Ege Üniversitesi Yenidoğan Yoğun Bakım Ünitesinde 2013-2018 yılları arasında yatan hastalarda invaziv araç ilişkili enfeksiyonların retrospektif olarak araştırılması
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2020
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Ege Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
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Amaç: Yenidoğan bakımındaki gelişmeler, daha küçük ve hasta bebeklerin hayatta kalma oranının artmasını sağlarken, sağlık hizmetleriyle ilişkili veya hastane kaynaklı enfeksiyonlar olarak da bilinen nozokomiyal enfeksiyon (NE)'ları da arttırmaktadır. Bu enfeksiyonlar artmış mortalite ve morbidite oranları, uzun süre hastane yatışı ve artan bakım maliyeti ile sonuçlanmaktadır. Bu çalışmada; yenidoğan yoğun bakım ünitemizdeki invaziv araç ilişkili enfeksiyon (İAİE) oranlarımızı görmek, verilerimizi Dünya ve Türkiye verileri ile karşılaştırmak ve buna yönelik ünitemizde gerekli düzenlemeleri yaparak lüzum halinde yeni tedbirler almak amaçlandı. Gereç ve Yöntem: Ege Üniversitesi 2.-3. düzey Yenidoğan Yoğun Bakım Ünitesinde Ocak 2013- Aralık 2018 tarihleri arasında yatarak tedavi alan 1795 hastanın verileri retrospektif olarak incelenerek, invaziv araç ilişkili enfeksiyon saptanan olgular çalışmaya dahil edildi. Karşılaştırma için invaziv araç kullanımı olan ancak invaziv araç ilişkili enfeksiyonu olmayan olgulardan kontrol grubu oluşturuldu. Ventilatör ilişkili pnömoni (VİP), santral venöz kateter ilişkili kan dolaşım enfeksiyonu (SVKİ-KDE) ve umblikal kateter ilişkili kan dolaşım enfeksiyonu (UKİ-KDE) hızları ile invaziv araçların kullanım oranları araştırıldı. Olgular kilolarına ve gestasyonel haftalarına göre gruplandırıldı. Hasta olgularda ana yatış tanısı, eşlik eden komorbiditeler, prenatal anneye ait risk faktörleri, beslenme durumları ve mortalite durumları ile, herbir faktörün VİP, SVKİ-KDE ve UKİ-KDE'una etkisi incelendi. Bulgular: Hastaların elektronik ve arşiv dosyaları tarandığında invaziv araç ilişkili enfeksiyon geçiren 86 olgu ve bu olgular içinde toplam 169 atak saptandı. Çalışma grubunda olguların %55,8'i (n=48) erkek, %44,2'si kızdı (n=38). Ortalama gestasyonel hafta 33,65±5,23 hafta ve ortalama doğum ağırlığı 2158,29±1064,19 gram idi. Ortalama yatış süresi 101,49±69,73 gün olarak saptandı. Ana yatış tanıları prematürite %40,7 (n=35), konjenital kalp hastalığı (KKH) %39,5 (n=34) ve diğer tanılar %17,8 (n=17) olarak dağılım göstermekteydi. Olgu bazında İAİE insidansı 4,79/100, İAİE insidans yoğunluğu (dansitesi) 