Türkiye'de Bir Yenidoğan Yoğun Bakım Ünitesinde Sağlık Hizmetlerine Bağlı Enfeksiyonların Özellikleri

Yıl 2023, Cilt: 20 Sayı: 2, 1691 - 1700, 03.07.2023

Akan Yaman , Aslı Memişoğlu , Yasemin Masal , Uluhan Sili , Ahmet Soysal , Hülya Selva Bilgen , Volkan Korten , Eren Özek

https://doi.org/10.38136/jgon.994734

Öz

Giriş: Sağlık hizmeti ile ilişkili enfeksiyonlar (SHİE), yenidoğan yoğun bakım ünitelerinde (YYBU) neonatal mortalite, morbidite ve sağlık bakım maliyetini artıran risklerden biridir. SHİE'lerin özellikleri farklı bölgelerde ve zaman içinde önemli ölçüde farklılık gösterdiğinden, sürekli SHİE sürveyansı, enfeksiyon kontrolü için SHİE oranlarını ve sağlık bakımıyla ilişkili patojenleri belirlemek açısından önemlidir.
Gereç ve Yöntemler: Türkiye'de üçüncü basamak bir referans merkezindeki SHİE'nin özelliklerini incelemeyi amaçladık. 2011-2013 yılları arasında YYBU'ye kabul edilen tüm yenidoğanlar bu çalışmaya dahil edildi. SHİE ile ilgili bilgiler “Ulusal Hastane Enfeksiyon Gözetim Ağı” ve Hastalık Kontrol ve Önleme Merkezleri(CDC)’nin standartlarına göre toplanmıştır.
Bulgular: Toplam yatan hasta sayısı 1030 idi. Bunların% 29'unda SHİE gelişti. SHİE'nin genel oranı ve yoğunluğu sırasıyla% 29.0 ve% 24.0 idi. Kan dolaşımı enfeksiyonları, SHİE 'lerin% 36.4'ü idi. En sık izole edilen mikro-organizmalar koagülaz negatif Staphylococci ve Klebsiella pneumonia idi. Ortalama metisilin direnci % 87, ESBL oranı% 79 ve VRE oranı % 40 idi.
Sonuçlar: Bu çalışma, SHİE 'nin YYBU'de hala ciddi bir sorun teşkil ettiğini belirlemiştir. Sağlık bakımıyla ilişkili patojenler hakkında zamanında ve doğru epidemiyolojik bilgilerin mevcudiyeti, enfeksiyon kontrolü ve uygun ampirik antibiyotik seçimi için gereklidir.

Anahtar Kelimeler

Yenidoğan Yoğun Bakım, Sağlık bakımı ile ilişkili enfeksiyon, yenidoğan

Characteristics of Healthcare Associated Infections in a Neonatal Intensive Care Unit in Turkey

Öz

Introduction: Healthcare associated infections (HCAI) is one of the risks which increase neonatal mortality, morbidity, and health care cost in neonatal intensive care units (NICU). As the characteristics of HCAI’s vary considerably in different regions and over time, continual HCAI surveillance is important to determine HCAI' s rates and healthcare associated pathogens for infection control.
Material and Methods: We aimed to analyze the characteristics of HCAI in a tertiary referring centre in Turkey. All newborns admitted to the NICU between 2011-2013 were included in this study. HCAI related information has been collected according to the “National Hospital Infection Surveillance Network" and the standards of Centers for Disease of Control and Prevention.
Results: The total number of inpatients was 1030. Out of them, 29% have developed HCAI. Overall rate and density of HCAI were 29.0% and 24.0%, respectively. Bloodstream infections were 36.4% of HCAI’s. The most frequently isolated organisms were coagulase-negative Staphylococci. and Klebsiella pneumonia. Overall meticiline resistance was 87%, ESBL rate was 79%, and VRE rate was 40%.
Conclusions: This study determined that HCAI still presents a serious problem in NICU. The availability of timely and accurate epidemiological information on healthcare associated pathogens is necessary for infection control and the appropriate selection of empiric antibiotics.

