Trakya Üniversitesi Sağlık Araştırma ve Uygulama Merkezinde, hastanede yatan hastalarda vankomisin dirençli enterokok (VRE) taşıyıcılığının geniş spektrumlu antibiyotik kullanımı ve hastanede yatış süresi ile ilişkisi
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Dosyalar
Tarih
2014
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Yayıncı
Trakya Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu prospektif vaka-kontrol çalışmasının amacı, vankomisin dirençli enterokok rektal taşıyıcılığı sıklığını, vankomisin dirençli enterokok rektal kolonizasyonunun hastanede yatış süresi ve antibiyotik kullanımı ile ilişkisini değerlendirmektir. Çalışmamızda 271 hastadantoplam 873 adet perirektal sürüntü kültürü alındı.271 hastanın 14?ünde vankomisin dirençli enterokok rektal kolonizasyonu saptandı. 14 kolonize hastadan toplam 44 üreme tespit edildi. Örnek bazlı kolonizasyon prevalansı %5.0, hasta bazlı kolonizasyon prevalansı da %5.2 olarak bulundu. Ayrıca vaka grubunda kolonizasyon riski, kontrol grubuna göre 5.9 kat daha fazla bulundu. Tespit edilen tüm vankomisin dirençli enterokoklar E. faecium olarak tanımlanırken, çalışma döneminde invazif vankomisin dirençli enterokokenfeksiyonu ile karşılaşılmadı. Vankomisin dirençli enterokokrektal kolonizasyonu saptanan hastaların ortalama yatış günü 23,1±17.8 bulunurken, saptanmayan hastaların ortalama yatış günü11.3±11.2 bulundu. Uzun süre yatan hastalarda vankomisin dirençli enterokok kolonizasyonunun daha sık görüldüğü tespit edildi. Yoğun bakımda yatma(p=0.040), servisler arası nakil olma(p=0.010), son bir yıl içinde herhangi bir hastaneye yatma(p=0.029), hastane enfeksiyonu tedavisi alma(p=0.002)risk faktörü olarak tespit edildi. Ayrıca vankomisin dirençli enterokok kolonize hastalar ile aynı serviste yatmanın diğer hastalar için 12.9 kat fazla risk olduğu saptandı. Antibiyotik kullanımı ile vankomisin dirençli enterokok kolonizasyonu arasında vankomisin dirençli enterokokvaka sayısı az olduğundan ilişki bulunamadı.
Abstract
This prospective case – control study aimed at assessing the prevalence of rectal carriage of VRE and the relationship between rectal colonization with vancomycin-resistant enterococci and the length of hospital stay as well as antibiotic use. In our study a total of 873 perirectal swap cultures were taken from 271 patients. Rectal colonization with vancomycin-resistant enterococci was determined in 14 out of 271 patients. A total of 44 growths were determined in the cultures of these 14 colonized patients. Sample based colonization prevalence was found as 5.0%, while patient based prevalence was 5.2%. In addition the colonization risk in the case group was found to be 5,9 times higher than the control group. While all isolated vancomycin-resistant enterococci?s were E. faecium, any case of invasive vancomycin-resistant enterococciinfection was not encountered. The mean length of hospital stay in patients with rectal colonization of vancomycinresistant enterococciwas 23,1±17.8, the mean length of stay in the patients without rectal colonization of vancomycin-resistant enterococciwas 11.3±11.2. Longer durations of hospital stay were associated with higher rates of vancomycin-resistant enterococcicolonization.Intensive Care Unit admission (p=0.040), inpatient transfer between wards (p=0.010), any hospital admission during the last year (p=0.029) and being treated for hospital acquired infections (p=0.002) were determined to be risk factors for rectal carriage of vancomycinresistant enterococci. In addition, patients hospitalized in the same ward with VRE colonized patients were 12.9 times more likely to be at risk No relationship was found between antibiotic use and vancomycin-resistant enterococcicolonization consequently to the small size of the study sample.
Abstract
This prospective case – control study aimed at assessing the prevalence of rectal carriage of VRE and the relationship between rectal colonization with vancomycin-resistant enterococci and the length of hospital stay as well as antibiotic use. In our study a total of 873 perirectal swap cultures were taken from 271 patients. Rectal colonization with vancomycin-resistant enterococci was determined in 14 out of 271 patients. A total of 44 growths were determined in the cultures of these 14 colonized patients. Sample based colonization prevalence was found as 5.0%, while patient based prevalence was 5.2%. In addition the colonization risk in the case group was found to be 5,9 times higher than the control group. While all isolated vancomycin-resistant enterococci?s were E. faecium, any case of invasive vancomycin-resistant enterococciinfection was not encountered. The mean length of hospital stay in patients with rectal colonization of vancomycinresistant enterococciwas 23,1±17.8, the mean length of stay in the patients without rectal colonization of vancomycin-resistant enterococciwas 11.3±11.2. Longer durations of hospital stay were associated with higher rates of vancomycin-resistant enterococcicolonization.Intensive Care Unit admission (p=0.040), inpatient transfer between wards (p=0.010), any hospital admission during the last year (p=0.029) and being treated for hospital acquired infections (p=0.002) were determined to be risk factors for rectal carriage of vancomycinresistant enterococci. In addition, patients hospitalized in the same ward with VRE colonized patients were 12.9 times more likely to be at risk No relationship was found between antibiotic use and vancomycin-resistant enterococcicolonization consequently to the small size of the study sample.
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Anahtar Kelimeler
Sürveyans, Risk Faktörleri, Rektal Kolonizasyon, HastaneEenfeksiyonları, Vankomisin Dirençli Enterokok, Rectalcolonization, Risk Factors, Nosocomial Infections, Vancomycin-Resistant Enterococci, Surveillance
