Öz
Aim: This study aims to study the risk factors that are related with the development of bloodstream infections in the patients hospitalized in intensive care units (ICUs). Materials and Methods: We have prospectively examined the risk factors and microbiologic analyses of 18 patients with catheter-related blood stream infections (CR-BSI) who were selected from among 300 patients at ICU with central venous catheters (CVC) for 12 months (between August 2011 and August 2012). Results: The mean duration of the catheterization was 15,19±5,977 days. The sensitivity and specificity of the time factor for receiving positive signal from cultures of CVC and blood samples were 88.8% and 93%, respectively. The CR-BSI attack rate was 20.9%. Metabolic disorders, duration of hospitalization in ICU, urinary catheterization, longer length of CVC duration, and whether CVC was used for other tests were found to be significant risk factors for the development of CR-BSI (p<0,001). Methicilin-resistant coagulase-negative staphylococcus (MRCNS) was detected in 6 (33.3%) cases while Acinetobacter baumanii was detected in 2 (11.1%) cases and polymicrobial agents were detected in 5 cases (27.7%). We also detected the following bacteria in 1 (5,6%) patient (for each) Pseudomonas aeruginosa, diphteroid bacilli, Aeromonas veronii, methicillin-susceptible Staphylococcus aureus, and Klebsiella pneumoniae. Conclusion: In this study, metabolic disorders and CVC related factors were determined as risk factors for CR-BSI development. Taking these preventable factors into consideration and proper use of infection control measurements will provide significant decrease in CR-BSI rates. However, there is need for new scientific approaches on the diagnosis, treatment, and prevention for CR-BSI
Anahtar Kelimeler
Kaynakça
- Seifert H, Jansen B, Widmer AF, Farr BM. Central –Venous Catheters. In: Seifert H, Jansen B, Farr BM (eds). Catheter-Related Infections. 2th ed. New York: Marcel Dekker 2005;293-326.
- Mermel LA. Prevention of intravascular catheter-relatedinfections. Ann Intern Med 2000;132:391-402.
- Beekman ES, Henderson KD. Infections Caused by Percutaneous Intravascular Devices. In: Mandell GL, Bennett JE, Dolin R (eds). Principles and Practice of Infectious Diseases. 6th ed. Philadelphia. Elsevier, Churchill Livingstone 2010;3697-715.
- O’Grady NP, Alexander M, Dellinger EP. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2009;51:1-29.
- Glover S. Bru-Brisson C. Infections associated within travascular lines, grafts and devices. Infect Dis 2010;19:125-36.
- Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of healthcare–associated infection and criteria for spesific types of infections in the acute care setting. Am J Infect Control 2008;36(9):655.
- Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect 2002;8:295-309.
- Fraenkel DJ, Rickard C, Lipman J. Can we achieve consensus on central venous catheter-related infections? Anaesth Intensive Care 2000;28:475-90.
- Matthew R. Goede, Craig M, Cooper S. Catheter-related blood stream infection. Surg Clin N Am 2009;89:463-74.
- Mary C. Barsanti, Keith F, Woelt JE. Infection prevention in the intensive care unit. Infect Dis Clin N Am 2009;23:703-25.
- David KW, Jeanne EZ, Alexis M, Michael J, Victoria F. Primary blood stream infections in ICU patients. Clin Infect Dis 2001; 33: 1329-35.
- Bakır M. Kateter infeksiyonlarının epidemiyolojisi, etyoloji ve patogenez. Ankem Dergisi 2000;14(4):456-9.
- Öncü S, Özsüt H, Yıldırım A, Ay P, Çakar N, Eraksoy H, Çalangu S. Central venous catheter related infections: risk factors and the effect of glycopeptide antibiotics. Ann Clin Microbiol Antimicrob 2003;27;2:3.
- Kritchevsky SB, Barbara I, Braun, LK, Edward SW, Steven LS, Michael FP, Cheryl L. The impact of hospital practice on central venous catheter-associated bloodstream infection rates at the patient and unit level: a multicenter study. Am J Med Qual 2008;23:24.
