Çocuk cerrahisi kliniğinde cerrahi alan enfeksiyonları sıklığı ve etkileyen faktörlerin belirlenmesi
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç
Cerrahi alan enfeksiyonları (CAE), sağlık bakımı ile ilişkili en sık enfeksiyon olarak
tanımlanmaktadır. Pediatrik yaş grubunda bu konuda az sayıda yayın olup, CAE sıklığı %1 ile
özellikle pediatrik yoğun bakımlarda %20 arasında değişmektedir. Bu oran erişkinlere göre daha
az olmakla birlikte, genellikle yaş ile ters orantılıdır. Türkiye’de yalnızca çocukluk çağı CAE’larını
inceleyen ulusal bir çalışma yoktur. Ulusal literatüre katkıda bulunmak ve klinik verilerimizi ortaya
koymak amacı ile kliniğimizdeki CAE sıklığı ve etkileyen faktörler prospektif olarak
değerlendirilmiştir.
Gereç ve Yöntem
Çalışmamıza Ege Üniversitesi Tıp Fakültesi Çocuk Cerrahisi Anabilim Dalına Kasım 2019
ile Kasım 2020 tarihleri arasında başvuran ve ameliyathane şartlarında cerrahi prosedür uygulanan
1571 hasta dahil edilmiştir. Ameliyat edilen hastalar; ameliyat öncesi, sırası ve sonrasında
poliklinik ve telefon değerlendirmeleri ile 30 gün, implant varlığında 90 gün takipte tutularak
cerrahi yara sınıflamasına göre, CAE sıklığı (insidans) ve etkileyen faktörler belirlenmiştir. Bu
faktörler (yara yeri sınıflaması ile CAE arasındaki ilişki, operasyon süresi-anestezi süresi, ameliyat
sırasında kanama gibi komplikasyon varlığı, dren-implant varlığı, uygulanan cilt temizliği,
proflaktik antibiyotik kullanımı ve zamanlaması, eşlik eden hastalık varlığı- immunsupresyon
varlığıdır. İstatistiksel analizler IBM SPSS Statistics 25.0 ile yapılmış olup veriler Ki-kare, logistik
regresyon analizi, Mann Whitney U testi ve Roc analizleri ile incelenmiştir.
Bulgular
Belirlenen süre içerisinde kliniğimizde ameliyat edilen 1716 hastadan 1517’si (0-18 yaş)
çalışmaya dahil edilmiş, 199 hasta çalışma dışı bırakılmıştır. Hastalar yaş, cinsiyet, kilo, boy,
hastalık nedeni gibi demografik veriler açısından incelenmiş ve anlamlı farklılık bulunmamıştır.
Hastaların 95’inde CAE gelişmiş, yıllık insidansımız %6.26 olarak hesaplanmıştır. CAE sıklığının
yara yeri sınıfı; anestezi- ameliyat süresi; immunsupresyon varlığı, cerrahi tipi (minimal invazivaçık),
acil cerrahi ihtiyacı, ek hastalık varlığı, komplikasyon gelişimi, implant varlığı gibi faktörlerden anlamlı olarak etkilendiği gösterilmiştir. Risk faktörleri kendi arasında
incelendiğinde; yara yeri sınıfı, immunsupresyon durumu ve ameliyat süresinin 90 dakika üzeri
olmasının en belirleyici faktörler olduğu ortaya koyulmuştur.
Sonuç
CAE önlenebilir en sık nosokomiyal enfeksiyonlardandır. Bu sebeple belirlenen risk
faktörleri ışığında hastalar titizlikle değerlendirilmeli ve uygun önlemler alınmalıdır. Minimal
invaziv cerrahi, enfeksiyon gelişme sıklığını olumlu yönde etkiler. İmmunsupresyon durumu olan
hastalar, CAE gelişimi açısından en riskli gruplardandır, uygun asepsi ve antibiyotik seçimine
önem verilmelidir. Port kateter yerleştirilmesi temiz yara olmasına rağmen implant varlığı ve hasta
grubunun ek hastalık sıklığı göz önünde tutularak mutlaka profilaksi uygulanmalıdır.
