Yaşlılarda toplum kaynaklı enfeksiyonların irdelenmesi
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Dosyalar
Tarih
2019
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/embargoedAccess
Özet
İleri yaş enfeksiyona duyarlılığı arttıran bir faktördür. Yaşlıların şikayetleri genellikle yaşlılığın doğal sonucu olarak görülmektedir. Bu nedenle enfeksiyon hastalıklarının teşhisinde ve etkili tedavisinde gecikme, mortalite ve morbidite oranlarında artış olmaktadır. Bu çalışmada, Trakya Üniversitesi Sağlık Uygulama ve Araştırma Merkezi Enfeksiyon Hastalıkları Anabilim Dalı Kliniği’ne yatırılan yaşlı hastaların irdelenmesi amaçlanmıştır. Çalışmamızda, 01.10.2014 ve 01.10.2016 tarihleri arasında kliniğimize yatırılan 65 yaş üstü toplum kökenli enfeksiyonu olan 134 hastanın tüm verileri retrospektif olarak incelendi. Hastalarda en sık saptanan enfeksiyon hastalıkları; üriner sistem enfeksiyonu (% 41), deri ve yumuşak doku enfeksiyonu (% 18,7) ve toplum kökenli pnömoni (% 11,2) olarak saptandı. En sık gözlenen semptomlar yüksek ateş (% 55,2), iştahsızlık keyifsizlik (%35,8) ve halsizlik (%25,4) olarak saptandı. En sık saptanan fizik muayene bulguları yüksek ateş (% 55,2), taşikardi (%54,5) ve genel durum bozukluğu (%38,1) olarak saptandı. Hastaların %47’sinde lökositoz, %94,7'sinde C–reaktif protein düzeyi yüksek bulundu. Eşlik eden yaygın sistemik hastalıklar hipertansiyon (% 48,5), diabetes mellitus (% 44,8), koroner arter hastalığı (% 25,4) olarak saptandı. Hastaların 119’unda (% 88,8) en az bir kronik hastalık varlığı tespit edildi. Hastalarda en sık izole edilen etken E. coli olarak saptandı (%39,3). Tedavide en sık kullanılan antibiyotik ampisilin-sulbaktamdı. Ortalama hastanede kalış süresi 11,2 ± 6,6 gündü. Çalışmamızda hastaların 117’si (%87) şifa ile taburcu edildi; dört hasta ise (%3) hayatını kaybetti. Toplum kökenli pnömoni olan hastalarda, serebrovasküler hastalık varlığı ve kronik obstrüktif akciğer hastalığı varlığı (p=0,001, p=0,001); üriner sistem enfeksiyonu olan hastalarda kronik böbrek yetmezliği varlığı (p=0,09) istatistiksel olarak anlamlı bulundu. Genişletilmiş spektrumlu beta laktamaz üreten bakterilerin etken olduğu enfeksiyonlar ile hastanede yatış öyküsü ve son üç ay içindeki antibiyotik kullanımı öyküsü arasındaki ilişki istatiksel olarak anlamlı bulundu(p=0,01, p=0,001). Santral sinir sistemi enfeksiyonu tanılı hastalar ile ölüm arasındaki ilişki istatiksel olarak anlamlı bulundu (p=0,01). Sonuç olarak yaşlanmanın sebep olduğu değişimler enfeksiyon hastalıklarının bulgularını maskeleyebilmekte, yaşlı toplum kökenli enfeksiyonu olan hasta grubunda klinik ve laboratuar bulgular genç erişkin gruptan farklı olabilmektedir. Bu neden ile yaşlı hastaları değerlendirirken daha duyarlı yaklaşılmalı ve özellikle toplum kökenli enfeksiyon hastalıkları başta olmak üzere, yaşlıların sağlık sorunları her yönüyle değerlendirilmelidir.
