.: ORİJİNAL ARAŞTIRMA
Pandemi Sonrası Yozgat Şehir Hastanesinde Nozokomiyal Enfeksiyonlar: Yoğun Bakım Tecrübemiz: Retrospektif Kohort Çalışması
Nosocomial Infections at Yozgat City Hospital After the Pandemic: Our Intensive Care Experience: Retrospective Cohort Study
Turkiye Klinikleri J Anest Reanim. 2023;21(3):120-5
doi: 10.5336/anesthe.2023-100728
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] enfeksiyonu sonrası yoğun bakım ünitelerinde tedavi görmüş hastaların nozokomiyal enfeksiyon sıklığı, tipi ve en sık görülen sorumlu etkenlerin araştırılması amaçlanmıştır. Gereç ve Yöntemler: 1 Ekim 2022-1 Ocak 2023 tarihleri arasında Yozgat Şehir Hastanesi 3. Basamak Genel Yoğun Bakım A ve Genel Yoğun Bakım B ünitelerinde takip edilen ve izlemleri sırasında nozokomiyal enfeksiyon gelişen 496 hasta çalışmaya dâhil edildi. Tek merkezli, retrospektif gerçekleştirilen bu tanımlayıcı çalışmada, hasta verileri hastane bilgi sisteminden ve Enfeksiyon Kontrol Komitesi tarafından tutulan kayıtlardan yararlanılarak toplandı. Bulgular: Pandemi dönemi ve sonrası yoğun bakımlarda en sık gördüğümüz etken Acinetobacter baumannii'dir. Pandemi dönemi sırasında bu etken %86,35 oranında görülürken, pandemi sonrası %68,42 oranında görülmüştür. Pandemi dönemi Pseudomonas aeruginos'a %4,55 saptanırken pandemi sonrası bu etken %10,53'e, Escherichia coli pandemi dönemi %4,55 saptanırken pandemi sonrası %15,79 seviyelerine çıkmıştır. Pandemi dönemi Klebsiella pneumoniae etkeni görülürken, pandemi sonrası bu etken yerini Enterococcus faecium'a bırakmıştır. Enfeksiyon bulaşlarında en sık yol ventilatör ilişkili pnömoni, daha az oranlarda ise kateter ilişkili idrar yolu enfeksiyonu ve kan dolaşım enfeksiyonu olarak bildirilmiştir. Sonuç: Çalışmamız, COVID-19 hastalarında ikincil enfeksiyon insidansının daha yüksek ve enfeksiyonda farklı etkenler olduğunu doğrulamaktadır. Bundan dolayı çalışmamız, pandemi sonrası görülme oranları değişen enfeksiyon etkenlerine, izolasyon ve bulaş önlenmelerine yönelik daha dikkatli olunması gerektiğine ve etkin antibiyotik tedavilerinin önemli katkı sağlayacağına inanmaktayız.
Anahtar Kelimeler: Pandemi; nozokomiyal enfeksiyon; yoğun bakım; COVID-19
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] enfeksiyonu sonrası yoğun bakım ünitelerinde tedavi görmüş hastaların nozokomiyal enfeksiyon sıklığı, tipi ve en sık görülen sorumlu etkenlerin araştırılması amaçlanmıştır. Gereç ve Yöntemler: 1 Ekim 2022-1 Ocak 2023 tarihleri arasında Yozgat Şehir Hastanesi 3. Basamak Genel Yoğun Bakım A ve Genel Yoğun Bakım B ünitelerinde takip edilen ve izlemleri sırasında nozokomiyal enfeksiyon gelişen 496 hasta çalışmaya dâhil edildi. Tek merkezli, retrospektif gerçekleştirilen bu tanımlayıcı çalışmada, hasta verileri hastane bilgi sisteminden ve Enfeksiyon Kontrol Komitesi tarafından tutulan kayıtlardan yararlanılarak toplandı. Bulgular: Pandemi dönemi ve sonrası yoğun bakımlarda en sık gördüğümüz etken Acinetobacter baumannii'dir. Pandemi dönemi sırasında bu etken %86,35 oranında görülürken, pandemi sonrası %68,42 oranında görülmüştür. Pandemi dönemi Pseudomonas aeruginos'a %4,55 saptanırken pandemi sonrası bu etken %10,53'e, Escherichia coli pandemi dönemi %4,55 saptanırken pandemi sonrası %15,79 seviyelerine çıkmıştır. Pandemi dönemi Klebsiella pneumoniae etkeni görülürken, pandemi sonrası bu etken yerini Enterococcus faecium'a bırakmıştır. Enfeksiyon bulaşlarında en sık yol ventilatör ilişkili pnömoni, daha az oranlarda ise kateter ilişkili idrar yolu enfeksiyonu ve kan dolaşım enfeksiyonu olarak bildirilmiştir. Sonuç: Çalışmamız, COVID-19 hastalarında ikincil enfeksiyon insidansının daha yüksek ve enfeksiyonda farklı etkenler olduğunu doğrulamaktadır. Bundan dolayı çalışmamız, pandemi sonrası görülme oranları değişen enfeksiyon etkenlerine, izolasyon ve bulaş önlenmelerine yönelik daha dikkatli olunması gerektiğine ve etkin antibiyotik tedavilerinin önemli katkı sağlayacağına inanmaktayız.