4,68/1000 olarak saptandı. VİP hızı 9/1000, VİP insidansı 3,7/100, SVKİ-KDE hızı 7,6/1000, xii SVKİ-KDE insidansı 2,2/100, UKİ-KDE hızı 1,25/1000, UKİ-KDE insidansı ise 0,38/100 olarak saptandı. İnvaziv mekanik ventilasyon kullanım oranı 0,25, SVK kullanım oranı 0,18 ve UK kullanım oranı 0.19 olarak bulundu. VİP ve vücut ağırlığı grupları arasında düşük doğum ağırlıklı gruplar lehine (p=0.025), gestasyonel ve VİP arasında preterm grup lehine (p=0.001) ve SVKİ-KDE arasında preterm grup lehine (p=0.039) istatistiksel anlamlılık saptandı. Eşlik eden komorbiditelerden respiratuar distres sendromu (RDS) ile VİP arasında anlamlı ilişki saptandı (p=0,002). VİP+santral kateter ilişki kan dolaşım enfeksiyonu (SKİ- KDE) birlikteliği olan olgular ile siyanotik konjenital kalp hastalığı olan olgular arasında da anlamlı ilişki saptandı (p=0,016). Mortalite ile kilo grupları ve gestasyonel hafta grupları arasında anlamlılık saptanmazken, KKH birlikteliği olan İAİE'lu olgularda, >2500 gr olan grup (p=0,008) ile ≥37 hafta olan grupta (p=0,007) mortalite ile anlamlı ilişki saptandı. Univariate lojistik regresyon analizi ve Multiple lojistik regresyon analizi için 59 hastadan oluşan kontrol grubu oluşturuldu. Kontrol grubunda, hasta gruptaki ile benzer olarak olguların %52,5 (n=31) erkek ve %47,5'i (n=28) kızdı. Ortalama gestasyonel hafta 31,492±5,07 hafta ve ortalama doğum ağırlığı 1769,05±940,68 gram idi. Ortalama yatış süresi 53,91±43,64 gün olarak saptandı. KKH'nın İAİE'a etkisine bakıldığında İAİE'nu 2.3 kat arttırdığı (OR:2.359 95%CI:1,18-4.07 P=0,015) saptandı. Total parenteral nütrisyon (TPN) süresinin uzun olmasının İAİE'nu %4,3 arttırdığı (OR:1,043 95%CI:1,023-1,064 P=,000) ve total enteral (T/E) beslenmeye geçişteki gecikmenin %2,9 arttırdığı (OR:1,029 95%CI:1,010-1,049 P=0,002) bulundu. Sonuç: Hastane kaynaklı İAİE'lar, yenidoğan bakımındaki ilerlemelere ve yenidoğanların sağkalımını iyileştirmeye yönelik yoğun çabalara rağmen halen en önemli morbidite ve mortalite nedenlerinden biridir. Ünitemizin VİP hızı, gelişmiş ülkelerin verilerine göre daha yüksek seyretmektedir. Buna karşılık gelişmekte olan ülkeler ile VİP hızımız benzer SVK/UKİ-KDE hızımız düşük bulundu. Türkiye verileri ile karşılaştırmada, üniversite hastaneleri baz alındığında VİP hızımız hafif yüksek SVKİ-KDE hızımız benzer UKİ-KDE hızımız oldukça düşük idi. Her yıl kendi içinde değerlendirildiğinde, bir önceki yıla göre enfeksiyon hızlarımız düşük bulundu. İAİE hızındaki yükseklik, kardiyopatili hasta oranımızdaki yükseklik ile ilişkilendirildi.