Anahtar Kelimeler

Neonatal Intensive Care, Healthcare associated infection, neonate

Kaynakça

• 1.Polin, R. A., Denson, S., Brady, M. T., & Committee on Infectious Diseases. (2012). Epidemiology and diagnosis of health care–associated infections in the NICU. Pediatrics, 129(4), e1104-e1109.
• 2.Horan, T. C., Andrus, M., & Dudeck, M. A. (2008). CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control, 36(5), 309-332.
• 3.Hansen, S., Sohr, D., Geffers, C., Astagneau, P., Blacky, A., Koller, W., ... & Gastmeier, P. (2012). Concordance between European and US case definitions of healthcare-associated infections. Antimicrobial resistance and infection control, 1(1), 1-8.
• 4.Shah, P. S., Yoon, W., Kalapesi, Z., Bassil, K., Dunn, M., & Lee, S. K. (2013). Seasonal variations in healthcare-associated infection in neonates in Canada. Archives of Disease in Childhood-Fetal and Neonatal Edition, 98(1), F65-F69.
• 5.Brito, D. V. D., Brito, C. S. D., Resende, D. S., Moreira do Ó, J., Abdallah, V. O. S., & Gontijo Filho, P. P. (2010). Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study. Revista da Sociedade Brasileira de Medicina Tropical, 43(6), 633-637.
• 6.Borghesi, A., & Stronati, M. (2008). Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. Journal of Hospital Infection, 68(4), 293-300.
• 7.Ferreira, J., Bouzada, M. C., Jesus, L. A. D., Cortes, M. D. C. W., Armond, G. A., Clemente, W. T., ... & Romanelli, R. (2014). Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology. Jornal de pediatria, 90(4), 389-395.
• 8.Lautenbach E. Epidemiological Methods for Investigating Infections in the Healthcare Setting. In: William R. Jarwis, editors. Bennet's & Brachman's Hospital Infections. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 109-20.
• 9.Clark, R., Powers, R., White, R., Bloom, B., Sanchez, P., & Benjamin, D. K. (2004). Nosocomial infection in the NICU: a medical complication or unavoidable problem?. Journal of perinatology, 24(6), 382-388.
• 10.Jeong, I. S., Jeong, J. S., & Choi, E. O. (2006). Nosocomial infection in a newborn intensive care unit (NICU), South Korea. BMC infectious diseases, 6(1), 1-8.
• 11.Unal S, Celik FC, Tezer H. Nosocomial Infections In A Neonatal Intensive Care Unit and Trouble With Klebsiella. Turk J Pediatr Dis. 2010; 4: 133-9.
• 12.Bolat, F., Uslu, S., Bolat, G., Comert, S., Can, E., Bulbul, A., & Nuhoglu, A. (2012). Healthcare-associated infections in a neonatal intensive care unit in Turkey. Indian pediatrics, 49(12), 951-957.
• 13.Hacımustafaoğlu, M., Çelebi, S., Köksal, N., Kavurt, S., Özkan, H., Çetinkaya, M., & Özkaya, G. (2011). Nosocomial infections in neonatology clinic and neonatal intensive care unit. Turk Arch Ped, 46, 302-307.
• 14.Yapicioglu, H., Ozcan, K., Sertdemir, Y., Mutlu, B., Satar, M., Narli, N., & Tasova, Y. (2011). Healthcare-associated infections in a neonatal intensive care unit in Turkey in 2008: incidence and risk factors, a prospective study. Journal of tropical pediatrics, 57(3), 157-164.
• 15.Sohn, A. H., Garrett, D. O., Sinkowitz-Cochran, R. L., Grohskopf, L. A., Levine, G. L., Stover, B. H., ... & Jarvis, W. R. (2001). Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. The Journal of pediatrics, 139(6), 821-827.
• 16.Couto, R. C., Carvalho, E. A., Pedrosa, T. M., Pedroso, Ê. R., Neto, M. C., & Biscione, F. M. (2007). A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units. American journal of infection control, 35(3), 183-189.
• 17.Zaidi, A. K., Huskins, W. C., Thaver, D., Bhutta, Z. A., Abbas, Z., & Goldmann, D. A. (2005). Hospital-acquired neonatal infections in developing countries. The Lancet, 365(9465), 1175-1188.
• 18.Patel, S. J., & Saiman, L. (2012, December). Principles and strategies of antimicrobial stewardship in the neonatal intensive care unit. In Seminars in perinatology (Vol. 36, No. 6, pp. 431-436). WB Saunders.
• 19.Snydman, D. R. (2012). Empiric antibiotic selection strategies for healthcare‐associated pneumonia, intra‐abdominal infections, and catheter‐associated bacteremia. Journal of hospital medicine, 7(S1), S2-S12.
• 20.Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Report, Data Summary for 2011, Device-associated Module. Available:http://www.cdc.gov./nhsn/PDFs/dataStat/NHSN-Report-2011-Data-Summary.pdf. Accessed 29 March 2015.
