Yenidoğan Yoğun Bakım Ünitesinde Gelişen Sağlık Bakım İlişkili Enfeksiyonlar: Son 6 Yılın Değerlendirilmesi
Abstract
Amaç: Sağlık bakım ilişkili
enfeksiyonlar (SBİE) yenidoğan yoğun bakım ünitelerinde (YDYBÜ)
önemli morbidite ve mortalite nedenidir.
Bu çalışmada, bir üçüncü basamak YDYBÜ’nde gelişen SBİE değerlendirildi.
Gereç ve yöntem: Çalışma Sakarya Üniversitesi Eğitim ve Araştırma Hastanesi merkez
kampüsü YDYBÜ’nde 1 Ocak 2013-31 Aralık 2018 arasında yapıldı. YDYBÜ’de gelişen
SBİE retrospektif olarak değerlendirildi. YDBÜ günlük aktif sürveyans
yöntemiyle takip edildi ve SBİE tanısı Center for disease controle (CDC)’nin
2014 rehberine göre koyuldu. YDYBÜ’de yatan hasta sayısı, hasta günü, gelişen
SBİE, invaziv alet kullanımı, izole edilen etkenler ve antibiyotik direnç
oranları hesaplandı. Elde edilen veriler bilgisayar ortamında değerlendirildi.
Bulgular: Toplam 2196 hasta, 33652 hasta günü, 4157 ventilatör günü, 3343
umbilikal kateter günü, 5210 santral venöz kateter günü ve 92 üriner kateter
günü izlendi. SBİE hızı %4,78 (105/2196) ve insidans dansitesi ‰ 3,12 (105/33652) idi. SBİE
alt dağılımlarına göre değerlendirildiğinde kan dolaşımı enfeksiyonları (KDE)
%96,1 (101/105) ilk sıradaydı.
SBİE etkenlerinin %59,0 (62/105)’si gram negatif (GNB) %41,0 (43/105)’i gram
pozitif etkenlerdi. En sık izole edilen GNB Klebsiella
spp. (%34,2) ve Enterobacter spp.
(%12,3) idi. Gram pozitif etkenler ise koagülaz
negatif stafilokoklar (%26,6) ve Staphylococcus
aureus (%10,4) idi. İnvaziv alet ilişkili enfeksiyon hızları
değerlendirildiğinde; santral venöz kateter ilişkili kan dolaşımı enfeksiyon
hızı ‰ 0,95 umbilikal kateter ilişkili
kan dolaşımı enfeksiyon hızı ‰ 2,09 idi ve ventilatör ilişkili pnömoni ile
üriner kateter ilişkili üriner sistem enfeksiyonu gelişmedi.
Tartışma: KDE’nin en
sık görülen SBİE olduğu tespit edildi. Ünitede hastaların uzun süre izlenmesi,
invaziv girişimler, düşük doğum ağırlığı, erken doğum, total parenteral
beslenme ve doğumsal anomaliler enfeksiyon riskini artıran faktörlerdir. SBİE
gelişme oranı bebeğin gestasyon yaşı ve vücut ağırlığı ile ters orantılı idi.
SBİE en fazla ≤ 750 gr ağırlığında ki bebeklerde görülürken, en az > 2500 gr
ağırlığındaki bebeklerde görülmüştür. Doğum ağırlığı düşük olan yenidoğanlarda
enfeksiyon kontrol önlemleri hassas bir şekilde uygulanmalıdır.