Aim: Advances in neonatal care increase the survival rate of smaller and sick babies, while increasing nosocomial infection (NI), also known as health care associated or hospital acquired infections. These infections result in increased mortality and morbidity rates, prolonged hospital stay and increased cost of care. This study was aimed; to analyze device assosiated infection (DAI) rates in our neonatal intensive care unit (NICU), compare our datas with the data of other countries and our country, and to take new measures by making the necessary arrangements for our unit when needed. Material and Methods: Our study was designed retrospectively. The data of 1795 patients who received inpatient treatment in 2nd and 3rd level treatment at NICU between January 2013 and December 2018 at Ege University were retrospectively analyzed and cases with DAI included in the study. For comparison, a control group was formed with patients who used invasive devices but did not have an infection. The rates of ventilator-associated pneumonia (VAP), central venous catheter-associated bloodstream infection (CVCA-BSI), and umbilical catheter-associated bloodstream infection (UCA-BSI) and the utilization ratio of invasive devices were investigated. The cases were grouped according to their weight and gestational weeks. The diagnoses of main hospitalization of sick cases, accompanying comorbidities, prenatal risk factors, nutritional status and mortality status, and the effects of each factor on VAP, CVCA-BSI and UCA-BSI were examined in all patients. Results: There is 86 patients with invasive device-assosiated infections and 169 attacks in total were detected. The gender distribution of our cases was %55,8 (n=48) male and %44,2 (n=38) female. The mean gestational age and mean birthweight of the patients were 33.65 ± 5.23 weeks and 2158.29 ± 1064.19 grams, respectively. The average length of hospital stay was 101.49 ± 69.73 days. The main hospitalization diagnoses were of premature 40.7% (n=35), congenital heart disease (CHD) 39.5% (n=34), and other diagnoses were 17.8% (n=17). On a case-by-case basis, the incidence of DAI was 4.79/100 and the incidence density of DAI was 4.68/1000. VAP rate 9/1000, VAP incidence 3.7/100, CVCA-BSI rate 7.6/1000, xiv CVCA-BSI incidence 2.2/100, UCA-BSI rate 1.25/1000 and incidence of UCA-BSI 0,38/100 was found as. Ventilator utilization ratio was 0,25, CVC utilization ratio was 0,18 and UC utilization ratio was 0.19. A statistical significance was found between VAP and body weight groups in favor of low birth weight groups (p=0.025), gestational age in favor of the preterm group (p=0.001), and between CVCA-BSI and gestational age in favor of the preterm group (p=0.039). A significant correlation was found between respiratory distress syndrome (RDS) and VAP (p=0.002). A significant correlation was also found between cases with VAP + central line assosiated bloodstream infection (CLABSI) and cases with cyanotic congenital heart disease (p=0.016). While there was no significance between mortality and weight groups and gestational week groups, a significant relationship was found between the group with >2500 g (p=0.008) and the group with ≥37 weeks (p=0.007) in patients with DAI with CHD. A control group of 59 patients was formed for univariate logistic regression analysis and Multiple logistic regression analysis. In the control group distrubition was similar to the patient group of 52.5% (n=31) were male and 47.5% (n=28) were female. The mean gestational age and mean birthweight of the patients were 31,492±5,07 weeks and 1769,05±940,68 grams, respectively. The average length of hospital stay was 53,91±43,64 days. Considering the effect of CHD on DAI, it was found that it increased the DAI 2.3 times (OR:2.359 95%CI:1,18-4.07 P=0,015). It was found that a long total parenteral nutrition (TPN) duration increased the DAI by 4.3% (OR:1,043 95%CI:1,023-1,064 P=,000) and the delay in transition to total enteral (T/E) feeding increased 2.9% (OR:1,029 95%CI:1,010- 1,049 P=0,002). Conclusion: Hospital-acquired DAIs are still one of the most important causes of morbidity and mortality, despite the advances in neonatal care and intensive efforts to improve neonatal survival. The VAP rate of our unit is still higher than the data of developed countries. On the other hand, our VAP rate was similar with developing countries and our CVC/UCA-BSI rate was low. According to the University Hospital in Turkey's data base, our VAP rate was slightly high, CVCA-BSI rate was similar, and UCA-BSI rate was quite low. When looked by years, our infection rates were decreasing compared to previous years. Higher rates of DAI have been associated with our higher rate of cardiopathy patients.
