2016-2020 yılları arasında Ege Üniversitesi Çocuk Onkoloji Bilim Dalı'nda tedavi alan hastalarda santral venöz kateter ile ilişkili enfeksiyonların araştırılması
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Dosyalar
Tarih
2022
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Çocukluk çağı kanseri tanısı alan hastalarda uzun süreli ilaç tedavisinin sürdürülmesi, kan ve kan ürünleri verilmesi, kan örneklerinin alınması ve total parenteral nütrisyon gibi vasküler erişimi kolaylaştırmak amacıyla santral venöz kateterler son derece önemli araçlardır. Tüm önleyici tedbirlere rağmen, sistemik ve lokal enfeksiyonlar, santral venöz kateterlerin kullanımında en sık karşılaşılan komplikasyonlar olarak devam etmektedir. Kateter ile ilişkili enfeksiyonlar, pediatrik onkoloji hastalarında önemli bir morbidite ve mortalite nedenidir. Kateter ile ilişkili enfeksiyonlar, hastanın primer kemoterapi tedavisinde gecikmeye, uzamış hospitalizasyona ve antimikrobiyal ajan ihtiyacına bağlı olarak maliyet artışına neden olmaktadır. Amaç: Bu çalışmanın amacı, pediatrik onkoloji kliniğinde tedavi alan ve takip edilen hastalarda, kateter ile ilişkili enfeksiyonların sıklığını, ortaya çıkan klinik bulguları ve etken mikroorganizmaların dağılımını incelemektir. Yöntem: Ocak 2016- Aralık 2020 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Çocuk Onkoloji Bilim Dalı'nda kanser tanısı alan ve santral venöz kateter (SVK) takılan hastaların verileri retrospektif olarak değerlendirildi. Hastaların verileri hastane otomasyon sistemi, poliklinik izlem notları ve yatan hasta dosyalarından elde edildi. Kanser tanısı ile tedavi alan 0-18 yaş arasındaki 398 hastanın dosyası tarandı ve santral venöz kateteri olan 202 hastanın verileri çalışmaya dahil edildi. Çocuk onkoloji poliklinik ve çocuk acil servise 38 ℃ ve üzerinde ateşle başvuran hastalar incelenerek her enfeksiyon atağı değerlendirildi. Çalışmaya dahil edilen 202 hastanın 1055 ateşli başvurusunda alınan kateter kültür ve eş zamanlı alınan VII periferik kan, idrar ve diğer kültürleri incelenerek kateter enfeksiyonu sıklığı ve kültürde üretilen mikroorganizmaların dağılımı, antibiyotik direnci gibi verileri dökümente edildi. Hastaların demografik verilerinden yaş, cinsiyet, tanı dağılımları, kateter türü, kateter enfeksiyonu, kan akımı enfeksiyonu, idrar ve diğer enfeksiyonlarda üreyen mikroorganizma dağılımı incelendi. Hastaların enfeksiyon döneminde düzenlenen antimikrobiyal tedaviler değerlendirildi. Elde edilen veriler SPSS 25.0 paket programı ile analiz edildi. Bulgular: Çalışmaya dahil edilen 202 santral kateteri olan kanser hastasının 96'sı (% 47.1) kız, 106'sı (% 52.9) erkek olup hastaların ortalama yaşı 7.25 ± 5.37 yaş (0-18 yaş) idi. Çalışmaya alınan hastalarda kullanılan kateterlere bakıldığında; 152 (% 75.2) hastada sadece port kateter, 33 (%16.3) hastada port katetere ek olarak tedavi süresinde klinik gereklilik nedeniyle diğer santral venöz kateterler takılmıştır. Hickman kateter takılması klinik rutininde daha az tercih edilmekte olup toplam 2 (%1.0) hastaya uygulanmıştır. Geri kalan 15 (%7.5) hastaya SVK ve diğer tür kateterler takılmıştır. Kanser tedavisi alan ve kateteri olan toplam 202 hastanın 1055 ateşli başvurusundaki mikrobiyolojik etkenler incelendi. Alınan 1055 kateter kan kültüründen 253'ünde (% 24) üreme saptandı. Kateter kültürlerinde üreyen mikroorganizmaların dağılımına bakıldığında; % 17.2'i Gram pozitif bakteriler ve % 4.6'sı Gram negatif bakteriler idi. Olguların 7'sinde (% 0.7) ikili üreme saptandı. Sonuç: Kateterli hastalarımızın ateşli başvurularının yalnızca %24'ünde etken mikroorganizma üretilmiştir. Kateter enfeksiyonu etkeni olarak en sık Gram pozitif bakteriler saptanmıştır. Gram pozitif bakterilerden en sık KNS, Gram negatif bakterilerden en sık Pseudomonas saptanmıştır. Mantarlardan en sık Candida spp. saptanmıştır. Enfeksiyon nedeniyle kateter çekme oranı % 7.8 olarak hesaplanmıştır. Kateter ve periferik kan kültüründe üretilen mikroorganizmaların dağılımı arasında belirgin fark saptanmamıştır.
