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Investigation of Changes in Infection Rates in the Reconstructed Anesthesia Intensive Care Unit

Yıl 2024, Cilt: 46 Sayı: 1, 59 - 67, 16.01.2024
https://doi.org/10.20515/otd.1352171

Öz

Infection is an important cause of mortality and morbidity in intensive care units. One recommended strategy to reduce the growth and transmission of resistant organisms in the intensive care unit is to place patients in single-bed rooms to reduce the likelihood of transmission of organisms from neighboring beds and to increase compliance with infection control measures. The intensive care unit, which was managed with an open ward system, was restructured and started to be managed with a closed ward system. We aimed to retrospectively examine the infection rates in hospitalized patients during the 6-month period followed in the open ward system and the 6-month period after the transition to the isolated room system. In the new intensive care unit, 274 patients (group A) were followed up for a period of 6 months, but 35 patients who met the study criteria, and 23 patients out of 203 patients who were hospitalized in the old intensive care unit for a 6-month period (group B) were included in the study. Patients admitted from external centers and intubated in-hospital patients were excluded from the study.With the computer data system, the patients' APACHE II, GCS, age, gender, reason for hospitalization, culture results and the number of days of positivity were recorded. According to these records, the places of infection in the patients, their frequency, factors and the growth rates of resistant microorganisms were compared. As a result of the statistical analysis, a significant difference in terms of colistin resistant reproduction results (p<0.05) was found and the rate of development of colistin resistance was higher in Group B patients. When tracheal aspirate culture results were examined, statistically significant difference in Group B (p<0.05), with higher reproductive rates was found. In conclusion; strategies to prevent the emergence and spread of multidrug-resistant bacteria in intensive care units (ICUs) includes strategies to increase the effectiveness of antimicrobial therapy, as well as patient isolation is important strategy for infection control. As a result of our study, it has been shown that there is a less resistant microorganism growth rate in the isolated room intensive care unit.

Kaynakça

  • 1. Blot S, Ruppé E, Harbarth S, Asehnoune K, Poulakou G, Luyt CE, et al. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs. 2022:1;70.
  • 2. Strich JR, Palmore TN. Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit. Vol. 31, Infectious Disease Clinics of North America. W.B. Saunders; 2017. p. 535–50.
  • 3. Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol. 2010;31(10):1025-1029.
  • 4. Kollef MH, Torres A, Shorr AF, Martin-Loeches I, Micek ST. Nosocomial Infection. Vol. 49, Critical care medicine. NLM (Medline); 2021. p. 169–87.
  • 5. Smith RL. Prevention of infection in the intensive care unit. Curr Opin Infect Dis. 2006;19(4):323-6.
  • 6. Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Li Bassi G, Luna CM, Martin-Loeches I, Paiva JA, Read RC, Rigau D, Timsit JF, Welte T, Wunderink R. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017;50(3):1700582.
  • 7. Patel PK, Gupta A, Vaughn VM, Mann JD, Ameling JM, Meddings J. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. J Hosp Med. 2018;13(2):105-116.
  • 8. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-63.
  • 9. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, Scheld M, Spellberg B, Bartlett J. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(1):1-12.
  • 10. Rosenthal VD, Maki DG, Salomao R, Mehta Y, Higuera F, Cuellar LE, et al. Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries [Internet]. 2006. Available from: www.inicc.org
  • 11. McDonald EG, Dendukuri N, Frenette C, Lee TC. Time-Series Analysis of Health Care-Associated Infections in a New Hospital with All Private Rooms. JAMA Intern Med. 2019;179(11):1501–6.
  • 12. Teerawattanapong N, Kengkla K, Dilokthornsakul P, Saokaew S, Apisarnthanarak A, Chaiyakunapruk N. Prevention and control of multidrug-resistant Gram-negative bacteria in adult intensive care units: A systematic review and network meta-analysis. Vol. 64, Clinical Infectious Diseases. Oxford University Press; 2017. p. S51–60.
  • 13. Al-Kadmy IMS, Ibrahim SA, Al-Saryi N, Aziz SN, Besinis A, Hetta HF. Prevalence of Genes Involved in Colistin Resistance in Acinetobacter baumannii: First Report from Iraq. Microbial Drug Resistance. 2020;26(6):616–22.
  • 14. Ko KS, Suh JY, Kwon KT, Jung SI, Park KH, Kang CI, et al. High rates of resistance to colistin and polymyxin B in subgroups of Acinetobacter baumannii isolates from Korea. Journal of Antimicrobial Chemotherapy. 2007;60(5):1163–7.
  • 15. Yelken B, Erkasap N, Bayram B, Us T, Ceylan I, Aslan G. Epidemiology of Acinetobacter baumannii isolates from patients with severe sepsis in anesthesia intensive care unit. Vol. 36, J. Pharm. Sci. 2011.
  • 16. Hussein NH, AL-Kadmy IMS, Taha BM, Hussein JD. Mobilized colistin resistance (mcr) genes from 1 to 10: a comprehensive review. Vol. 48, Molecular Biology Reports. Springer Science and Business Media B.V.; 2021. p. 2897–907.
  • 17. Karakoç, Ebru; Ayyıldız, Ayşe; Yelken, Birgül. Antibiotic resistance of acinetobacter strains in our intensive care unit: a retrospective study. Acta Medica Nicomedia, 2023, 6.1: 60-64
  • 18. Chowdhury D, Duggal AK. Intensive care unit models: Do you want them to be open or closed? A critical review. Neurol India. 2017;65(1):39-45.
  • 19. Deniz A, Erhan ÖL, Bayar MK, Karatepe Ü, Demirel İ. Examination of Changes in Infection Rates in a Restructured Anaesthesia Intensive Care Unit: A Retrospective Study. Turk J Anaesthesiol Reanim. 2017;45(6):353-360.
  • 20. Montrucchio G, Sales G, Catozzi G, et al. Effectiveness of an Active and Continuous Surveillance Program for Intensive Care Units Infections Based on the EPIC III (Extended Prevalence of Infection in Intensive Care) Approach. J Clin Med. 2022;11(9):2482

