Crush Sendromu İlişkili Enfeksiyonlar: 2023 Türkiye Depremi Sonrasında Bir Üniversite Hastanesinde Görülen Yara Enfeksiyonlarının Retrospektif Analizi

Year 2024, Volume: 50 Issue: 2, 191 - 195, 08.10.2024

İpek Koçer , Hadiye Demirbakan , Demet Arı , Aydın Budeyri

https://doi.org/10.32708/uutfd.1457322

Abstract

Depremzedelerde meydana gelen Crush sendromu sonrasında enfeksiyon morbidite ve mortaliteyi etkileyen komplikasyonlardan biridir. Çalışmamızın amacı, deprem sonrası travma ilişkili yaralanma ile hastanemize başvuran depremzedelerin yara kültürlerinde mikroorganizmaların sıklığını ve antibiyotik duyarlılık paternini belirlemektir. Yara kültürleri için yara yerlerinden alınan sürüntü ve doku örneklerinden izole edilen bakterilerin tanımlanma ve antibiyotik duyarlılıkları BD Phoenix (Becton Dickinson, ABD) ile yapıldı. Yara kültürlerinin değerlendirilmesinde Q skorlaması kullanıldı. Hastanemize deprem ilişkili yaralanma şikayetiyle toplam 552 hasta başvurdu. Bunlardan 186’sının yatışı yapıldı. Depremzede 14 hastanın (11 kadın, 3 erkek) yaş ortalaması 36,5 (2-83), ortalama enkazda kalma süresi 23,5 saatti (8-120 saat). Hastaların 12’sine fasyotomi uygulanırken, 4’ünün çeşitli uzuvlarına ampütasyon yapılmıştır. Üremesi olan 24 kültürden toplam 30 mikroorganizma izole edilirken; 6 kültürde üreme olmadı. Yara enfeksiyonların %30’u polimikrobiyal olup ilk sırada Gram negatif etkenler ikinci sırada ise Gram pozitif etkenlerin ürediği saptanmıştır. En sık görülen etken Acinetobacter baumanii %56,7 (n:17) iken; diğerleri Pseudomonas aureginosa %10 (n:3), Enterobacter cloace %10 (n:3), Enterococcus faecium %10 (n:3), Klebsiella pneumoniae %6,7 (n:2) Escherchia coli %6,7 (n:2) olarak saptanmıştır. Acinetobacter baumanii, Pseudomonas aureginosa ve Klebsiella pneumoniae izolatlarında çoklu antibiyotik direnci olduğu izlenmiş olup hastane bakımı ilişkili enfeksiyon olduğu düşünülmüştür. Genellikle doğal afetlerden sonra çoklu ilaca dirençli mikroorganizmalar rapor edilmektedir. Crush sendromu hastane enfeksiyonlar için risk oluştururken, erken ve uygun profilaktik antibiyotik tedavisi hastaların prognozunda önem taşımaktadır.

Keywords

Deprem, Crush sendromu, Sağlık hizmeti ilişkili enfeksiyonlar (SHİE);, Gram negatif

Crush Syndrome Related Infections: A Retrospective Analysis of Wound Infections in a University Hospital After the 2023 Earthquake in Turkey

Abstract

Infection is one of the complications affecting morbidity and mortality after Crush syndrome in earthquake victims. The aim of our study was to determine the frequency and antibiotic susceptibility pattern of microorganisms in wound cultures of earthquake victims admitted to our hospital with post-earthquake trauma-related injuries. For wound cultures, identification and antibiotic susceptibility of bacteria isolated from wound swabs and tissue samples were performed with BD Phoenix (Becton Dickinson, USA). Q scoring was used for the evaluation of wound cultures. A total of 552 patients were admitted to our hospital with earthquake-related injuries. Of these, 186 were hospitalised. The mean age of 14 earthquake survivors (11 females, 3 males) was 36.5 years (2-83) and the mean duration of stay in the rubble was 23.5 hours (8-120 hours). Fasciotomies were performed in 12 of the patients and amputations were performed in 4 of them. A total of 30 microorganisms were isolated from 24 cultures, while 6 cultures were negative. It was found that 30% of the wound infections were polymicrobial and Gram-negative agents were isolated firstly and Gram-positive agents were isolated secondly. The most common agent was Acinetobacter baumanii 56.7% (n:17); the others were Pseudomonas aureginosa 10% (n:3), Enterobacter cloace 10% (n:3), Enterococcus faecium 10% (n:3), Klebsiella pneumoniae 6.7% (n:2), Escherchia coli 6.7% (n:2). Multiple antibiotic resistance was observed in Acinetobacter baumanii, Pseudomonas aureginosa and Klebsiella pneumoniae isolates and nosocomial infection was considered. Generally, multidrug resistant microorganisms are reported after natural disasters. Crush syndrome poses a risk for nosocomial infections and early and appropriate prophylactic antibiotic treatment is important in the prognosis of patients.

Keywords

Earhquake, Crush syndrome, healthcare-associated infections (HAI);, Gram negative

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