Öz
Objective: Several problems are present nosocomial sepsis which still remains an important health problem in Turkish intensive care units (ICUs). The aim of the study is to decrease the mortality rate of nosocomial sepsis in ICUs. This study sought to find mortality – related risk factors in ICUs. Material and Methods: The prospective study was performed with following of one year in the ICUs of Firat University Hospital. The patients who were followed in the ICUs for at least 48 hours were enrolled in the study. Nosocomial infections were defined according to the Center for Disease Control and Prevention (CDC) criteria and were categorised by specific infection site. Results: Among the 470 patients, 81 had ICU- acquired sepsis episodes. In- ICUs nosocomial was sepsis rate 17.2% (81/470) and mortality rate 63% (51/81). Needs for mechanical ventilation, entubation, nasogastric catheter, urinary catheters episodes of sepsis were significantly associated with fatalities. Respiratory failure, used of H2 receptor antagonist was associated with a fatal outcome. The most frequent primary sources of nosocomial sepsis were lungs 38.3%, urinary 29.7% and intra-abdominal 12.4%. Cultures were positive of the patients with common microorganisms were Pseudomonas spp. 22.3% (14.5% P.aeruginosa), E.coli 17.1%, S.aureus 17% (including 9% methicillin-resistant), Acinetobacter spp. 13.1%. Conclusion: The most important risk factors of mortality were observed older age, high APACHE II score, mechanical ventilation, intubation, nasogastric catheterization, urinary catheterization, respiratory failure and used H2 receptor antagonist.
Anahtar Kelimeler
Kaynakça
- Balk RA. Severe sepsis and septic shock. Definitions, epidemiology, and clinical manifestations Crit Care Clin 2000; 16: 179-192. 2. Richards MJ, Edwards JR, Culver DH, et al. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999; 27: 887-892.
- Spengler RF, Greenough WB, 3rd.Hospital costs and mortality attributed to nosocomial bacteremias. JAMA 1978; 240: 2455- 2458.
- Jarvis WR, Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996; 17: 552-557. 77
- Wichmann MW, Inthorn D, Andress HJ, Scildberg FW, Incidense and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome. Intensive Care Med 2000: 26; 167-172.
- Warren KD, Zack EJ, Elward MA, et al. Nosocomial primary bloodstream infections in intensive care unit patients in a Nonteaching Community Medical Center: A 21-Month Prospective Study. Clinical Infectious Diseases 2001; 33: 1329-1335.
- Annane D, Aegerter P, Jars-Guincestre MC, Guidet B; CUB- Réa Network Current epidemiology of septic shock: the CUB- Réa Network. Am J Respir Crit Care Med 2003; 168: 165- 172.
- Erbay H, Yalçın NA, Serin S, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 2003; 1482-1488.
- Alberti C, Brun-Buisson C, Goodman S.V, et al. Epidemiyoloji of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 2002; 28: 108-121.
- Alberti C, Brun-Buisson C, Goodman SV, et al. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically iii infected patients. Am J Respir 2003; 168: 77-84.
- Raymond DP, Shawn J, Cradtree DT, et al. Impact of bloodstream ınfection on outcomes among ınfected surgical ınpatient. Annal Surg 2000; 233: 549–555.
- Dettenkofer M, Ebner W, Els T, et al. Surveillance of nosocomial infections in a neurology intensive care unit. J Neurol 2001; 248: 959-964.