- Baruönü F. Merkezi yoğun bakım ünitelerinde yatan hastalarda gelişen nazokomiyal kan dolaşımı infeksiyonları ve bu infeksiyonların gelişimine neden olan risk faktörlerinin belirlenmesi. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları Anabilim Dalı Uzmanlık Tezi, Zonguldak, 2009.
- Opilla M. Epidemiology of blood stream infection associated with parenteral nutrition. Am J Infect Control 2008;36:5-8.
An Evaluation of Catheter-Related Bloodstream Infections in Intensive Care Units/ Yoğun Bakım Ünitelerinde Gelişen Kateter İlişkili Kan Dolaşım Enfeksiyonlarının İrdelenmesi
Öz
Abstract
Aim: This study aims to study the risk factors that are related with the development of bloodstream infections in the patients hospitalized in intensive care units (ICUs).
Materials and Methods: We have prospectively examined the risk factors and microbiologic analyses of 18 patients with catheter-related blood stream infections (CR-BSI) who were selected from among 300 patients at ICU with central venous catheters (CVC) for 12 months (between August 2011 and August 2012).
Results: The mean duration of the catheterization was 15,19±5,977 days. The sensitivity and specificity of the time factor for receiving positive signal from cultures of CVC and blood samples were 88.8% and 93%, respectively. The CR-BSI attack rate was 20.9%. Metabolic disorders, duration of hospitalization in ICU, urinary catheterization, longer length of CVC duration, and whether CVC was used for other tests were found to be significant risk factors for the development of CR-BSI (p<0,001). Methicilin-resistant coagulase-negative staphylococcus (MRCNS) was detected in 6 (33.3%) cases while Acinetobacter baumanii was detected in 2 (11.1%) cases and polymicrobial agents were detected in 5 cases (27.7%). We also detected the following bacteria in 1 (5,6%) patient (for each) Pseudomonas aeruginosa, diphteroid bacilli, Aeromonas veronii, methicillin-susceptible Staphylococcus aureus, and Klebsiella pneumoniae.
Conclusion: In this study, metabolic disorders and CVC related factors were determined as risk factors for CR-BSI development. Taking these preventable factors into consideration and proper use of infection control measurements will provide significant decrease in CR-BSI rates. However, there is need for new scientific approaches on the diagnosis, treatment, and prevention for CR-BSI.
Anahtar Kelimeler: Central Venous Catheter; Catheter-Related Bloodstream İnfection; Intensive Care Unit, Bacteremia.
Özet
Amaç: Bu çalışmada, yoğun bakım ünitelerinde (YBÜ) yatan hastalarda gelişen kateter ilişkili kan dolaşımı infeksiyonları ile ilişkili risk faktörlerinin araştırılması amaçlanmıştır.
Gereç ve Yöntemler: Bir yıllık sürede (Ağustos 2011-Ağustos 2012) yoğun bakım ünitelerinde takip edilen ve santral venöz kateter (SVK) takılan 300 hastada gelişen 18 kateter ilişkili kan dolaşımı infeksiyonu (KİKDİ) olgusundaki risk faktörleri ve mikrobiyolojik analizleri prospektif olarak araştırılmıştır.
Bulgular: Santral venöz kateterlerin takılı kalma süreleri ortalama 15,19±5,977 gündü. KİKDİ gelişen hastalarda SVK ve kan kültürlerinin sinyal pozitifleşmesinde zaman faktörünün duyarlılığı (sensitivity) %88,8, özgüllüğü (specifity) %93,0 olarak bulundu. KİKDİ atak oranı %20,9 olarak belirlendi. Metabolik bozukluklar, YBÜ yatış süresi, üriner kateterizasyon, SVK takılı kalma süresi ve çok amaçlı kullanılması KİKDİ gelişimi için anlamlı risk faktörleri (p<0,001) olarak belirlendi. Altı (%33,3) olguda metisilin-dirençli koagülaz-negatif stafilokok (MRKNS), 2 (%11,1) olguda Acinetobacter baumanii, birer (%5,6) olguda Pseudomonas aeruginosa, difteroid basil, Aeromonas veronii, metisilin-duyarlı Staphylococcus aureus (MSSA) ve Klebsiella pneumoniae ve 5 (%27,7) olguda polimikrobiyal etkenler saptandı.
