Nosocomial infections in neonatology clinic and neonatal intensive care unit

Yıl 2011, Cilt: 46 Sayı: 4, 302 - 307, 01.12.2011

Mustafa Hacımustafaoğlu Solmaz Çelebi Nilgün Köksal Sumru Kavurt Hilal Özkan Merih Çetinkaya Güven Özkaya

https://doi.org/10.4274/tpa.46.286

Öz

Aim: Nosocomial infections NI in a neonatal intensive care unit NICU and neonatal clinic were evaluated during a one year period Material and Method: 314 newborns were investigated for nosocomial infections Local ethics committee approval was given for this study Nosocomial infections was defined using the CDC criteria Results: Nosocomial infections developed in 53 of 127 patients 58 with culture positivity in the NICU and in 2 6 of 187 patients all with a negative culture in the neonatal clinic In total NICU plus neonatal clinic NI developed in 23 of hosptalized patients Nosocomial infections rate was 42 3 and in terms of patient days NI rate was 14 1000 patient day When evaluated separately NI developed in 53 5 of patients admitted in NICU and in 2 6 of neonatal clinic patients Also NI rates were 17 9 1000 patient day in NICU and 1 6 1000 patient day in the neonatal clinic Patients with NI stayed at the hospital for 73 6 plusmn;47 8 day in NICU and for 16 0 plusmn;6 7 day in the neonatal clinic Nosocomial infections developed on the 29 4 plusmn;30 9th d in NICU and on the 7 6 plusmn;2 9th day in the neonatal clinic In NICU in terms of 128 NI episodes the NI related mortality was 8 5 16 1 n: 11 of the patients with NI died They died on the 56 7 plusmn;50 2nd day of admission and on the 25 8 plusmn;10 2nd day second after NI diagnosis There was no mortality in neonatal clinic patients Conclusions: Our NI rates were slightly higher than the developed countries and lower than the developing countries Turk Arch Ped 2011; 46: 302 7

Anahtar Kelimeler

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Yenidoğan ve yenidoğan yoğun bakım servisinde hastane enfeksiyonları

Öz

Amaç: Bir yılda Yenidoğan Yoğun Bakım Birimi YYBB ve Yenidoğan Kliniği rsquo;ne yatan hastalarda gelişen hastane enfeksiyonları HE incelendi Gereç ve Yöntem: Hastane enfeksiyonları Centers for Diseases Control and Prevention CDC ölçütlerine göre tanımlandı Çalışma için Uludağ Üniversitesi Tıp Fakültesi Etik Kurul onayı alındı 04 Mart 2008 tarih ve 2008 5 12 sayılı etik kurul yazısı

Bulgular: Yenidoğan YBB rsquo;de yatan 127 hastanın 53 rsquo;ünde 58 5 rsquo;i kültür pozitif Yenidoğan Kliniği rsquo;nde yatan 187 hastanın 2 6 rsquo;sında hepsi kültür negatif HE gelişti Yenidoğan YBB ve Yenidoğan Kliniği rsquo;nde toplam 23 hastada HE gelişti HE hızı 42 3 yatış gününe göre HE oranı ise 14 1000 hasta günü olarak bulundu Hastane enfeksiyonları oranı YYBB rsquo;de 17 9 Yenidoğan Kliniği rsquo;nde 1 6 1000 hasta günü bulundu Hastane enfeksiyonları olan hastalar YYBB rsquo;de 73 6 plusmn;47 8 gün Yenidoğan Kliniği rsquo;nde 16 0 plusmn;6 7 gün yattı Hastane enfeksiyonları tanısı YYBB rsquo;sinde hastaneye yatışlarının ortalama 29 4 plusmn;30 9 gününde Yenidoğan Kliniği rsquo;nde 7 6 plusmn;2 9 gününde konuldu Yenidoğan YBB rsquo;de 128 HE atağında atak ilişkili ölüm oranı 8 5 idi Hastane enfeksiyonları saptanan 68 hastanın 11 rsquo;i 16 1 kaybedildi Hastane enfeksiyonları tanısı alan hastalar Yenidoğan YBB rsquo;de ortalama yatışının 56 7 plusmn;50 2 gününde kaybedildi Hastane enfeksiyonları tanısı konulduktan sonraki ortalama ölüm günü; YYBB rsquo;de 25 8 plusmn;10 2 gün olarak saptandı Yenidoğan Kliniği rsquo;nde HE gelişen hastalarda ölüm saptanmadı.