- Gönderilme Tarihi: 06.01.2011
Fırat Üniversitesi Hastanesi Yoğun Bakım Ünitelerinde Gelişen Nozokomiyal Sepsiste Mortalite İçin Risk Faktörleri
Öz
Amaç: Nozokomiyal sepsis, yoğun bakım ünitelerinde (YBÜ) önemli bir sorun olmaya devam etmektedir. Klinik çalışmanın amacı, yoğun bakım ünitelerindeki nozokomiyal sepsiste mortaliteyle ilişkili risk faktörlerinin tespitidir. Bu çalışmada yoğun bakım ünitelerinde mortaliteyle ilişkili risk faktörleri bulunmaya çalışıldı. Gereç ve Yöntem: Bu prospektif çalışma Fırat Üniversitesi Hastanesi Yoğun Bakım Üniteleri'nin bir yıllık izlemi ile yapıldı. YBÜ'ne kabul edilen hastalar en azından 48 saat izlendikten sonra çalışmaya dahil edildi. Nozokomiyal infeksiyonların tanısı CDC (Center for Disease Control and Prevention) kriterlerine göre kondu ve spesifik infeksiyon alanlarına göre sınıflandırıldı. Bulgular: 470 hastadan 81'inde YBÜ kaynaklı sepsis atağı gelişti. YBÜ'nde nozokomiyal sepsis oranı %17.2 (81/470) ve mortalite oranı %63 (51/81) idi. Sepsis atağında gereksinim duyulan mekanik ventilasyon, entübasyon, nazogastrik tüp, üriner kateter mortaliteyi önemli ölçüde artırıyordu. Solunum yetmezliği, H2 reseptör antagonisti kullanımı mortaliteyi artırıyordu. Nozokomiyal sepsisin en sık primer kaynağı pulmoner %38.3, üriner % 29.7 ve intra-abdominal infeksiyonlar %12.4 idi. Kültür pozitif hastalardaki en sık mikroorganizmalar Pseudomonas spp. %22.3 (%14.5 P.aeruginosa), E.coli %17.1, S.aureus %17 (%9 metisilin-rezistans), Acinetobacter spp. %13.1 idi. Sonuç: Mortaliteyle ilişkili en önemli risk faktörleri yaş, APACHE II skoru yüksekliği, mekanik ventilasyon, entübasyon, nazogastrik tüp, üriner kateterizasyon, solunum yetmezliği, H2 reseptör antagonisti kullanımı ve H2 reseptör antagonisti kullanma süresi olarak gözlemlendi.
Anahtar Kelimeler
Yoğun Bakım Ünitesi nozokomiyal sepsis sürveyans mortalite risk faktörleri
Kaynakça
- Balk RA. Severe sepsis and septic shock. Definitions, epidemiology, and clinical manifestations Crit Care Clin 2000; 16: 179-192. 2. Richards MJ, Edwards JR, Culver DH, et al. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999; 27: 887-892.
- Spengler RF, Greenough WB, 3rd.Hospital costs and mortality attributed to nosocomial bacteremias. JAMA 1978; 240: 2455- 2458.
- Jarvis WR, Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996; 17: 552-557. 77
- Wichmann MW, Inthorn D, Andress HJ, Scildberg FW, Incidense and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome. Intensive Care Med 2000: 26; 167-172.
- Warren KD, Zack EJ, Elward MA, et al. Nosocomial primary bloodstream infections in intensive care unit patients in a Nonteaching Community Medical Center: A 21-Month Prospective Study. Clinical Infectious Diseases 2001; 33: 1329-1335.
- Annane D, Aegerter P, Jars-Guincestre MC, Guidet B; CUB- Réa Network Current epidemiology of septic shock: the CUB- Réa Network. Am J Respir Crit Care Med 2003; 168: 165- 172.
- Erbay H, Yalçın NA, Serin S, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 2003; 1482-1488.
- Alberti C, Brun-Buisson C, Goodman S.V, et al. Epidemiyoloji of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 2002; 28: 108-121.
- Alberti C, Brun-Buisson C, Goodman SV, et al. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically iii infected patients. Am J Respir 2003; 168: 77-84.
- Raymond DP, Shawn J, Cradtree DT, et al. Impact of bloodstream ınfection on outcomes among ınfected surgical ınpatient. Annal Surg 2000; 233: 549–555.
- Dettenkofer M, Ebner W, Els T, et al. Surveillance of nosocomial infections in a neurology intensive care unit. J Neurol 2001; 248: 959-964.
- Gönderilme Tarihi: 06.01.2011
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2011 |
| Yayımlandığı Sayı | Yıl 2011 Cilt: 16 Sayı: 2 |