• 21. Graves, N., Weinhold, D., Tong, E., Birrell, F., Doidge, S., Ramritu, P., ... & Whitby, M. (2007). Effect of healthcare-acquired infection on length of hospital stay and cost. Infection control and hospital epidemiology, 28(3), 280-292.
• 22.Rosenthal, V. D., Maki, D. G., Jamulitrat, S., Medeiros, E. A., Todi, S. K., Gomez, D. Y., ... & Members, I. N. I. C. C. (2010). International nosocomial infection control consortium (INICC) report, data summary for 2003-2008, issued June 2009. American journal of infection control, 38(2), 95-104.
• 23.Orsi, G. B., d'Ettorre, G., Panero, A., Chiarini, F., Vullo, V., & Venditti, M. (2009). Hospital-acquired infection surveillance in a neonatal intensive care unit. American journal of infection control, 37(3), 201-203.
• 24.Van der Zwet, W. C., Kaiser, A. M., Van Elburg, R. M., Berkhof, J., Fetter, W. P. F., Parlevliet, G. A., & Vandenbroucke-Grauls, C. M. J. E. (2005). Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. Journal of hospital infection, 61(4), 300-311.
• 25.Gastmeier, P., Geffers, C., Schwab, F., Fitzner, J., Obladen, M., & Rüden, H. (2004). Development of a surveillance system for nosocomial infections: the component for neonatal intensive care units in Germany. Journal of Hospital Infection, 57(2), 126-131.
• 26.Kasim, K., El Sadak, A. A., Zayed, K., Abdel-Wahed, A., & Mosaad, M. (2014). Nosocomial infections in a neonatal intensive care unit. Middle East J Sci Res, 19, 1-7.
• 27.Abdel-Wahab, F., Ghoneim, M., Khashaba, M., El-Gilany, A. H., & Abdel-Hady, D. (2013). Nosocomial infection surveillance in an Egyptian neonatal intensive care unit. Journal of Hospital Infection, 83(3), 196-199.
• 28.Özdemir, N., Soysal, A., Bilgen, H., Çulha, G., Bakır, M., & Özek, E. (2004). Nosocomial infections in the neonatal intensive care unit for 2001 in Marmara University hospital. Turk J Hosp Infect, 8(256), e60.
• 29.Mireya, U. A., Martí, P. O., Xavier, K. V., Cristina, L. O., Miguel, M. M., & Magda, C. M. (2007). Nosocomial infections in paediatric and neonatal intensive care units. Journal of infection, 54(3), 212-220.
• 30.Lin, I. J., Chen, C. H., Chen, P. Y., Wang, T. M., & Chi, C. S. (2000). Nosocomial infection in a neonatal intensive care unit--from a viewpoint of national health insurance. Acta Paediatrica Taiwanica= Taiwan er ke yi xue hui za zhi, 41(3), 123-128.
• 31.Auriti, C., Maccallini, A., Di Liso, G., Di Ciommo, V., Ronchetti, M. P., & Orzalesi, M. (2003). Risk factors for nosocomial infections in a neonatal intensive-care unit. Journal of Hospital Infection, 53(1), 25-30.
• 32.Munson DA, and Jacquelyn RE. Health Care-Acquired Infections in the Nursery. In: Gleason CA, Devaskar SU, editors. Avery's Diseases of the Newborn. 9th ed. Philadelphia: Elsevier Saunders; 2012. p. 551-564.
• 33.Gray, J. W. (2007). Surveillance of infection in neonatal intensive care units. Early human development, 83(3), 157-163.
• 34.Babazono, A., Kitajima, H., Nishimaki, S., Nakamura, T., Shiga, S., Hayakawa, M., ... & Une, H. (2008). Risk factors for nosocomial infection in the neonatal intensive care unit by the Japanese Nosocomial Infection Surveillance (JANIS). Acta Medica Okayama, 62(4), 261-268.
• 35.Dudeck MA, Weiner LM, Allen-Bridson K, et al. National Healthcare Safety Network (NHSN) Report, Data Summary for 2012, Device-associated Module. Am J Infect Control. 2013; 41: 1148-66.
• 36.Korpela KJ, Campbell J, Singh N. Healthcare-associated infections. In: MacDonald MG, Mullett MD, Seshia MMK, editors. Avery’s Neonatology Pathophysiology Management of the Newborn, 6th ed. Philadelphia: Lippincott Williams Wilkins; 2005. p. 1357-1383.
• 37.Turkish Neonatal, S. (2010). Nosocomial Infections Study G. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr, 52(1), 50-57.
• 38.Cronin, W. A., Germanson, T. P., & Donowitz, L. G. (1990). Intravascular Catheter Colonization and Related Bloodstream Infection in Critically III Neonates. Infection Control & Hospital Epidemiology, 11(6), 301-308.
• 39.Muto, C. A., Jernigan, J. A., Ostrowsky, B. E., Richet, H. M., Jarvis, W. R., Boyce, J. M., & Farr, B. M. (2003). SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infection control and hospital epidemiology, 24(5), 362-386.
• 40.Orsi, G. B., & Ciorba, V. (2013). Vancomycin resistant enterococci healthcare associated infections. Ann Ig, 25(6), 485-92.