Trakya Üniversitesi Sağlık Araştırma ve Uygulama Merkezinde genişlemiş spekturumlu beta-laktamaz üreten gram negatif bakteri etkenli kan akımı infeksiyonlarında risk faktörlerinin irdelenmesi
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Dosyalar
Tarih
2011
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Yayıncı
Trakya Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Genişletilmiş spekturumlu beta-laktamaz üreten gram negatif bakteri etkenli bakteriyemi önemli bir oranda mortalite ve morbiditeye neden olmaktadır. Bu retrospektif vaka-kontrol çalışmasında bir yıllık dönemi kapsayan ve hastanemizdeki erişkin hastaların dahil edildiği genişletilmiş spekturumlu beta-laktamaz üreten gram negatif bakteri etkenli infeksiyonlar ile ilgili epidemiyolojik verilerin, risk faktörlerinin ve mortalite ile ilişkili faktörlerin ortaya çıkarılması amaçlanmıştır. Bu amaçla kan kültürlerinde genişletilmiş spekturumlu beta-laktamaz üreten gram negatif bakteri saptanan 41 hasta vaka grubunu ve aynı dönemde genişletilmiş spekturumlu beta-laktamaz üretmeyen gram negatif bakteri saptanan 44 hasta ise kontrol grubunu oluşturmuştur. Genişletilmiş spekturumlu beta-laktamaz üreten gram negatif kan akımı infeksiyonu insidansı o dönem için % 0,15 (on binde 15) olarak saptandı. Vaka grubunu oluşturan hastaların %78.0'si hastane kökenli , %19.57'si ise toplum kökenli infeksiyon olarak belirlendi.Etken olarak belirlenen bakteriler sırası ile % 70.7 oranında Escherichia coli, %21.9 oranında Klebsiella pneumoniae ve %7.4 Klebsiella oxytoca idi. Primer infeksiyon odağı hastaların % 73.1'in de saptanmış olup en sık üriner sistem (%50.0) ve ikinci olarak da alt solunum yolları (%23.3) olarak tespit edildi. Genişletilmiş spekturumlu beta-laktamaz üreten gram negatif bakteri etkenli kan dolaşımı infeksiyonu gelişimi ile ilgili olarak tek-değişkenli analiz sonucuna göre, antibiyotik kullanım öyküsü (p<0.001) ve üretral kateter varlığı (p=0.007) istatistiksel olarak anlamlı bulundu. Çok-değişkenli logistik regresyon analizinde ise hiçbir faktör anlamlı değildi. Mortalite ile ilişkili olabilecek faktörlerin tek-değişkenli analizinde başlangıç tedavi yanıtı (p<0.001) ve yatış yapılan servis (p=0.03) istatistiksel olarak anlamlı bulundu. Çok-değişkenli logistik regresyon analizinde ise sadece başlangıç tedavi yanıtı anlamlı bulundu (p=0.005). Antibiyotik kullanım öyküsü ve üretral kateter kullanım öyküsü olan hastalarda genişletilmiş spekturumlu beta-laktamaz üreten gram negatif bakteri etkenli infeksiyon riski yüksektir. Başlangıç tedavi yanıtının mortalite ile ilişkili bağımsız risk faktörü olarak saptanması tedavi seçimini hayati kılmaktadır. Anahtar kelimeler: Genişlemiş spekturumlu beta laktamaz, gram negatif bakteri, kan dolaşımı infeksiyonu.
Abstract
The blood stream infections due to extended spectrum beta-lactamase producing gram negative bacteria have been among the major causes of mortality and morbidity. In our study, we aimed to evaluate epidemiologic data and risk factors in blood stream infections caused by extended spectrum beta-lactamase producing gram negative bacterial infections as well as factors regarding mortality in an adult inpatient group of our hospital for a year's period in a retrospective, case-controlled study. Forty one patients with positive blood cultures for extended spectrum beta-lactamase producing gram negative bacteria and 44 patients with positive blood cultures for gram negative bacteria that don't produce extended spectrum beta-lactamase were enrolled in our study as case group and control group, respectively. The prevalance of extended spectrum beta-lactamase producing gram negative bacterial blood stream infections were observed to be 0,15%. 78% of these infections were hospital acquired while 19,57% were community acquired. Isolated microorganisms included Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca with frequencies as 70,7%, 21,9%, and 7,4% respectively. The primary infection site was demonstrated in 73,1% of the patients. The most frequent infection site was observed to be the urinary system (50%) and the second was observed to be the lower respiratory system (23,3%). In single-variate analysis factors statistically associated with higher risk for extended spectrum beta-lactamase producing gram negative bacterial infections included history of antibiotic use (p<0.001) and the urethral catetherization (p=0.007). In multi-variate analysis, no factor was observed to be significant. In single-variate analysis, factors statistically associated with higher mortality included initial theraphy response (p<0.001) and the clinical status of the patient (p=0.03). However, only initial therapy was observed to be statistically significant in multi-variate analysis (p=0.005). The risk of extended spectrum beta-lactamase producing gram negative bacterial infections is higher in patients with history of antibiotheraphy and urethral catheterization. The choice of theraphy is essential since reponse to treatment is an independent risk factor regarding mortality. Key words: Extended spectrum beta lactamase, gram negative bacteria, blood stream infections
Abstract
The blood stream infections due to extended spectrum beta-lactamase producing gram negative bacteria have been among the major causes of mortality and morbidity. In our study, we aimed to evaluate epidemiologic data and risk factors in blood stream infections caused by extended spectrum beta-lactamase producing gram negative bacterial infections as well as factors regarding mortality in an adult inpatient group of our hospital for a year's period in a retrospective, case-controlled study. Forty one patients with positive blood cultures for extended spectrum beta-lactamase producing gram negative bacteria and 44 patients with positive blood cultures for gram negative bacteria that don't produce extended spectrum beta-lactamase were enrolled in our study as case group and control group, respectively. The prevalance of extended spectrum beta-lactamase producing gram negative bacterial blood stream infections were observed to be 0,15%. 78% of these infections were hospital acquired while 19,57% were community acquired. Isolated microorganisms included Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca with frequencies as 70,7%, 21,9%, and 7,4% respectively. The primary infection site was demonstrated in 73,1% of the patients. The most frequent infection site was observed to be the urinary system (50%) and the second was observed to be the lower respiratory system (23,3%). In single-variate analysis factors statistically associated with higher risk for extended spectrum beta-lactamase producing gram negative bacterial infections included history of antibiotic use (p<0.001) and the urethral catetherization (p=0.007). In multi-variate analysis, no factor was observed to be significant. In single-variate analysis, factors statistically associated with higher mortality included initial theraphy response (p<0.001) and the clinical status of the patient (p=0.03). However, only initial therapy was observed to be statistically significant in multi-variate analysis (p=0.005). The risk of extended spectrum beta-lactamase producing gram negative bacterial infections is higher in patients with history of antibiotheraphy and urethral catheterization. The choice of theraphy is essential since reponse to treatment is an independent risk factor regarding mortality. Key words: Extended spectrum beta lactamase, gram negative bacteria, blood stream infections
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Genişlemiş spekturumlu beta laktamaz, Gram negatif bakteri, Kan dolaşımı infeksiyonu, Extended spectrum beta lactamase, Gram negative bacteria, Blood stream infections.
