1. Yo un bak m m zda izole edilen enfeksiyon etkenleri içinde gram pozitif patojenlerin s kl (%54) gram negatif patojenlerden (%42.5) daha fazlad r. Gram pozitif patojenler içinde en s k üreyen mikroorganizma Stafilokok lard r (%38). Stafilokok lardaki metisilin direnci s ras yla S. aureus ta %75, KNS de %98 dir.
2. Çal mam zda enfeksiyon kayna olarak en s k patojen üretilen örnek yeri kan kültürleridir (%66.5). Kan kültürlerinde en s k üreyen patojen ise Stafilokoklard r (%50). Stafilokoklar için enfeksiyon kayna olabilecek intravaskuler kateter uygulamalar ve giri imsel i lemlerde optimal sterilizasyon sa lanmal , katater bak mlar düzenli olarak yap lmal ve t bbi gereklili i ortadan kalkar kalkmaz kateterler ç kar lmal d r. Ayr ca bas yaralar n n geli imini önlemek için gerekli önlemler al nmal d r.
3. Özellikle solunumsal yo un bak m ünitemizden izole edilme s kl yüksek olan A. baumannii, K. pneumoniae ve Enterokok su lar nda olmak üzere, izole edilen patojenlerin antibiyotiklere yüksek direnç oranlar dikkati çekmi tir. Üreyen bakteriler ve direnç oranlar bu ünitelerde ampirik antibiyotik tedavilerinin güçlü ünü, aktif izlem ve önleyici tedbirlerin artt r lmas gerekti ini göstermektedir.
4. Yo un bak m sürveyans çal malar rutin yap lmal d r. Retrospektif çal malar önemli bilgiler sa lasa da, bu çal malarda saptad m z sonuçlar n neden-sonuç ili kisini daha ayr nt l ekilde ortaya koyacak prospektif çal malara ihtiyaç vard r.
5. Pnömoni dahil olmak üzere üretilen etkenlerin ço unlu unun kan kültürleri olmas , alt solunum yollar ndan yeterli örneklemenin yap lmad n dü ündürmektedir. Yo un bak mlarda enfeksiyon üphesi oldu unda, solunumsal yak nma olsun-olmas n mümkün olan tüm durumlarda alt solunum yolu örneklerinin al nmas rutin hale getirilmelidir.
6. Çal mam zda saptad m z patojenlerin yüksek antibiyotik direnç durumlar dikkat çekicidir. Her merkezin kendi yo un bak m etkenlerini ve bu etkenlerin antibiyotik duyarl l k profilini saptamas nozokomiyal enfeksiyonlar n kontrolünde önemli faydalar sa layacakt r. Bu hem etkili ve h zl antibiyoterapi ba lang c yla tedavi ba ar m z artt rabilecek, hem de etkisiz antibiyoterapi ile rezistan su lar n ortaya ç k n azaltabilecektir.
ÖZET
Yo un bak mda geli en enfeksiyonlar hem önemli düzeyde kaynak kullan m n gerektirmekte hem de artm morbidite ve mortaliteye neden olmaktad r. Kullan lacak antibiyoterapi seçimini etkileyecek önemli faktörlerden biride, o birimde saptanan etken mikroorganizmalar ve antibiyotik direnç durumlar d r. Bu çal ma ile solunumsal yo un bak m ünitemizde yatan hastalarda enfeksiyon etkeni olan patojenleri ve antibiyotik direnç paternlerini ortaya koymay amaçlad k. Çal mam zda 2008 y l boyunca gönderilen kültür materyallerinde üreme olan tüm hastalar n, kültür antibiyogram sonuçlar ve klinik verileri retrospektif olarak incelendi. 78 hasta ve bunlara ait 200 kültür sonucu çal maya dahil edildi.