Aim of study: Surgical site infections (SSI) are among the highest infections related to patient care. There is a dearth of data in pediatric care where SSI rates can go from 1% to 20%, especially in intensive care units. Even though these rates are less than what is observed in adult patients, they are inversely correlated with age. There has been no study previously carried out in our clinic in this regard. We conducted this prospective study to ascertain frequency of SSI, factors affecting it, and to identify measures of prevention Methods: This study included a total of 1517 patients who had surgery in Ege University School of Medicine, Pediatric Surgery Department between November 2019 and November 2020. SSI incidence and contributing factors were evaluated in these patients prior to and during surgery as well as via phone interviews for 30 days post-surgery or 90 days post-surgery if prosthetics were installed. Contributing factors were as follows: classification of injury site and SSI relationship, duration of operation and duration of anesthesia, complications such as occurrence of bleeding during surgery, katheter usage/prosthetics insertion, skin care, prophylactic antibiotic usage and its timing, co-morbidities, and immunosuppression. Statistical analyses were conducted using IBM SPSS Statistics 25.0, and results were obtained using qi-squared, logistical regression, Mann- Whitney U test and Roc analyses Findings: Of the 1,716 patients included in surgeries in our clinic during the specific time, 1,517 (aged 0-18 years) were included in this study while 199 were excluded. Patients were analyzed demographically based on age, sex, weight and disease type but no significant differences found. SSI incidence rate was %6.26 (n=95) in all grous and %5.4 (n=68) in incisional surgeries( natural orifice surgeries excluded) The frequencry of SSI was drastically affected by wound class, anesthesia - surgery time, presence of immunosuppression, type of surgery (minimally invasiveopen), urgent need for surgery, underlying of additional disease, development of complications, presence of implants in a meaningfull way. When the risk factors analyzed by multivariate logistic regression technique; wound class, presence of immunosuppression and surgery time over 90 minutes were proved to be the most important risk factors. Results: SSI’s are the most preventable nosocomial infections. For this reason the patients must be evaluated with precision under the light of the risk factors. Minimally invasive surgery lowers the frequency of SSI development. Patients with immunosuppression are most risky groups in terms of development of SSI and the selection of appropriate asepsis and antibiotic is vital. Although port catheter placement is a clean wound, prophylaxis must be applied after considering the presence of implant and the frequency of additional diseases of the patient group.
Aim of study: Surgical site infections (SSI) are among the highest infections related to patient care. There is a dearth of data in pediatric care where SSI rates can go from 1% to 20%, especially in intensive care units. Even though these rates are less than what is observed in adult patients, they are inversely correlated with age. There has been no study previously carried out in our clinic in this regard. We conducted this prospective study to ascertain frequency of SSI, factors affecting it, and to identify measures of prevention Methods: This study included a total of 1517 patients who had surgery in Ege University School of Medicine, Pediatric Surgery Department between November 2019 and November 2020. SSI incidence and contributing factors were evaluated in these patients prior to and during surgery as well as via phone interviews for 30 days post-surgery or 90 days post-surgery if prosthetics were installed. Contributing factors were as follows: classification of injury site and SSI relationship, duration of operation and duration of anesthesia, complications such as occurrence of bleeding during surgery, katheter usage/prosthetics insertion, skin care, prophylactic antibiotic usage and its timing, co-morbidities, and immunosuppression. Statistical analyses were conducted using IBM SPSS Statistics 25.0, and results were obtained using qi-squared, logistical regression, Mann- Whitney U test and Roc analyses Findings: Of the 1,716 patients included in surgeries in our clinic during the specific time, 1,517 (aged 0-18 years) were included in this study while 199 were excluded. Patients were analyzed demographically based on age, sex, weight and disease type but no significant differences found. SSI incidence rate was %6.26 (n=95) in all grous and %5.4 (n=68) in incisional surgeries( natural orifice surgeries excluded) The frequencry of SSI was drastically affected by wound class, anesthesia - surgery time, presence of immunosuppression, type of surgery (minimally invasiveopen), urgent need for surgery, underlying of additional disease, development of complications, presence of implants in a meaningfull way. When the risk factors analyzed by multivariate logistic regression technique; wound class, presence of immunosuppression and surgery time over 90 minutes were proved to be the most important risk factors. Results: SSI’s are the most preventable nosocomial infections. For this reason the patients must be evaluated with precision under the light of the risk factors. Minimally invasive surgery lowers the frequency of SSI development. Patients with immunosuppression are most risky groups in terms of development of SSI and the selection of appropriate asepsis and antibiotic is vital. Although port catheter placement is a clean wound, prophylaxis must be applied after considering the presence of implant and the frequency of additional diseases of the patient group.
Açıklama
Anahtar Kelimeler
Cerrahi Alan Enfeksiyonları, Çocuk Cerrahisi Hastaları, Yara Yeri Sınıflaması, İmmunsupresyon, Ameliyat Süresi, Surgical Site Infections, Pediatric Surgery Patients, Wound Classification System, Immunsupression, Operation Time