Aim: Advances in neonatal care increase the survival rate of smaller and sick babies, while increasing nosocomial infection (NI), also known as health care associated or hospital acquired infections. These infections result in increased mortality and morbidity rates, prolonged hospital stay and increased cost of care. This study was aimed; to analyze device assosiated infection (DAI) rates in our neonatal intensive care unit (NICU), compare our datas with the data of other countries and our country, and to take new measures by making the necessary arrangements for our unit when needed. Material and Methods: Our study was designed retrospectively. The data of 1795 patients who received inpatient treatment in 2nd and 3rd level treatment at NICU between January 2013 and December 2018 at Ege University were retrospectively analyzed and cases with DAI included in the study. For comparison, a control group was formed with patients who used invasive devices but did not have an infection. The rates of ventilator-associated pneumonia (VAP), central venous catheter-associated bloodstream infection (CVCA-BSI), and umbilical catheter-associated bloodstream infection (UCA-BSI) and the utilization ratio of invasive devices were investigated. The cases were grouped according to their weight and gestational weeks. The diagnoses of main hospitalization of sick cases, accompanying comorbidities, prenatal risk factors, nutritional status and mortality status, and the effects of each factor on VAP, CVCA-BSI and UCA-BSI were examined in all patients. Results: There is 86 patients with invasive device-assosiated infections and 169 attacks in total were detected. The gender distribution of our cases was %55,8 (n=48) male and %44,2 (n=38) female. The mean gestational age and mean birthweight of the patients were 33.65 ± 5.23 weeks and 2158.29 ± 1064.19 grams, respectively. The average length of hospital stay was 101.49 ± 69.73 days. The main hospitalization diagnoses were of premature 40.7% (n=35), congenital heart disease (CHD) 39.5% (n=34), and other diagnoses were 17.8% (n=17). On a case-by-case basis, the incidence of DAI was 4.79/100 and the incidence density of DAI was 4.68/1000. VAP rate 9/1000, VAP incidence 3.7/100, CVCA-BSI rate 7.6/1000, xiv CVCA-BSI incidence 2.2/100, UCA-BSI rate 1.25/1000 and incidence of UCA-BSI 0,38/100 was found as. Ventilator utilization ratio was 0,25, CVC utilization ratio was 0,18 and UC utilization ratio was 0.19. A statistical significance was found between VAP and body weight groups in favor of low birth weight groups (p=0.025), gestational age in favor of the preterm group (p=0.001), and between CVCA-BSI and gestational age in favor of the preterm group (p=0.039). A significant correlation was found between respiratory distress syndrome (RDS) and VAP (p=0.002). A significant correlation was also found between cases with VAP + central line assosiated bloodstream infection (CLABSI) and cases with cyanotic congenital heart disease (p=0.016). While there was no significance between mortality and weight groups and gestational week groups, a significant relationship was found between the group with >2500 g (p=0.008) and the group with ≥37 weeks (p=0.007) in patients with DAI with CHD. A control group of 59 patients was formed for univariate logistic regression analysis and Multiple logistic regression analysis. In the control group distrubition was similar to the patient group of 52.5% (n=31) were male and 47.5% (n=28) were female. The mean gestational age and mean birthweight of the patients were 31,492±5,07 weeks and 1769,05±940,68 grams, respectively. The average length of hospital stay was 53,91±43,64 days. Considering the effect of CHD on DAI, it was found that it increased the DAI 2.3 times (OR:2.359 95%CI:1,18-4.07 P=0,015). It was found that a long total parenteral nutrition (TPN) duration increased the DAI by 4.3% (OR:1,043 95%CI:1,023-1,064 P=,000) and the delay in transition to total enteral (T/E) feeding increased 2.9% (OR:1,029 95%CI:1,010- 1,049 P=0,002). Conclusion: Hospital-acquired DAIs are still one of the most important causes of morbidity and mortality, despite the advances in neonatal care and intensive efforts to improve neonatal survival. The VAP rate of our unit is still higher than the data of developed countries. On the other hand, our VAP rate was similar with developing countries and our CVC/UCA-BSI rate was low. According to the University Hospital in Turkey's data base, our VAP rate was slightly high, CVCA-BSI rate was similar, and UCA-BSI rate was quite low. When looked by years, our infection rates were decreasing compared to previous years. Higher rates of DAI have been associated with our higher rate of cardiopathy patients.
Açıklama
Anahtar Kelimeler
İnvaziv Araç İlişkili Enfeksiyon, Neonatoloji, Prematürite, Konjenital Kalp Hastalığı, Yenidoğan, Nozokomiyal Enfeksiyon, Device Assosiated Infection, Neonatology, Prematurity, Congenital Heart Disease, Newborn, Nosocomial Infection