Çıkarımlar: Kliniğimizde Yenidoğan YBB ve Yenidoğan Kliniği rsquo;ndeki HE rsquo;leri gelişmiş ülkelere göre biraz yüksek gelişmekte olan ülkelere göre daha düşük saptandı Türk Ped Arfl 2011; 46: 302 7

Anahtar Kelimeler

Hastane enfeksiyonu, tanı, yenidoğan, yoğunbakım

Kaynakça

• Moore DL. Nosocomial infections in newborn nurseries and neonatal
• intensive care units. In: Mayhall CG (ed). Hospital epidemiology and infection control. Baltimore: Williams-Wilkins, 1996: 535-64.
• Yalaz M, Arslanoğlu S, Çetin H, et al. Üçüncü basamak Yenidoğan
• Yoğun Bakım Merkezi’nde kanıtlanmış nozokomiyal sepsis etkenle- rinin değerlendirilmesi: iki yıllık analiz. ADÜ Tıp Fakültesi Dergisi 2004; 5: 5-9.
• Couto RC, Carvalho EA, Pedrosa TM, Pedroso ER, Neto MC, Biscione
• FM. A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units. Am J Infect Control 2007; 35: 183-9.
• Su BH, Hsieh HY, Chiu HY, Lin HC, Lin HC. Nosocomial infection in a
• neonatal intensive care unit: a prospective study in Taiwan. Am J Infect Control 2007; 35: 190-5.
• Jeong IS, Jeong JS, Choi EO. Nosocomial infection in a newborn
• intensive care unit (NICU), South Korea. BMC Infect Dis 2006; 6: 103.
• Efird MM, Rojas MA, Lozano JM, et al. Epidemiology of nosocomial
• infections in selected neonatal intensive care units in Columbia, South America. J Perinatol 2005; 25: 531-6.
• van der Zwet WC, Kaiser AM, van Elburg RM, et al. Nosocomial
• infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005; 61: 300-11.
• Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR,
• Pediatric Prevention Network. Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units. Am J Infect Control 2001; 29: 152-7.
• Gikas A, Pediaditis J, Papadakis JA, et al. Prevalence study of
• hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. J Hosp Infect 2002; 50: 269-75.
• Salamati P, Rahbarimanesh AA, Yunesian M, Naseri M. Neonatal nosocomial infections in Bahrami Children. Indian J Pediatr 2006; 73: 197-200.
• Özdemir N, Soysal A, Bilgen H, Çulha G, Bakır M, Özek E. Marmara Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesi 2001 yılı nozokomiyal enfeksiyonları. Hastane İnfeksiyonları Dergisi 2004; 8: 256-60.
• Celebi S, Hacimustafaoglu M, Ozdemir O, Ozakin C. Nosocomial gram-positive bacterial infections in children: results of a 7 year study. Pediatr Int 2007; 49: 875-82.
• Yalaz M, Cetin H, Akisu M, Aydemir S, Tunger A, Kültürsay N. Neonatal nasocomial sepsis in a level III NICU: evaluation of the causative agents and antimicrobial susceptibilities. Turk J Pediatr 2006; 48: 13-8.
• Turkish Neonatal Society, Nosocomial Infections Study Group. Nasocomial infections in neonatal units in Turkey : epidemiology problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010; 52: 50-7.
• Erdoğan F, Arslan S. Nozokomiyal enfeksiyonlar (1998-1992) XXX. Türk Pediatri ve II. Ulusal Neonataloji Kongresi, 14-18 Haziran 1993, İstanbul, Kongre Özet Kitabı, P144: 35-6.
• Huskins WC, Goldmann DA. Prevention and control of nosocomial infections in healty care fasilities that serve children. Hospital control of infections. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds). Textbook of pediatric infectious diseases. 5.baskı. Philadelphia: WB Saunders, 2004: 2924-41.
