Publication: Yenidoğan cerrahi yoğun bakım ünitesinde cerrahi sonrası sepsis ve risk faktörleri
Abstract
Amaç: Sepsis, yenidoğan cerrahi yoğun bakım ünitelerinde (YCYBÜ) önemli morbitide ve mortalité nedenleri arasındadır. Bu geriye dönük çalışmada, YCYBÜ'müzdeki postoperatif sepsis sıklığının ve sepsis gelişimine neden olabilecek risk f aktörlerinin belirlenmesi amaçlandı. Yöntem: Ekim 1996Mayıs 2001 tarihleri arasında YCYBÜ'müze yatan, ameliyat olan ve dosyalarından verilerine ulaşılabilen 72 yenidoğan çalışmaya alındı. Yenidoğanlarda ameliyat sonrası sepsisi, kan kültüründe mikroorganizma üremesi, pürülan yara akıntısı veya postoperatif dönemde sepsisi destekleyici klinik ve laboratuvar verilerin bulunması olarak tanımlandı. Sepsis geçiren yenidoğanlar sepsis grubu, diğerleri de kontrol grubu olarak isimlendirildi. Her grup için H muhtemel risk faktörü incelendi. Bunlar; cinsiyet, prematürite, operasyon yaşı, yara tipi, cerrahi stres derecesi, TPN kullanımı, endotrakeal entübasyon, mekanik ventilasyon, üriner kateterizasyon, göğüs tüpü takılması ve postoperatif oral beslenmeye geçiş süresidir. Bulgular: Ameliyat sonrası sepsis sıklığı % 40 olarak saptandı. Sadece onsekiz hastada (% 25) kan kültüründe üreme oldu ve en çok izole edilen mikroorganizma da Klebsiella pneumonia idi. Sepsise bağlı ölüm sadece 2 olguda gözlendi. Sepsis grubu kontrol grubu ile karşılaştırıldığında, cinsiyet, prematürite, operasyon yaşı ve göğüs tüpü takılması açısından belirgin bir fark yoktu. Sepsis grubunda; orta derecede cerrahi stres, kontamine yara tipi, TPN kullanımı, endotrakeal entübasyon, mekanik ventilasyon, üriner kateterizasyon ve postoperatif oral beslenmeye geç başlama kontrol grubuna göre istatistiksel olarak anlamlı bulundu (p<0.001). Sonuç: l.YCYBÜ'müzde Klebsiella pneumonia en sık izole edilen mikroorganizmadır. 2. Majör operasyon geçiren ve orta derecede cerrahi strese maruz kalan yenidoğanlarda sepsis riski daha yüksek saptandı. 3. TPN kullanımı, postoperatif oral beslenmeye geç başlanması ve endotrakeal entübasyon, mekanik ventilasyon, üriner kateterizasyon gibi invazif girişimler sepsisli yenidoğanlarda en sık saptanan risk faktörleridir.
Aim: Sepsis remains a significant source of mortality and morbidity in neonatal surgical intensive care units (NS1CU). In this retrospective study, we aimed to determine the incidence of postoperative sepsis and to identify the risk factors associated with the development of sepsis in our NSICU. Method: We could reach the files of 72 neonates admitted to our NSICU during the period October 1996 to May 2001. Neonatal postoperative sepsis was defined as growth of microorganism in blood culture, purulent wound discharge or clinical and laboratory data supportive of sepsis in the postoperative period. The neonates having sepsis was named as septic group, the others as control. Eleven probable risk factors were evaluated; sex, prematurity, age at operation, wound type, degree of surgical stress, TPN, having an endotracheal tube, mechanical ventilation, urinary catheterisation, insertion of chest tube and time for starting postoperative enteral feeding. Results: The postoperative sepsis incidence was 40.21%. Only 18 patients (25 %) had positive hemoculture and Klebsiella pneumonia was the most commonly isolated microorganism. Only two cases died due to sepsis. When comparing the septic group with controls, there were no significant difference in sex, prematurity, age at operation and having chest tube. Factors found to be significantly associated with a postoperative sepsis in our NSICU were moderate degree of surgical stress, contaminated wound type, TPN, having an endotracheal tube, mechanical ventilation, urinary catheterisation and time for starting postoperative oral feeding (p<0.001). Conclusion: 1. Klebsiella pneumonia was the most common isolated microorganism in our NStCU. 2. The babies undergoing major operation and having a moderate degree of surgical stress were most likely at risk of sepsis. 3. Prolonged TPN, late onset of postoperative enteral feeding and interventive procedures such as having an endotracheal tube, mechanical ventilation, urinary catheterisation were the most frequently encountered risk factors in our surgical neonates with sepsis.
Aim: Sepsis remains a significant source of mortality and morbidity in neonatal surgical intensive care units (NS1CU). In this retrospective study, we aimed to determine the incidence of postoperative sepsis and to identify the risk factors associated with the development of sepsis in our NSICU. Method: We could reach the files of 72 neonates admitted to our NSICU during the period October 1996 to May 2001. Neonatal postoperative sepsis was defined as growth of microorganism in blood culture, purulent wound discharge or clinical and laboratory data supportive of sepsis in the postoperative period. The neonates having sepsis was named as septic group, the others as control. Eleven probable risk factors were evaluated; sex, prematurity, age at operation, wound type, degree of surgical stress, TPN, having an endotracheal tube, mechanical ventilation, urinary catheterisation, insertion of chest tube and time for starting postoperative enteral feeding. Results: The postoperative sepsis incidence was 40.21%. Only 18 patients (25 %) had positive hemoculture and Klebsiella pneumonia was the most commonly isolated microorganism. Only two cases died due to sepsis. When comparing the septic group with controls, there were no significant difference in sex, prematurity, age at operation and having chest tube. Factors found to be significantly associated with a postoperative sepsis in our NSICU were moderate degree of surgical stress, contaminated wound type, TPN, having an endotracheal tube, mechanical ventilation, urinary catheterisation and time for starting postoperative oral feeding (p<0.001). Conclusion: 1. Klebsiella pneumonia was the most common isolated microorganism in our NStCU. 2. The babies undergoing major operation and having a moderate degree of surgical stress were most likely at risk of sepsis. 3. Prolonged TPN, late onset of postoperative enteral feeding and interventive procedures such as having an endotracheal tube, mechanical ventilation, urinary catheterisation were the most frequently encountered risk factors in our surgical neonates with sepsis.