaban N, Öztürk S, Işılak İ. Hastane in- feksiyonu etkeni Pseudomonas aeruginoso’ların in vitro antibiotik duyarlılıkları.İnfeksiyon Dergisi 1998; 12: 361.
  • Çolak D, Erdinç Ç, Öğünç D,Öngüt G, Demirgiller D, Mutlu G. Klinik örneklerden izole edilen Pseudomonas türlerine karşı çeşit- li antibiotiklerin in vitro etkinliği. Türk Mikrobiyol Cem Dergisi ; 26: 48-51. Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, Rosenzweig R, Gutmann L, Safar M, Acar J. Nazocomial acqui- sition of multiresistant Acinetobacter baumannii : risk factor and prognosis. Clin Infect Dis 1995;20:790-796.
  • Yalaz M, Cetin H, Akisu M, Aydemir S, Tunger A, Kültürsay N. Neonatal nosocomial sepsis in a level-III NICU: evaluation of the causative agents and antimicrobial susceptibilities. Turk J Pediatr. ;48:13-18. Molina-Cabrillana J, Santana-Reyes C, Hernandez J, Lopez I, Dor- ta E. Incidence of nosocomial infections at a neonatal intensive care unit: a six-year surveillance study. Enferm Infecc Microbiol Clin 2006;24:307-312.
  • Parry GJ, Tucker JS, Tarnow-Mordi WO; UK Neonatal Staffing Study Group. Relationship between probable nosocomial bacte- raemia and organisational and structural factors in UK neonatal intensive care units.Qual Saf Health Care 2005;14:264-269.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA78AV52CU
Bölüm Research Article
Yazarlar

Ebru Arhan Bu kişi benim

A. Esin Kibar Bu kişi benim

Sevim Ünal Bu kişi benim

Figen Günindi Bu kişi benim

Gülnar Uysal Bu kişi benim

Hülya Oskovi Bu kişi benim

F. Nur Çakmak Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2009
Gönderilme Tarihi 1 Nisan 2009
Yayımlandığı Sayı Yıl 2009 Cilt: 3 Sayı: 4

Kaynak Göster

Vancouver Arhan E, Kibar AE, Ünal S, Günindi F, Uysal G, Oskovi H, Çakmak FN. NOSOCOMIAL PSEUDOMONAS INFECTIONS IN OUR NEONATAL INTENSIVE CARE UNIT. Türkiye Çocuk Hast Derg. 2009;3(4):16-22.

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