Bir Üniversite Hastanesi Çocuk Yoğun Bakım Ünitesinde Dirençli Gram-negatif Enfeksiyonların Değerlendirilmesi

Abstract

Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital. Material and Methods: In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively. Results: One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1–205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates , the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance. Conclusion: Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.

Devlet hastanesi üçüncü basamak çocuk yoğun bakımda çoklu ilaç dirençli gram negatif enfeksiyonların değerlendirilmesi

“…Durdu ve ark'nın [1] İstanbul'da erişkin yoğun bakım ünitelerinde gram negatif enfeksiyonları değerlendirdiği çok merkezli çalışmada, yine en sık A.baumannii, Klebsiella türleri, P.aeruginosa ve E.coli saptanmıştır. Ülkemiz ve Mısır'dan çocuk yoğun bakım servisinde gram negatif enfeksiyonların değerlendirildiği iki çalışma da aynı etkenler ve VİP bizim çalışmamızdaki gibi en sık olarak belirtilmiştir [16,17]. Çalışmamızda en sık saptanan patojen P.aeruginosa'da meropenem direnci %69, piperasilin-tazobaktam ve seftazidim direnci %87,5 iken, en duyarlı olduğu antimikrobiyal ajan amikasin idi (%69).…”