Karbapenem dirençli klebsiella pneumoniae üremesi saptanan hastaların risk faktörleri ve mortalite açısından incelenmesi
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Dosyalar
Tarih
2019
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Yayıncı
Trakya Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Klebsiella pneumoniae enfeksiyon etkeni olarak sıklıkla izole edilen bir patojendir. Karbapenem dirençli suşlar tüm dünyada beraberinde ülkemizde hızlı bir artış göstermiştir. KDKP’nin sıklıkla nozokomiyal ve sistemik enfeksiyonlarla ilişkili olması ve tedavi seçeneklerinin oldukça kısıtlı olması bu patojenin önemini arttırmaktadır. Bu retrospektif çalışmanın amacı, bir yıllık süreçte Trakya Üniversitesi Tıp Fakültesi hastanesinde gelişen KDKP enfeksiyonlarının risk faktörleri ve mortalite açısından incelenmesidir. Çalışmamızda, Trakya Üniversitesi Sağlık Uygulama ve Araştırma Merkezi’nde 01.01.2016-01.01.2017 tarihleri arasında en az 72 saat yatırılarak takip edilen hastalardan 18 yaş üstü olup alınan kültürlerinde KDKP üremesi olan ve etken kabul edilen olgular vaka grubu olarak çalışmaya dahil edildi. Kontrol grubu ise vakalar ile aynı dönemde, aynı servislerde >72 saat yatan, KDKP üremesi olmayan hastalar arasından rastgele seçildi. Çalışmaya 54 hasta dahil edildi. Ortalama yaş 63,9 olarak bulunurken; erkek ve kadın cinsiyet oranı eşitti. Vaka grubunda ortalama yatış süresi 24 gün, kontrol grubunda 10 gün olarak bulundu (p<0.05). Son iki ay içerisinde antibiyotik kullanımı vaka grubunda %85.2, kontrol grubunda ise %14.8 olarak saptandı (p<0.05). Vaka grubunda en sık enfeksiyon odağı kan dolaşımı enfeksiyonuydu (%60.4). KDKP enfeksiyonu olan hastalarda bakteriemi olduğunda daha yüksek mortalite olduğu görüldü (%69.7). Vaka grubunda mortalite 33 (%61.1) hastada gelişirken, kontrol grubunda 14 (%25.9) hastada gelişti (p<0.05). Sonuç olarak; KDKP sıklığı hızla artmaktadır. Bu etken ile gelişen enfeksiyonlarda mortalite yüksektir. Hastalarda uzamış yatış süresi, gereksiz ve geniş spektrumlu antibiyoterapi kullanımı, invaziv işlemler KDKP sıklığını artırmaktadır. Bu enfeksiyonları önlemek amacıyla gereksiz antibiyotik kullanımından ve invaziv girişimlerden kaçınılmalı, enfeksiyon kontrol önlemleri tüm hastalarda titizlikle uygulanmalı, sürveyans sonuçları yakın takip edilmeli ve kritik durumdaki hastalarda ampirik tedavide KDKP akla getirilmelidir.
Klebsiella pneumoniae is a pathogen that is often isolated as an infectious agent. Carbapenem resistant strains have increased rapidly worldwide and in our country. The fact that Carbapenem resistant K.pneumoniae (CRKP) is frequently associated with nosocomial and systemic infections and has limited treatment options increase the importance of this pathogen. The aim of this retrospective study is to investigate the risk factors and mortality rates of CRKP infections; in Trakya University Faculty of Medicine Hospital in one year process. In our study, from the patients who were followed up between 01.01.2016-01.01.2017 at Trakya University Health Application and Research Center for at least 72 hours and for cases with positive culture for CRKP and accepted for infection agent those who were above the age of 18 were included in the study as a case group. The control group was randomly selected among the patients who had > 72 hours in the same services and who did not have CRKP growth in clinical samples during the same period. 54 patients were included in the study. The mean age was 63.9 years; male and female sex ratio was equal. The mean length of hospital stay was 24 days in the case group and 10 days in the control group (p<0.05). The use of antibiotics in the last two months was 85.2% in the case group and 14.8% in the control group (p<0.05). In the case group, the most common infection focus was bloodstream infection (60.4%). A higher mortality was observed in patients with CRKP infection when bacteremia occurs (69.7%). Mortality was observed in 33 (61.1%) patients in the case group and in 14 (25.9%) patients in the control group (p<0.05). As a result; The incidence of CRKP is increasing rapidly. Mortality is high in these infections. The duration of prolonged stay, unnecessary and wide spectrum antibiotherapy and invasive procedures increase the incidence of CRKP infection. In order to prevent infections developed with CRKP, unnecessary antibiotic use and invasive procedures should be avoided, infection control measures should be applied meticulously especially for patients followed up in ICU, surveillance results should be closely monitored and CRKP should be considered in empirical treatment in critically ill patients.
Klebsiella pneumoniae is a pathogen that is often isolated as an infectious agent. Carbapenem resistant strains have increased rapidly worldwide and in our country. The fact that Carbapenem resistant K.pneumoniae (CRKP) is frequently associated with nosocomial and systemic infections and has limited treatment options increase the importance of this pathogen. The aim of this retrospective study is to investigate the risk factors and mortality rates of CRKP infections; in Trakya University Faculty of Medicine Hospital in one year process. In our study, from the patients who were followed up between 01.01.2016-01.01.2017 at Trakya University Health Application and Research Center for at least 72 hours and for cases with positive culture for CRKP and accepted for infection agent those who were above the age of 18 were included in the study as a case group. The control group was randomly selected among the patients who had > 72 hours in the same services and who did not have CRKP growth in clinical samples during the same period. 54 patients were included in the study. The mean age was 63.9 years; male and female sex ratio was equal. The mean length of hospital stay was 24 days in the case group and 10 days in the control group (p<0.05). The use of antibiotics in the last two months was 85.2% in the case group and 14.8% in the control group (p<0.05). In the case group, the most common infection focus was bloodstream infection (60.4%). A higher mortality was observed in patients with CRKP infection when bacteremia occurs (69.7%). Mortality was observed in 33 (61.1%) patients in the case group and in 14 (25.9%) patients in the control group (p<0.05). As a result; The incidence of CRKP is increasing rapidly. Mortality is high in these infections. The duration of prolonged stay, unnecessary and wide spectrum antibiotherapy and invasive procedures increase the incidence of CRKP infection. In order to prevent infections developed with CRKP, unnecessary antibiotic use and invasive procedures should be avoided, infection control measures should be applied meticulously especially for patients followed up in ICU, surveillance results should be closely monitored and CRKP should be considered in empirical treatment in critically ill patients.
Açıklama
Anahtar Kelimeler
Karbapenem Dirençli Klebsiella Pneumoniae, Enfeksiyon, Risk Faktörleri, Mortalite, Carbapenem Resistant Klebsiella Pneumoniae, Infection, Risk Factors, Mortality