Background: Central venous catheters are extremely important tools to facilitate vascular access such as maintaining long-term drug therapy, administering blood and blood products, collecting blood samples and total parenteral nutrition in the patients diagnosed with childhood cancer. Catheter-related infections are common complications in this patient population. Despite all preventive measures, systemic and local infections remain the most common complications in the use of central venous catheters. Catheter-related infections are an important cause of morbidity and mortality in the pediatric oncology patients. Catheter- related infections cause delay in the primary chemotherapy treatment of the patient, prolonged hospitalization and cost increase due to the need for antimicrobial agents. Objective: The aim of this study is to examine the frequency of catheter-related infections, emerging clinical findings and distribution of causative microorganisms in the patients treated and followed-up at the pediatric oncology clinic. Method: The data of the patients diagnosed with cancer and inserted central venous catheter (CVC) at the Ege University Pediatric Oncology Division between January 2016 and December 2020 was evaluated retrospectively. The patients data was obtained from the hospital records and patient files. The files of 398 patients aged 0-18 years who received treatment with the diagnosis of cancer were reviewed, and the data of 202 patients with CVC were included into the study. The patients with 38 ℃ or more seen in the emergency room or in the inpatient service of the pediatric oncology division were evaluated in terms of catheter infections. 1055 febrile episodes at of 202 patients were included in to the study. In every episode, simultaneously taken peripheral blood, urine and other cultures were examined. The frequency of the catheter infection, the distribution of the microorganisms grown in the culture, and antibiotic resistance were documented. Demographic data of the patients such as age, gender, diagnosis, catheter type, catheter infection, blood stream or urine infection and microorganism distribution in the other infections were analyzed. Antimicrobial treatments during the infection period of the patients were evaluated. The obtained data were analyzed with SPSS 25.0 package program. Results: There were, 96 (47.1%) female and 106 (52.9%) were male, and the mean age was 7.25 ± 5.37 years (0-18 years). The distribution of the catheters used in the study was as follows: 152 (75.2 %) only port catheters, 33 (16.3%) other central venous catheters in addition to port catheter in case of clinical necessity and 2 (1.0%) Hickman catheters. The remaining 15 (7.5%) patients had other types of catheters. The microbiological agents in 1055 febrile admissions were analyzed. In 253 out of 1055 (24%) had bacterial growth in the catheter blood cultures taken. The distribution of the microorganisms grown in the catheter cultures was as follows: 17.2% of them were Gram positive bacteriae and 4.6 % Gram negative bacteriae. Seven (0.7%) cases had two microorganisms grown at the same time. Conclusion: The causative microorganism growth was observed in only 24 % out of the 1055 febrile episodes. Gram-positive bacteriae were the most common causative agents of the catheter infection. CNS was detected as the most frequent agent among the Gram-positive bacteriae, while Pseudomonas among the Gram-negative bacteriae. Candida spp. were found most frequently among the fungi. Catheter removal rate due to the infection was calculated as 7.8%. There was no significant difference between the distribution of microorganisms grown in the catheter and the peripheral blood culture.
Background: Central venous catheters are extremely important tools to facilitate vascular access such as maintaining long-term drug therapy, administering blood and blood products, collecting blood samples and total parenteral nutrition in the patients diagnosed with childhood cancer. Catheter-related infections are common complications in this patient population. Despite all preventive measures, systemic and local infections remain the most common complications in the use of central venous catheters. Catheter-related infections are an important cause of morbidity and mortality in the pediatric oncology patients. Catheter- related infections cause delay in the primary chemotherapy treatment of the patient, prolonged hospitalization and cost increase due to the need for antimicrobial agents. Objective: The aim of this study is to examine the frequency of catheter-related infections, emerging clinical findings and distribution of causative microorganisms in the patients treated and followed-up at the pediatric oncology clinic. Method: The data of the patients diagnosed with cancer and inserted central venous catheter (CVC) at the Ege University Pediatric Oncology Division between January 2016 and December 2020 was evaluated retrospectively. The patients data was obtained from the hospital records and patient files. The files of 398 patients aged 0-18 years who received treatment with the diagnosis of cancer were reviewed, and the data of 202 patients with CVC were included into the study. The patients with 38 ℃ or more seen in the emergency room or in the inpatient service of the pediatric oncology division were evaluated in terms of catheter infections. 1055 febrile episodes at of 202 patients were included in to the study. In every episode, simultaneously taken peripheral blood, urine and other cultures were examined. The frequency of the catheter infection, the distribution of the microorganisms grown in the culture, and antibiotic resistance were documented. Demographic data of the patients such as age, gender, diagnosis, catheter type, catheter infection, blood stream or urine infection and microorganism distribution in the other infections were analyzed. Antimicrobial treatments during the infection period of the patients were evaluated. The obtained data were analyzed with SPSS 25.0 package program. Results: There were, 96 (47.1%) female and 106 (52.9%) were male, and the mean age was 7.25 ± 5.37 years (0-18 years). The distribution of the catheters used in the study was as follows: 152 (75.2 %) only port catheters, 33 (16.3%) other central venous catheters in addition to port catheter in case of clinical necessity and 2 (1.0%) Hickman catheters. The remaining 15 (7.5%) patients had other types of catheters. The microbiological agents in 1055 febrile admissions were analyzed. In 253 out of 1055 (24%) had bacterial growth in the catheter blood cultures taken. The distribution of the microorganisms grown in the catheter cultures was as follows: 17.2% of them were Gram positive bacteriae and 4.6 % Gram negative bacteriae. Seven (0.7%) cases had two microorganisms grown at the same time. Conclusion: The causative microorganism growth was observed in only 24 % out of the 1055 febrile episodes. Gram-positive bacteriae were the most common causative agents of the catheter infection. CNS was detected as the most frequent agent among the Gram-positive bacteriae, while Pseudomonas among the Gram-negative bacteriae. Candida spp. were found most frequently among the fungi. Catheter removal rate due to the infection was calculated as 7.8%. There was no significant difference between the distribution of microorganisms grown in the catheter and the peripheral blood culture.
Açıklama
Anahtar Kelimeler
Santral Venöz Kateter, Kateter Enfeksiyonları, Kanser, Çocuk, Central Venous Catheter, Catheter Infections, Cancer, Children