Advanced age is a factor that increases susceptibility to infection. The complaints of the elderly are generally seen as a natural consequence of old age. Therefore, there is an increase in delay, mortality and morbidity rates in the diagnosis and effective treatment of infectious diseases. In this study, it was aimed to examine elderly patients who were admitted to Trakya University Health Practice and Research Center Infectious Diseases Department. In our study, all the data of 134 patients aged 65 and older over community-acquired infections patients who were hospitalized to our clinic between 01.10.2014 and 01.10.2016 were evaluated retrospectively. The most common diagnosis of infectious diseases in patients had urinary tract infection (41%), soft skin infections (18,7%) and communıty acquıred pneumonıa (11,2%). The most common symptoms were high fever (55,2%), loss of appetite, malaise (35,8%) and weakness (25,4%), respectively. The most common physical examination findings were fever (55,2%), tachycardia (54,5%) and general condition disorder (38,1%). Leukocytosis was found in 47% of patients and C-reactive protein level was high in 94,7% of patients. The most common systemic diseases were hypertension (48,5%), diabetes mellitus (44,8%), coronary artery disease (25,4%). The presence of at least one of chronic disease was detected in the 119 (88,8%) of all patients. The most frequently isolated factor was E. coli in those patients (39,3%). The most commonly used antibiotic in treatment was ampicillin sulbactam (34%). The average hospital stay was 11,2 ± 6,6 days. In our study, 117 (87%) of the patients were discharged with healing; four patients (3%) lost their lives. In patients with community-acquired pneumonia; presence of cerebrovascular disease and chronic obstructive pulmonary disease, presence of chronic renal failure in patients with urinary tract infection were statistically significant. The relationship between infections with extended spectrum Beta lactamase producing bacteria and hospitalization history and the history of antibiotic use within the last three months was statistically significant (p=0,01, p=0,001). The relationship between deaths with patients with central nervous system infection and death was statistically significant (p=0,01). As a result, the changes caused by aging can mask the findings of infectious diseases, and the laboratory and clinical findings in the group of patients with elderly community-acquired infections may be different from the young adult group. For this reason, elderly patients should be approached more sensitive while evaluating and health problems of the elderly should be assessed in every aspect, especially infectious diseases of community origin.
Advanced age is a factor that increases susceptibility to infection. The complaints of the elderly are generally seen as a natural consequence of old age. Therefore, there is an increase in delay, mortality and morbidity rates in the diagnosis and effective treatment of infectious diseases. In this study, it was aimed to examine elderly patients who were admitted to Trakya University Health Practice and Research Center Infectious Diseases Department. In our study, all the data of 134 patients aged 65 and older over community-acquired infections patients who were hospitalized to our clinic between 01.10.2014 and 01.10.2016 were evaluated retrospectively. The most common diagnosis of infectious diseases in patients had urinary tract infection (41%), soft skin infections (18,7%) and communıty acquıred pneumonıa (11,2%). The most common symptoms were high fever (55,2%), loss of appetite, malaise (35,8%) and weakness (25,4%), respectively. The most common physical examination findings were fever (55,2%), tachycardia (54,5%) and general condition disorder (38,1%). Leukocytosis was found in 47% of patients and C-reactive protein level was high in 94,7% of patients. The most common systemic diseases were hypertension (48,5%), diabetes mellitus (44,8%), coronary artery disease (25,4%). The presence of at least one of chronic disease was detected in the 119 (88,8%) of all patients. The most frequently isolated factor was E. coli in those patients (39,3%). The most commonly used antibiotic in treatment was ampicillin sulbactam (34%). The average hospital stay was 11,2 ± 6,6 days. In our study, 117 (87%) of the patients were discharged with healing; four patients (3%) lost their lives. In patients with community-acquired pneumonia; presence of cerebrovascular disease and chronic obstructive pulmonary disease, presence of chronic renal failure in patients with urinary tract infection were statistically significant. The relationship between infections with extended spectrum Beta lactamase producing bacteria and hospitalization history and the history of antibiotic use within the last three months was statistically significant (p=0,01, p=0,001). The relationship between deaths with patients with central nervous system infection and death was statistically significant (p=0,01). As a result, the changes caused by aging can mask the findings of infectious diseases, and the laboratory and clinical findings in the group of patients with elderly community-acquired infections may be different from the young adult group. For this reason, elderly patients should be approached more sensitive while evaluating and health problems of the elderly should be assessed in every aspect, especially infectious diseases of community origin.
Açıklama
Anahtar Kelimeler
Yaşlı, Enfeksiyon, Risk Faktörleri, Ateş, Elderly, İnfectious, Risk Factors, Fever