Sonuç: Çalışmamızda, metabolik bozukluklar ve SVK kullanımına bağlı nedenlerin KİKDİ gelişiminde önemli faktörler olduğu saptanmıştır. Bu faktörlerin çoğunlukla önlenebilir olması, infeksiyon kontrol önlemlerinin doğru kullanılması ile KİKDİ oranlarında önemli düşüş sağlayacaktır. Ancak yine de KİKDİ tanımlanması, tedavisi ve korunma ile ilgili olarak yeni bilimsel yaklaşımlara ihtiyaç vardır.
Anahtar Kelimeler: Santral Venöz Kateter; Kateter-İlişkili Kan Dolaşımı İnfeskiyonu; Yoğun Bakım Ünitesi; Bakteriyemi.
Anahtar Kelimeler
Central Venous Catheter; Catheter-Related Bloodstream İnfection; Intensive Care Unit Bacteremia
Kaynakça
- Seifert H, Jansen B, Widmer AF, Farr BM. Central –Venous Catheters. In: Seifert H, Jansen B, Farr BM (eds). Catheter-Related Infections. 2th ed. New York: Marcel Dekker 2005;293-326.
- Mermel LA. Prevention of intravascular catheter-relatedinfections. Ann Intern Med 2000;132:391-402.
- Beekman ES, Henderson KD. Infections Caused by Percutaneous Intravascular Devices. In: Mandell GL, Bennett JE, Dolin R (eds). Principles and Practice of Infectious Diseases. 6th ed. Philadelphia. Elsevier, Churchill Livingstone 2010;3697-715.
- O’Grady NP, Alexander M, Dellinger EP. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2009;51:1-29.
- Glover S. Bru-Brisson C. Infections associated within travascular lines, grafts and devices. Infect Dis 2010;19:125-36.
- Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of healthcare–associated infection and criteria for spesific types of infections in the acute care setting. Am J Infect Control 2008;36(9):655.
- Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect 2002;8:295-309.
- Fraenkel DJ, Rickard C, Lipman J. Can we achieve consensus on central venous catheter-related infections? Anaesth Intensive Care 2000;28:475-90.
- Matthew R. Goede, Craig M, Cooper S. Catheter-related blood stream infection. Surg Clin N Am 2009;89:463-74.
- Mary C. Barsanti, Keith F, Woelt JE. Infection prevention in the intensive care unit. Infect Dis Clin N Am 2009;23:703-25.
- David KW, Jeanne EZ, Alexis M, Michael J, Victoria F. Primary blood stream infections in ICU patients. Clin Infect Dis 2001; 33: 1329-35.
- Bakır M. Kateter infeksiyonlarının epidemiyolojisi, etyoloji ve patogenez. Ankem Dergisi 2000;14(4):456-9.
- Öncü S, Özsüt H, Yıldırım A, Ay P, Çakar N, Eraksoy H, Çalangu S. Central venous catheter related infections: risk factors and the effect of glycopeptide antibiotics. Ann Clin Microbiol Antimicrob 2003;27;2:3.
- Kritchevsky SB, Barbara I, Braun, LK, Edward SW, Steven LS, Michael FP, Cheryl L. The impact of hospital practice on central venous catheter-associated bloodstream infection rates at the patient and unit level: a multicenter study. Am J Med Qual 2008;23:24.
- Baruönü F. Merkezi yoğun bakım ünitelerinde yatan hastalarda gelişen nazokomiyal kan dolaşımı infeksiyonları ve bu infeksiyonların gelişimine neden olan risk faktörlerinin belirlenmesi. Zonguldak Karaelmas Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları Anabilim Dalı Uzmanlık Tezi, Zonguldak, 2009.
- Opilla M. Epidemiology of blood stream infection associated with parenteral nutrition. Am J Infect Control 2008;36:5-8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Nisan 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 22 Sayı: 1 |