Supporting Institution
yoktur
References
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- 2.Chen YC, Lin CF, Rehn YJF, Chen JC, Chen PC, Chen CH, et al. Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period, Journal of the Chinese Medical Association 80 (2017) 427e431
- 3.Mohammed D, El Seifi SO. Bacterial nosocomial infections in neonatal intensive care unit, Zagazig University Hospital Egypt , Egyptian Pediatric Association Gazette (2014) 62, 72–79
- 4.Bowen JR, Callander I, Richards R, Lindrea KB,. Decreasing infection in neonatal intensive care units through quality improvement, Arch Dis Child Fetal Neonatal Ed 2017;102:F51–F57. doi:10.1136/archdischild-2015-310165
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- 7.Parlak E, Kahveci H, Alay HK. Yenidoğan Yoğun Bakım Ünitesindeki Hastane Enfeksiyonları Güncel Pediatri 2014;1:1-8
- 8.Moghaddam PS, Arjmandnia M, Shokrollahi M, Aghaali M. Does training improve compliance with hand hygiene and decrease infections in the neonatal intensive care unit? A prospective study, Journal of Neonatal-Perinatal Medicine 8 (2015) 221–225 DOI 10.3233/NPM-15915001
- 9.Huang YC. Device-associated Healthcare-associated Infections in the Neonatal Intensive Care Unit, Pediatrics and Neonatology (2013) 54, 293e294
- 10. Garcia H, Torres-Gutierrez J, Peregrino-Bejarano L, Cruz-Castaneda MA. Risk factors for nosocomial infection in a level III, Gac Med Mex. 2015;151:660-8 Neonatal Intensive Care Unit
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- 14. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network, Pediatrics. 2002 Aug;110(2 Pt 1):285-91
- 15. Stoll BJ1, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network, J Pediatr. 1996 Jul;129(1):72-80.
- 16. Pogorzelska-Maziarz M, The Use and Effectiveness of Bundles for Prevention of Central Line-Associated BloodstreamInfections in Neonates: A Review of the Literature, J Perinat Neonatal Nurs. 2016 Apr-Jun;30(2):148-59. doi: 10.1097/JPN.0000000000000171.
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- 20. Tseng YC1, Chiu YC, Wang JH, Lin HC, Lin HC, Su BH, et al. Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review, J Microbiol Immunol Infect. 2002 Sep;35(3):168-72.
Abstract
Objective: Healthcare-associated
ınfections (HAIs) are important causes of morbidity and mortality in neonatal
intensive care units (NICUs). In this study we aimed to investigate HAIs in a tertiary NICU was evaluated.
Materials and methods: The
study was carried out between January 1, 2013 and December 31, 2018 in Sakarya
University Training and Research Hospital. HAIs were evaluated retrospectively.
The NICU was followed up with daily active surveillance and the diagnosis of HAIs
was established according to the 2014 guidelines of the Center for Disease
Control (CDC). The number of inpatients in the NICU, day of the patient,
developing HAIs, invasive device use, isolated agents and antibiotic resistance
rates were calculated. The data obtained were evaluated by computer.
Results:
A total of 2196 patients, 33652 patient days, 4157 ventilator days, 3343
umbilical catheter days, 5210 central venous catheter days, and 92 urinary
catheter days were observed. The HAIs rate was 4.78% (105/2196) and the
incidence density was 3.16 (105/33652). Blood circulation infections (BCI) were
in the first place in 96.1% (101/105) when evaluated according to the subscale
of HAIs. 59.0% (62/105) of the HAIs agents were gram negative (GNB) 41.0%
(43/105) were gram positive bacteria. The most frequent isolated GNB Klebsiella spp. (34.2%) and Enterobacter spp. (12.3%). Gram positive
bacteria were coagulase negative staphylococci (26.6%) and Staphylococcus
aureus (10.4%). When invasive device-related infection rates were evaluated;
The rate of central venous catheter-related bloodstream infection was 5 0.95
umbilical catheter-related bloodstream infection rate ‰ 2.09, and
ventilator-associated pneumonia and urinary catheter-related urinary tract
infection did not develop.
Discussion:
BCI was found to be the most common HAIs. Long-term follow-up of patients in
the unit, invasive procedures, low birth weight, preterm birth, total
parenteral nutrition and congenital anomalies are factors that increase the
risk of infection. The rate of development of HAIs was inversely proportional
to gestational age and body weight of the baby. HAIs was seen in infants
weighing at least gr 750 g, whereas it was seen in infants weighing at
least> 2500 g. Infection control measures should be applied precisely in
newborns with low birth weight.