• Rosenthal VD, Maki DG, Graves N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008; 36: 1-12.
• Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16: 128-40.
• Clark R, Powers R, White R, Bloom B, Sanchez P, Benjamin DK Jr. Nosocomial Infection in the NICU: A medical complication or unavoidable problem? J Perinatol 2004; 24: 382-8.
• Aziz K, McMillan DD, Andrews W, et al. Canadian Neonatal Network. Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr 2005; 5: 22.
• Auriti C, Maccallini A, Di Liso G, Di Ciommo V, Ronchetti MP, Orzalesi M. Risk factors for nosocomial infections in a neonatal intensive-care unit. J Hosp Infect 2003; 53: 25-30.
• Mireya UA, Martí PO, Xavier KV, Cristina LO, Miguel MM, Magda CM. Nosocomial infections in paediatric and neonatal intensive care units. J Infect 2007; 54: 212-20.
• Geffers C, Baerwolff S, Schwab F, Gastmeier P. Incidence of health care-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. J Hosp Infect 2008; 68: 214-21.
• Hufnagel M, Burger A, Bartelt S, Henneke P, Berner R. Secular trends in pediatric bloodstream infections over a 20-year period at a tertiary care hospital in Germany. Eur J Pediatr 2008; 167: 1149-59.
• Nosocomial infection rates for interhospital comparison: limitations and possible solutions. A report from the National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol 1991; 12: 609-21.
• Saçar S, Toprak KS, Asan A, Cevahir N, Serin S, Turgut H. Pamukkale Üniversitesi Hastanesi’nde hastane enfeksiyonları sürveyansı: üç yıllık analiz. İnfeksiyon Dergisi (Turkish Journal of Infection) 2008; 22: 15-21.
• Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth wieght neonataes: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110: 285-91.
• Urrea M, Pons M, Serra M, Latorre C, Palomeque A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 2003; 22: 490-4.
• Soysal A, Toprak D, Yavuz B, ve ark. Marmara Üniversitesi Tıp Fakültesi Pediatri Servisi’nde 2004 yılı nozokomiyal enfeksiyonları. Hastane Enfeksiyonları Dergisi 2006; 10: 143-8.
• Köksal N, Kurtoğlu B, Bayram Y, Hacımustafaoğlu M. Neonatal nozokomiyal infeksiyon gelişen olgularımız. 44. Milli Pediatri Kongresi, 4-8 Eylül, 2000, Bursa. Kongre Kitabı, (P359),s.189.
• Raymond J, Aujard Y. Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol 2000; 21: 260-3.
• Gray J, Gossain S, Morris K. Three year survey of bacteremia and fungemia in a pediatric intensive care unit. Pediatr Infect Dis J 2001; 4: 416-21.
• Babazono A, Kitajima H, Nishimaki S, et al. Risk factors for nosocomial infection in the neonatal intensive care unit by the Japanese Nosocomial Infection Surveillance (JANIS). Acta Med Okayama 2008; 62: 261-8.
• Gastmeier P, Geffers C, Schwab F, Fitzner J, Obladen M, Rüden H. Development of a surveillance system for nosocomial infections: the component for neonatal intensive care units in Germany. J Hosp Infect 2004; 57: 126-31.
• Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics 2006; 117: 1680-7.
• Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. Pediatrics 1999; 103: 39-47. Görker ve ark.
• İleri derecede prematür yenidoğanlarda nöropsikiyatrik değerlendirme/Neuropsychiatric assessments in very preterm infants