Publication: Türkiye’deki çocuk yoğun bakım ünitelerinde sağlık hizmeti ilişkili enfeksiyonlar: tek günlük nokta prevalans çalışması
Abstract
Nokta Prevalans, Çocuk Yoğun Bakım Üniteleri, ÇYBÜ, Sağlık Hizmeti İlişkili Enfeksiyon, SHİE, Türkiye Amaç: Çocuk yoğun bakım ünitelerinde morbidite ve mortalitenin önde gelen sebeplerinden biri olan sağlık hizmeti ilişkili enfeksiyonların (SHİE) prevalansını belirlemek. Metod: Yirmi yedi Eylül, 2012 tarihinde gerçekleştirilen nokta prevalans çalışmamıza 50 çocuk yoğun bakım ünitesi dahil edildi. Demografik özellikler, enfeksiyon tipleri, mikrobiyolojik bulgular, tıbbi gereç kullanımı ve hastalık sonucun içeren veriler değerlendirildi. Sonuçlar: Elli çocuk yoğun bakım ünitesinden 327 hasta dahil edildi. Ortalama yaş 48 ± 57 (bir-216 ay) idi. Yüzyirmiiki (%37) hastada bir veya birden fazla sağlık hizmeti ilişkili enfeksiyon mevcuttu. En sık enfeksiyon tipleri alt solunum yolu enfeksiyonları (n=77, %23,5), kan akımı enfeksiyonları (n=38, %11,6) ve idrar yolu enfeksiyonları (n=10, %3) idi. En sık saptanan patojenler Pseudomonas aeruginosa (30 enfeksiyon, %42), Acinetobacter türleri (18 enfeksiyon, %25) ve Candida türleri (9 enfeksiyon, %12) idi. Hastane tipi, santral venöz kateter, idrar sondası, ortalama idrar kateter süresi, endotrakeal tüp, mekanik ventilasyon, total parenteral nütrisyon, ortalama total parenteral nütrisyon süresi, nazogastrik sonda, antibiyotik tedavisi, ortalama antibiyotik kullanım süresi, antifungal tedavi, ortalama antifungal kullanım süresi ve çocuk yoğun bakım ünitesi uzmanı varlığı SHİE için risk faktörü olarak saptandı. En sık kullanılan antibiyotik türleri üçüncü kuşak sefalosporinler (%19) karbapenemler (%14) ve glikopeptidler (%9) idi. Dört haftalık izlem sonrası 43 (%13) hasta eksitus oldu ve bunların 28’i (%8) SHİE ilişkili olarak bildirildi. Erkek cinsiyet, santral venöz kateter, idrar sondası, ortalama idrar sondası kullanım günü, endotrakeal tüp, mekanik ventilasyon, total parenteral nütrisyon, nazogastrik sonda, steroid kullanımı, hepatik yetmezlik, antifungal kullanımı ve SHİE varlığı mortalite ile ilişkili risk faktörleri olarak belirlendi. Sonuç: Ulusal çok merkezli nokta prevalans çalışmamızda ülkemiz çocuk yoğun bakım ünitelerinde SHİE prevalansının yüksek olduğu belirlendi. Bu enfeksiyonların önlenmesinin ulusal bir önceliğimiz haline gelmesi gerekmektedir.
Prevalance, Pediatric Intensive Care Units, PICU, Healthcare-Associated Infections, HCAI, Turkey Objective: To determine the prevalance of healthcare-associated infections, a major cause of morbidity and mortality in pediatric intensive care unit patients. Methods: Pediatric Intensive Care Units (n=50) participated in a pointprevalance survey on September 27, 2012. Data collected for all pediatric intensive care unit inpatients included demographics, infections, microbiological findings, therapeutic interventions and outcomes. Results: There were 327 patients in 50 PICUs. The median age was 48 ± 57 months (range 1-216 months). One hundred twenty two patients had 1 or more healthcare-associated infections corresponding to a prevalance of %37. The most frequently reported sites were lower respiratory tract (n=77, 23,5% ), blood-stream (n=38, 11,6%) and urinary tract (n=10, 3%). The most frequent pathogens were Pseudomonas aeruginosa (in 30 infections, 42%), Acinetobacter spp. (in 18 infections,25% ) and Candida spp. (in 9 infections, 12%). Hospital type (research and education or university hospital), central venous catheters, urinary catheters, mean urinary catheter duration, endotracheal tube, mechanical ventilation, total parenteral nutrition, mean total parenteral nutrition duration, nasogastric feeding, antibiotic therapy, mean antibiotic therapy duration, antifungal therapy, mean antifunga therapy duration and pediatric intensive care specialist existence were found to be risk factors. Most frequently administered antimicrobials were third generation cephalosporins (19%), carbapenems (14%) and glycopeptides (9%). According to a 4-weeks follow up, 43 (13%) patients died, 28 (8%) of whom died from healthcareassociated infections. Male gender, central venous catheter, urinary catheter, mean urinary catheter duration, endotracheal tube, mechanical ventilation, total parenteral nutrition, nasogastric feeding, steroids, hepatic failure, antifungals and healthcare associated infections were risk factors for death. Conclusion: This national multicenter study documented the high prevalence of healthcare associated infections. Preventing these infections should be a national priority.
Prevalance, Pediatric Intensive Care Units, PICU, Healthcare-Associated Infections, HCAI, Turkey Objective: To determine the prevalance of healthcare-associated infections, a major cause of morbidity and mortality in pediatric intensive care unit patients. Methods: Pediatric Intensive Care Units (n=50) participated in a pointprevalance survey on September 27, 2012. Data collected for all pediatric intensive care unit inpatients included demographics, infections, microbiological findings, therapeutic interventions and outcomes. Results: There were 327 patients in 50 PICUs. The median age was 48 ± 57 months (range 1-216 months). One hundred twenty two patients had 1 or more healthcare-associated infections corresponding to a prevalance of %37. The most frequently reported sites were lower respiratory tract (n=77, 23,5% ), blood-stream (n=38, 11,6%) and urinary tract (n=10, 3%). The most frequent pathogens were Pseudomonas aeruginosa (in 30 infections, 42%), Acinetobacter spp. (in 18 infections,25% ) and Candida spp. (in 9 infections, 12%). Hospital type (research and education or university hospital), central venous catheters, urinary catheters, mean urinary catheter duration, endotracheal tube, mechanical ventilation, total parenteral nutrition, mean total parenteral nutrition duration, nasogastric feeding, antibiotic therapy, mean antibiotic therapy duration, antifungal therapy, mean antifunga therapy duration and pediatric intensive care specialist existence were found to be risk factors. Most frequently administered antimicrobials were third generation cephalosporins (19%), carbapenems (14%) and glycopeptides (9%). According to a 4-weeks follow up, 43 (13%) patients died, 28 (8%) of whom died from healthcareassociated infections. Male gender, central venous catheter, urinary catheter, mean urinary catheter duration, endotracheal tube, mechanical ventilation, total parenteral nutrition, nasogastric feeding, steroids, hepatic failure, antifungals and healthcare associated infections were risk factors for death. Conclusion: This national multicenter study documented the high prevalence of healthcare associated infections. Preventing these infections should be a national priority.