Kültür örneklerinin 133 (%66.5) ü kan, 36 (%18) s derin trakeal aspirat, 23 (%11.5) ü idrar, 4 (%2) ü yara ak nt s , 3 (%1.5) ü balgam ve 1 (%0.5) i santral venöz kateter (CVP) den olu maktayd . Çal mam zda tüm kültür sonuçlar nda en s k saptanan mikroorganizmalar s ras yla; Koagülaz negatif stafilokoklar (KNS) (%29.5), Acinetobacter (%17.5), E. coli (%15), S. aureus (%8.5), Enterococcus (%8), Klebsiella (%5), Streptococcus (%5), Candida (%3.5) idi.
Kan yoluyla geli en enfeksiyonlarda en s k saptanan etken koagülaz negatif stafilokoklard (%41). En fazla duyarl oldu u (%100) antibiyotikler sefazolin, sefoksitin, meropenem ve linezolid idi. Alt solunum yolu örneklerinde en s k saptad m z etken Acinetobacter (%33) olup, en fazla duyarl oldu u antibiyotikler sefoperazon/sulbaktam (%100), meropenem (%31), imipenem (%26) ve amikasin (%26) di. drar kültürlerinde ise en s k saptanan patojen E. coli (%48) olup, en fazla duyarl oldu u antibiyotikler sefoperazon/sulbaktam (%100), meropenem (%97), imipenem (%93) ve amikasin (%83) idi. Hastalara ba lanan antibiyoterapi rejimlerinin %69 unun tedavi boyunca de i tirildi i ya da geni letildi i saptand .
Sonuç olarak yo un bak mlar n ço unda oldu u gibi solunumsal yo un bak m ünitemizde de yüksek oranlarda antibiyotik direnci saptand . Ampirik antibiyoterapi uygulamalar nda her hastane hatta her birim kendi lokal verilerini dikkate alarak antibiyotik seçimini yapmal d r.
Anahtar kelimeler: Solunumsal yo un bak m ünitesi, yo un bak m enfeksiyonlar ,
SUMMARY
The infections acquired in intensive care units both require using a significant amount of financial resources and lead to increased morbidity and mortality. One of the major factors that would affect antibiotherapy choice to be used is the pathogenes identified in the unit and antibiotic resistance patterns. Through this study, we aimed to establish pathogenes leading to infections and their antibiotic resistance patterns in patients admitted in our respiratory intensive care unit. In the study, culture antibiogram results of all the patients, in whose culture results were positive, during the year 2008, as well as clinical data were reviewed retrospectively. A total of 78 patients and their 200 culture specimen results were included into the study.
Of the culture specimens 133 (66.5%) were related to blood, 36 (18%) to deep tracheal aspirat, 23 (11.5%) to urinary, 4 (2%) to wound leakage, 3 (1.5%) to sputum, and 1 (0.5%) to central venous catheter (CVP). The most commonly encountered microorganisms in all of the culture specimen tests were in turn coagulase negative stafilococcus (KNS) (29.5%), Acinetobacter (17.5%), E. coli (15%), S. aureus (8.5%), Enterococcus (8%), Klebsiella (5%), Streptococcus (5%) and Candida (%3.5).
The most commonly encountered agent in bloodstream infections was coagulase negative stafilococcus (%41). The antibiotics to which it was sensitive most were cefazolin, cefoxitin, meropenem and linezolid. The agent we detected most commonly in lower respiratory tract was Acinetobacter (33%), which was sensitive most to cefoperazone/sulbactam (100%), meropenem (31%), imipenem (26%) and amikacin (26%).
In urinary culture specimens, however, the most commonly seen pathogen was E. coli (48%), and it was sensitive most to cefoperazone/sulbactam (100%), meropenem (97%), imipenem (93%) and amikacin (83%). Of the antibiotherapy regimens applied to patients, 69% was determined to have been changed or broadened during the treatment. In conclusion, in our respiratory intensive care unit, as in most intensive cares, high level of antibiotic resistance was determined. In ampirical antibiotherapy medication, each hospital, even each unit should decide on it s own antibiotic choice taking local data into account.
Key words: Respiratory intensive care unit, intensive care-acquired infections,
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