References
- 1.Kumar S, Shankar B, Arya S, Deb M, Chellani H. Healthcare associated infections in neonatal intensive care unit andits correlation with environmental surveillance, Journal of Infection and Public Health 11 (2018) 275–279
- 2.Chen YC, Lin CF, Rehn YJF, Chen JC, Chen PC, Chen CH, et al. Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period, Journal of the Chinese Medical Association 80 (2017) 427e431
- 3.Mohammed D, El Seifi SO. Bacterial nosocomial infections in neonatal intensive care unit, Zagazig University Hospital Egypt , Egyptian Pediatric Association Gazette (2014) 62, 72–79
- 4.Bowen JR, Callander I, Richards R, Lindrea KB,. Decreasing infection in neonatal intensive care units through quality improvement, Arch Dis Child Fetal Neonatal Ed 2017;102:F51–F57. doi:10.1136/archdischild-2015-310165
- 5.Djordjevic ZM, Markovic-Denic L, Folic MM, Igrutinovic Z, Jankovic SM. Health careeacquired infections in neonatal intensive care units: Risk factors and etiology, American Journal of Infection Control 43 (2015) 86-8
- 6.Sultan AM, Seliem WA. Identifying Risk Factors for Healthcare-Associated Infections Caused by Carbapenem-Resistant Acinetobacter baumannii in a Neonatal Intensive Care Unit, Sultan Qaboos Univ Med J. 2018 Feb;18(1):e75-e80. doi: 10.18295/squmj.2018.18.01.012. Epub 2018 Apr 4.
- 7.Parlak E, Kahveci H, Alay HK. Yenidoğan Yoğun Bakım Ünitesindeki Hastane Enfeksiyonları Güncel Pediatri 2014;1:1-8
- 8.Moghaddam PS, Arjmandnia M, Shokrollahi M, Aghaali M. Does training improve compliance with hand hygiene and decrease infections in the neonatal intensive care unit? A prospective study, Journal of Neonatal-Perinatal Medicine 8 (2015) 221–225 DOI 10.3233/NPM-15915001
- 9.Huang YC. Device-associated Healthcare-associated Infections in the Neonatal Intensive Care Unit, Pediatrics and Neonatology (2013) 54, 293e294
- 10. Garcia H, Torres-Gutierrez J, Peregrino-Bejarano L, Cruz-Castaneda MA. Risk factors for nosocomial infection in a level III, Gac Med Mex. 2015;151:660-8 Neonatal Intensive Care Unit
- 11. Guidelines Library | Infection Control | CDC (n.d.). Available: https://www.cdc.gov/infectioncontrol/guidelines/index.html. Accessed 6 July 2019.
- 12.https://dosyaism.saglik.gov.tr/Eklenti/15719,ulusal-saglik-hizmeti-iliskili-enf-surveyansi-rehberipdf.pdf?0, ET: 06.07.2019, 20:06
- 13. Mobley RE, Bizzarro MJ. Central line-associated bloodstream infections in the NICU: Successes and controversies in the quest for zero, Semin Perinatol. 2017 Apr;41(3):166-174. doi: 10.1053/j.semperi.2017.03.006.
- 14. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network, Pediatrics. 2002 Aug;110(2 Pt 1):285-91
- 15. Stoll BJ1, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network, J Pediatr. 1996 Jul;129(1):72-80.
- 16. Pogorzelska-Maziarz M, The Use and Effectiveness of Bundles for Prevention of Central Line-Associated BloodstreamInfections in Neonates: A Review of the Literature, J Perinat Neonatal Nurs. 2016 Apr-Jun;30(2):148-59. doi: 10.1097/JPN.0000000000000171.
- 17.Balaban I, Tanır G, Timur OM, Oz FN, Teke TA, Bayhan GI, et al. Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey, Jpn. J. Infect. Dis., 65, 318-321, 2012
- 18. Mai JY, Dong L, Lin ZL, Chen SQ. Investigation and analysis of nosocomial infection in neonates, Zhonghua Er Ke Za Zhi. 2011 Dec;49(12):915-20.
- 19. Maoulainine FM, Elidrissi NS, Chkil G, Abba F, Soraa N, Chabaa L, et al. Epidemiology of nosocomial bacterial infection in a neonatal intensive care unit in Morocco, Arch Pediatr. 2014 Sep;21(9):938-43. doi: 10.1016/j.arcped.2014.04.033.
- 20. Tseng YC1, Chiu YC, Wang JH, Lin HC, Lin HC, Su BH, et al. Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review, J Microbiol Immunol Infect. 2002 Sep;35(3):168-72.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Publication Date | March 30, 2021 |
| Submission Date | July 27, 2019 |
| Published in Issue | Year 2021 Volume: 15 Issue: 2 |
The publication language of Turkish Journal of Pediatric Disease is English.
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