Atay Gürkan, Kara Manolya, Sütçü Murat, Aydın Yesfa Şebnem, Torun Selda Hançerli, Karapınar Bahar Akgün, Kayacan Zeynep Çiğdem, Gürler Nezahat, Çıtak Agop, Nişli Kemal, Salman Nuran, Somer Ayper
Division of Pediatric Intensive Care, Department of Pediatrics, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Division of Pediatric Infectious Diseases, Department of Pediatrics, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Turk Pediatri Ars. 2019 Jul 11;54(2):105-112. doi: 10.14744/TurkPediatriArs.2019.00086. eCollection 2019.
Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital.
In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively.
One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1-205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included (n=50, 38.5%), (n=32, 24.6%) and (n=28, 21.5%). Among , the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance.
Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.
医疗保健相关感染会导致重症监护病房的发病率和死亡率上升。在本研究中，旨在比较多重耐药和广泛耐药感染情况，同时评估我校医院儿科重症监护病房中革兰氏阴性耐药感染的特征。
在本研究中，对2011年1月至2015年12月期间在我校医学院儿科重症监护病房住院期间被发现患有革兰氏阴性感染的儿科患者进行回顾性评估。
在研究期间，1030名患者入住了我们的科室。发现医疗保健相关感染的发生率为17.2%，发病密度为每1000患者日32.7例。每1000器械日的医疗相关感染发生率和器械使用率分别计算为66.9和0.59。在79名患者中发现了130例革兰氏阴性感染发作，这些患者的中位年龄为22（1 - 205）个月。最常见的感染包括呼吸机相关性肺炎（n = 78，60%）和血流感染（n = 38，29.2%）。最常见的病原体包括（n = 50，38.5%）、（n = 32，24.6%）和（n = 28，21.5%）。在中，对哌拉西林 - 他唑巴坦和美罗培南的耐药率分别为96.4%和89.3%。在广泛耐药革兰氏阴性细菌感染中，碳青霉烯类、氨基糖苷类和氟喹诺酮类的经验性使用、全胃肠外营养的存在以及儿科重症监护病房入院前革兰氏阴性细菌感染史明显更为常见。发现存在广泛耐药时晚期死亡率更高。革兰氏阴性感染史被发现是广泛耐药方面的一个独立危险因素。
医疗保健相关感染是一个重要的健康问题，医院感染控制委员会根据医院定植情况确定并应用预防策略很重要。
