Publication: Yoğun bakım hastalarında vankomisine dirençli enterekoklar ve alınan önlemlerin etkinliğinin araştırılması
Abstract
1. ÖZET Amaç: Yoğun bakım hastalarında Vankomisine Dirençli Enterekokların (VRE) ve alınan önlemlerin etkinliğinin araştırılması amacı ile retrospektif yapıldı. Gereç ve Yöntem: Çalışma 01.01.2012-31.12.2013 tarihleri arasında İstanbul’da bir eğitim hastanesi yoğun bakım ünitelerinde yatan toplam 2013 hastanın VRE kolonizasyonu ve/ veya enfeksiyonu olanlar alınarak yapıldı. Veri kaynağını enfeksiyon kontrol komitesinin sürveyans kayıtları oluşturdu. Verilerin değerlendirilmesinde yüzdelik, frekans, ortalama ve Pearson kikare kullanıldı. Bulgular: VRE kolonizasyonunda risk faktörleri; VRE enfeksiyonu olması (p=,001), Apache skoru’nun 25’ten yüksek olması (p=,006), hastane enfeksiyonu olması (p=,044), eşlik eden hastalık varlığı (p=,002) ve vankomisin kullanımı (p=,001) tespit edildi. İnvaziv VRE için eşlik eden hastalık (p=,003), Acinetobacter spp. varlığı (p=,017), daptomisin kullanımı (p=,003)’nün olduğu bulundu. İnvaziv VRE suşlarında yüksek antibiyotik direncine karşılık Linezolid direnci olmadığı ve %50 oranında idrarda izole edildiği belirlendi. VRE’ li hastaların %100’ünde özel derece kullanıldığı, kohort yapıldığı, %70,6’sında geliş sürüntüsü alınmadığı, %70,3’ünün özel odaya alınmadığı, %40.6’sının birebir hemşire bakımı uygulandığı bulundu. Sonuç: Apache skoru yüksekliği, altta yatan hastalıkların olması, vankomisin kullanımı VRE kolonizasyonu için risk faktörü iken, VRE enfeksiyonlarında daptomisin kullanımı, VRE kolonizasyonu, Acinetobacter spp. etkeni izole edilmesi risk faktörü olarak bulundu. Vankomisine dirençli enterekok, hastane enfeksiyonu, temas izolasyonu. 2.
Vancomycine Resistant Enterococci (VRE) In Intensive Care Units (ICU) and Efficacy of Prevention for Strategies Objective: The aim of the study is to survey the vancomycine resistant Enteroccocci, to determine the risk factors and to reveal present condition in our hospital about management of colonizations and infections and prevention strategies to prevent them. Methods and Materials: Totally 2013 patients were treated in our tertiary hospital ICUs between 01.01.2012 and 31.12.2013 and within there patients who had VRE colonization and/ or infection were enrolled in the study. Surveillance forms of infection control committee were used as data source. Percentile, frequency, average and pearson’s chi-square test were used for analysis of data. Results: The risk factors for VRE colonization were being infected with VRE (P=0,001), having APACHE score above 25 (P=0,06), nosocomial infections (p=0,044), accompanying other illnesses (p=0,002) and vancomycine usage (p=0,001). The risk factors for VRE infections were accompanying an other infection (p=0,003), isolation of Acinetobacter spp. (p=0.017) and prior daptomycin usage (p=0,003). We had no Linezolid resistance on VRE isolates, and 50% of the isolates were obtained from urinary samples. Conclusion: High APACHE score, accompanying diseases, prior use of Vancomycine were risk factors for VRE colonization, whereas use of daptomycin, VRE colonization, isolation of Acineobacter were risk factors for VRE infection. We concluded that isolation measures and antibiotic stewardship programmes are very important for critical patients. Vancomycine resistant enterococci, hospital infection, contact isolation
Vancomycine Resistant Enterococci (VRE) In Intensive Care Units (ICU) and Efficacy of Prevention for Strategies Objective: The aim of the study is to survey the vancomycine resistant Enteroccocci, to determine the risk factors and to reveal present condition in our hospital about management of colonizations and infections and prevention strategies to prevent them. Methods and Materials: Totally 2013 patients were treated in our tertiary hospital ICUs between 01.01.2012 and 31.12.2013 and within there patients who had VRE colonization and/ or infection were enrolled in the study. Surveillance forms of infection control committee were used as data source. Percentile, frequency, average and pearson’s chi-square test were used for analysis of data. Results: The risk factors for VRE colonization were being infected with VRE (P=0,001), having APACHE score above 25 (P=0,06), nosocomial infections (p=0,044), accompanying other illnesses (p=0,002) and vancomycine usage (p=0,001). The risk factors for VRE infections were accompanying an other infection (p=0,003), isolation of Acinetobacter spp. (p=0.017) and prior daptomycin usage (p=0,003). We had no Linezolid resistance on VRE isolates, and 50% of the isolates were obtained from urinary samples. Conclusion: High APACHE score, accompanying diseases, prior use of Vancomycine were risk factors for VRE colonization, whereas use of daptomycin, VRE colonization, isolation of Acineobacter were risk factors for VRE infection. We concluded that isolation measures and antibiotic stewardship programmes are very important for critical patients. Vancomycine resistant enterococci, hospital infection, contact isolation