Anahtar Kelimeler: Pandemi; nozokomiyal enfeksiyon; yoğun bakım; COVID-19
ABSTRACT
Objective: It was aimed to investigate the frequency, type, and most common responsible agents of nosocomial infection in patients treated in intensive care units after coronavirus disease-2019 (COVID-19) infection. Material and Methods: 496 patients who were followed up in Yozgat City Hospital general intensive care unit A and general Intensive Care unit B between October 1, 2022 and January 1, 2023 and developed nosocomial infection during their follow-up were included in the study. In this descriptive, single-center, retrospective study, patient data were collected using the hospital information system and records kept by the Infection Control Committee. Results: The most common agent we see in intensive care units during and after the pandemic is Acinetobacter baumannii. While this agent was seen in 86.35% during the pandemic period, it was seen in 68.42% after the pandemic. While Pseudomonas aeruginosa was detected at 4.55% during the pandemic period, this agent increased to 10.53% after the pandemic, and while Escherichia coli was detected at 4.55% during the pandemic period, it increased to 15.79% after the pandemic. While the agent Klebsiella pneumoniae was seen during the pandemic period, this agent was replaced by Enterococcus faeciuma after the pandemic. The most common way of infection transmission was found to be ventilator-associated pneumonia, and at lower rates, catheter-associated urinary tract infection and bloodstream infection. Conclusion: Our study confirms that the incidence of secondary infections is higher in COVID-19 patients and there are different factors. Therefore, we believe that our study indicates that more attention should be paid to the infectious agents whose incidence rates have changed after the pandemic, isolation and contamination prevention, and that effective antibiotic treatments will make a significant contribution.
Keywords: Pandemic; nosocomial infection; intensive care; COVID-19
Objective: It was aimed to investigate the frequency, type, and most common responsible agents of nosocomial infection in patients treated in intensive care units after coronavirus disease-2019 (COVID-19) infection. Material and Methods: 496 patients who were followed up in Yozgat City Hospital general intensive care unit A and general Intensive Care unit B between October 1, 2022 and January 1, 2023 and developed nosocomial infection during their follow-up were included in the study. In this descriptive, single-center, retrospective study, patient data were collected using the hospital information system and records kept by the Infection Control Committee. Results: The most common agent we see in intensive care units during and after the pandemic is Acinetobacter baumannii. While this agent was seen in 86.35% during the pandemic period, it was seen in 68.42% after the pandemic. While Pseudomonas aeruginosa was detected at 4.55% during the pandemic period, this agent increased to 10.53% after the pandemic, and while Escherichia coli was detected at 4.55% during the pandemic period, it increased to 15.79% after the pandemic. While the agent Klebsiella pneumoniae was seen during the pandemic period, this agent was replaced by Enterococcus faeciuma after the pandemic. The most common way of infection transmission was found to be ventilator-associated pneumonia, and at lower rates, catheter-associated urinary tract infection and bloodstream infection. Conclusion: Our study confirms that the incidence of secondary infections is higher in COVID-19 patients and there are different factors. Therefore, we believe that our study indicates that more attention should be paid to the infectious agents whose incidence rates have changed after the pandemic, isolation and contamination prevention, and that effective antibiotic treatments will make a significant contribution.
Keywords: Pandemic; nosocomial infection; intensive care; COVID-19
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