Enterokoklara bağlı kan akımı enfeksiyonlarında risk faktörlerinin değerlendirilmesi
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Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu retrospektif vaka-kontrol çalışmasının amacı, enterokok bakteriyemilerinin epidemiyolojisini, enterokok bakteriyemisi gelişiminde rol alan risk faktörlerini ve mortalite ile ilişkili risk faktörlerini değerlendirmektedir. Çalışmamızda 95 enterokok bakteriyemisi saptandı ve sıklığı 3.3/1000 taburcu olan hasta şeklinde idi. En sık izole edilen türler E. faecalis (%48.4) ve E. faecium (%47.4) idi. Bakteriyemilerin % 88.4 'ü hastane kökenli idi. En sık primer enfeksiyon kaynağı santral venöz kateter (%32.7) ve üriner sistem enfeksiyonu (%14.7) idi. Altı hastada bakteriyemiye eşlik eden enfektif endokardit, iki hastada menenjit saptandı. Otuz dokuz hastada (%41) polimikrobiyal bakteriyemi saptandı. Enterokoklarla birlikte en sık üreyen bakteri Acinetobacter baumannii (%17) idi. Enterokok bakteriyemisi gelişimindeki risk faktörlerini; immünsüpresyon, kronik karaciğer parankim hastalığı, kardiyovasküler ve gastrointestinal sistem hastalıkları, kronik böbrek yetmezliği, hemodiyaliz tedavisi, açık yara, foley sonda, abdominal cerrahi dışındaki cerrahi girişim, antiasid kullanımı, hastanede yatış süresinin 15 günden fazla olması, bakteriyemi öncesi antibiyotik (sefalosporinler, aminoglikozidler, karbapenemler ve metranidazol) kullanımı ve uygun olmayan empirik antibiyotik tedavisi olarak saptadık. Otuzuncu gündeki mortalite oranları, enterokok bakteriyemisi olan hastalarda %47.4, bakteriyemisi olmayanlarda ise %31.1 idi. Mortalite ile ilişkili risk faktörlerini; Charlson indeksinin yüksek olması, yoğun bakım ünitesinde yatma, hastanede 15 günden fazla kalma, santral venöz katater varlığı ve uygunsuz empirik antibiyotik tedavisi alma olarak saptadık. Lojistik regresyon analizinde; Charlson indeksinin yüksek olması, yoğun bakım ünitesinde yatma ve E. faecium üremesini mortaliteyle ilişkili bağımsız risk faktörü olarak saptadık. Enterokok bakteriyemileri riski altta yatan ciddi hastalıkları olan ve hastanede uzun süreli yatan hastalarda artmıştır. Uygunsuz empirik antibiyotik tedavileri hem enterokok bakteriyemisi sıklığını hem de mortaliteyi arttımaktadır.
Abstract
verall incidence was 3.3 per 1000 hospital admissions during the study period. The most frequently isolated species were Enterococcus faecalis (48.4%) and Enterococcus faecium (47.4%). 88.4% of these infections were hospital acquired. The most common primary site of infection was central venous catheter (32.7%) and urinary tract infection (14.7%). Six cases of infective endocarditis and two cases of meningitis and due to enterococci were identified. Polymicrobial bacteremia occurred in 41% of the patients and the most common co-isolate was Acinetobacter baumanni (17%). Statistical analysis revealed that presence of immunosuppressive therapy, gastrointestinal tract disease, cardiovascular disease, chronic liver parenchymal disease, chronic renal failure, indwelling urinary catheter, previous hospitalization, prolonged hospitalization (>15 days), ineffective empirical antimicrobial therapy and exposure to antimicrobial therapy in the preceding 30 days (mainly cephalosporins, carbapenems, metranidazol, aminoglycosides) were the risk factors significantly associated with enteroccoccal bacteremia. 73 The 30-day mortality rate was 47.4% in enteroccoccal bacteremia as compared with 31.1% in controls. Statistical analysis revealed that presence of high Charlson index, intensive-care unit admission, prolonged hospitalization (>15 days), central venous catheter use, ineffective empirical antimicrobial therapy were the risk factors significantly associated with mortality. In the multivariate logistic regression analysis, three factors were independently associated with mortality: high Charlson index, intensive-care unit admission (p:0.016) and isolation of E. faecium from blood cultures. The risk of developing enterococcal bacteremia is significantly higher in severely diseased patients with prolonged hospitalization. Prevalent ineffective empirical antimicrobial therapies contribute both to the occurence of nosocomial enterococcal infections and high mortality.
Abstract
verall incidence was 3.3 per 1000 hospital admissions during the study period. The most frequently isolated species were Enterococcus faecalis (48.4%) and Enterococcus faecium (47.4%). 88.4% of these infections were hospital acquired. The most common primary site of infection was central venous catheter (32.7%) and urinary tract infection (14.7%). Six cases of infective endocarditis and two cases of meningitis and due to enterococci were identified. Polymicrobial bacteremia occurred in 41% of the patients and the most common co-isolate was Acinetobacter baumanni (17%). Statistical analysis revealed that presence of immunosuppressive therapy, gastrointestinal tract disease, cardiovascular disease, chronic liver parenchymal disease, chronic renal failure, indwelling urinary catheter, previous hospitalization, prolonged hospitalization (>15 days), ineffective empirical antimicrobial therapy and exposure to antimicrobial therapy in the preceding 30 days (mainly cephalosporins, carbapenems, metranidazol, aminoglycosides) were the risk factors significantly associated with enteroccoccal bacteremia. 73 The 30-day mortality rate was 47.4% in enteroccoccal bacteremia as compared with 31.1% in controls. Statistical analysis revealed that presence of high Charlson index, intensive-care unit admission, prolonged hospitalization (>15 days), central venous catheter use, ineffective empirical antimicrobial therapy were the risk factors significantly associated with mortality. In the multivariate logistic regression analysis, three factors were independently associated with mortality: high Charlson index, intensive-care unit admission (p:0.016) and isolation of E. faecium from blood cultures. The risk of developing enterococcal bacteremia is significantly higher in severely diseased patients with prolonged hospitalization. Prevalent ineffective empirical antimicrobial therapies contribute both to the occurence of nosocomial enterococcal infections and high mortality.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Risk Faktörleri, Kan Akımı Enfeksiyonu, Enterokok, Risc Factors, Blood Stream Infections, Enterococci
