Turkiye Klinikleri Journal of Internal Medicine

.: ORIGINAL RESEARCH
Nöroloji Yoğun Bakım Ünitesinde Gelişen Hastane Enfeksiyonlarının Değerlendirilmesi
Evaluation of Nosocomial Infections Developing in Neurology Intensive Care Unit
Esma EROĞLUa
aKonya Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Konya, TÜRKİYE
Turkiye Klinikleri J Intern Med. 2020;5(2):49-54
doi: 10.5336/intermed.2019-72948
Article Language: TR
Full Text
ÖZET
 Amaç: Hastane enfeksiyonu (HE), günümüzde hastanede yatan hastalarda özellikle yoğun bakım ünitesi (YBÜ) gibi invaziv işlemlerin fazla yapıldığı yüksek riskli alanlarda oldukça önemli bir tehdit oluşturmaktadır. Bu çalışmada, nöroloji yoğun bakım ünitesinde (NYBÜ) HE dağılımlarını ve enfeksiyona neden olan patojenleri değerlendirmeyi planladık. Gereç ve Yöntemler: Çalışmaya, Konya Eğitim ve Araştırma Hastanesi, NYBÜ'de bir yıllık süreçte takip edilen 225 hasta dâhil edildi. Çalışma için SBÜ Konya Eğitim Araştırma Hastanesi Tıpta Uzmanlık Eğitim Kurumu (TUEK)'ndan, 5 Aralık 2019 tarihinde 48929119/774 sayılı izin alınmıştır. Hasta/hasta yakını onayı alınmıştır. HE tanıları, Hastalık Kontrol ve Önleme Merkezi [Centers for Disease Control and Prevention (CDC)] tanı kriterlerine uygun olarak konulmuştur. Bulgular: NYBÜ'de, bir yıllık süreçte takip edilen 225 hasta ve tanı koyulan 78 HE retrospektif olarak incelendi. NYBÜ'deki HE, tüm HE'nin %15,98'ini oluşturmaktadır. En sık rastlanan HE, %28,2 ile pnömoni dışında gelişen diğer alt solunum yolu enfeksiyonu iken %25,6'sı pnömoni idi. Kan dolaşım enfeksiyonu (KDE) %28,2 olarak saptandı. Tüm HE'nin %25,6'sı santral venöz kateter ilişkili kan dolaşımı enfeksiyonu (SVKİ-KDE), %2,5'i laboratuvar tarafından kanıtlanmış kan dolaşımı enfeksiyonu idi. Kateter ilişkili idrar yolu enfeksiyonu (Kİ-ÜSE) %14,1 oranında saptandı. Pnömoni dışında gelişen diğer alt solunum yolu enfeksiyonunda Acinetobacter baumannii (%68,1) en sık etken olarak saptandı. Gelişen HE'lerin %25,6'sı ise pnömoni idi. Spesifik laboratuvar bulguları olan pnömoni, klinik olarak tanımlanmış pnömoni ve mekanik ventilatör ilişkili pnömoni (VİP)'de A. baumannii (sırasıyla; %55,5; %60; %50), SVKİ-KDE'de koagülaz negatif stafilokok (KNS) (%35), Kİ-ÜSE'de Klebsiella pneumoniae (%54,5) en sık etkenlerdi. Sonuç: NYBÜ'deki hastaların komplike ve dirençlerinin düşük olması invaziv birçok işleme maruz bırakılmaları HE gelişimi için tehdit oluşturmaktadır. Her ünitenin kendilerine özgü patojen dağılımlarının değerlendirilmesi uygun ampirik antibiyotik tedavisini erken dönemde belirlemede önemlidir.

Anahtar Kelimeler: Hastane enfeksiyonu; nöroloji yoğun bakım ünitesi
ABSTRACT
 Objective: Nosocomial infections (NI), together with the increasing technology, constitute a significant threat in hospitalized patients, especially in high-risk such as intensivecareunits. In this study, we planned to evaluate NI distributions and pathogens causing infection in the Neurological Intensive Care Unit (Neuro-ICU). Material and Methods: 225 patients who were followed up in Konya Education and Research Hospital, Neuro-ICU for a period of 1 year were included in the study. For the study, permission numbered 48929119/774 was obtained on 5 December 2019 from Konya Training and Research Hospital, Medical Specialization Training Institution. Patient/patient relatives approval was obtained. NI diagnoses were made according to the criteria for Centers for Disease Control and Prevention. Results: 225 patients were followed-up retrospectively in the Neuro-ICU during a one-year period. 78 NI was diagnosed. NIs in the Neuro-ICU constitute 15.98% of all nosocomial infections. The most common HE was the lower respiratory tract infection that developed with 28.2%, other than pneumonia. Pneumonia was 25.6%. Bloodstream infection (BSI) was 28.2%. 25.6% of all HE were central venous catheter-related bloodstream infection (CR-BSI), 2.5% were laboratory-proven bloodstream infection. Catheter-related urinary tract infection was detected in 14.1% of the cases. In lower respiratory tract infection without pneumonia, Acinetobacter baumannii (68.1%) was the most common agent. In specific laboratory findings pneumonia, clinically defined pneumonia and mechanical ventilator-associated pneumonia, A. baumannii (55.5%, 60% and 50% respectively), in central venous catheter-related blood stream infection Coagulase negative staphylococci (35%), in catheter-related urinary tract infection, Klebsiella pneumoniae (54.5%) was the most common agent. Conclusion: Complicated and low resistance of Neuro-ICU patients is subject to many invasive procedures, which poses a threat to the development of NI. The evaluation of the specific HEs of each unitand the pathogen distributions causing these NIs is important in early empirical antibiotic therapy.

Keywords: Neurology intensive care unit; nosocomial infection
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