Yeniden Yapılandırılan Anestezi Yoğun Bakım Ünitesinde Enfeksiyon Oranlarındaki Değişimlerin İncelenmesi

Yıl 2024, Cilt: 46 Sayı: 1, 59 - 67, 16.01.2024
https://doi.org/10.20515/otd.1352171

Öz

Enfeksiyon, yoğun bakım ünitelerinde önemli mortalite ve morbidite nedenidir. Yoğun bakım ünitesinde dirençli organizmaların üremesini ve bulaşmasını azaltmak için önerilen stratejilerden biri, organizmaların komşu yataklardan bulaşma olasılığını azaltmak ve enfeksiyon kontrol önlemlerine uyumu artırmak için hastaları tek yataklı odalara yerleştirmektir. Açık koğuş sistemi ile yönetilen yoğun bakım ünitesi yeniden yapılandırılarak kapalı koğuş sistemi ile yönetilmeye başlandı. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte yatan hastalardaki enfeksiyon oranlarını retrospektif olarak incelemeyi amaçladık. Yeni yoğun bakım ünitesinde 6 aylık periyodda 274 hasta (grup A) takibi yapılmış ancak çalışma kriterlerine uygun 35 hasta, eski yoğun bakım ünitesinde 6 aylık periyodda yatan (grup B) 203 hastadan 23 hasta çalışmaya dahil edildi. Açık koğuş sisteminde takip edilen 6 aylık süreç ve izole oda sistemine geçtikten sonraki 6 aylık süreçte en az 1 hafta yatışı olan mekanik ventilatör desteği alan hastalar çalışmaya dahil edildi. Dış merkezlerden kabul edilen hastalar ile entübe halde kabul edilen hastane içi hastalar çalışma dışı bırakıldı. Bilgisayar data sistemi kullanılarak hastaların APACHE II, GKS, yaş, cinsiyet, yatış nedeni ve kültür sonuçları ile kaçıncı gün üreme olduğu kayıt edildi. Bu kayıtlara göre hastalardaki enfeksiyonların görülme yerleri, sıklıkları, etkenler ve dirençli mikroorganizmaların üreme oranları karşılaştırıldı. İstatistiksel analiz sonucunda kolistin dirençli üreme sonuçları yönünden anlamlı bir fark olduğu (p<0,05), Grup B hastalarında kolistin direnci gelişme oranının daha yüksek olduğu bulunmuştur. Trakeal aspirat kültür sonuçları incelendiğinde Grup B’de istatistiksel olarak anlamlı bir fark olduğu (p<0,05) üreme oranlarının daha yüksek olduğu bulunmuştur. Sonuç olarak; yoğun bakım ünitelerinde çoklu ilaca dirençli bakterilerin ortaya çıkmasını ve yayılmasını önlemeye yönelik stratejiler antimikrobiyal tedavinin etkinliğini ve kullanımını artırmaya çalışan stratejilerin yanısıra enfeksiyon kontrol önlemleri arasında hasta izolasyonu önem arzetmektedir. Çalışmamızın sonucunda izole oda yoğun bakım ünitesinde daha az dirençli mikroorganizma üreme oranı olduğu gösterilmiştir.

Kaynakça

  • 1. Blot S, Ruppé E, Harbarth S, Asehnoune K, Poulakou G, Luyt CE, et al. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs. 2022:1;70.
  • 2. Strich JR, Palmore TN. Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit. Vol. 31, Infectious Disease Clinics of North America. W.B. Saunders; 2017. p. 535–50.
  • 3. Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol. 2010;31(10):1025-1029.
  • 4. Kollef MH, Torres A, Shorr AF, Martin-Loeches I, Micek ST. Nosocomial Infection. Vol. 49, Critical care medicine. NLM (Medline); 2021. p. 169–87.
  • 5. Smith RL. Prevention of infection in the intensive care unit. Curr Opin Infect Dis. 2006;19(4):323-6.
  • 6. Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Li Bassi G, Luna CM, Martin-Loeches I, Paiva JA, Read RC, Rigau D, Timsit JF, Welte T, Wunderink R. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017;50(3):1700582.
  • 7. Patel PK, Gupta A, Vaughn VM, Mann JD, Ameling JM, Meddings J. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. J Hosp Med. 2018;13(2):105-116.
  • 8. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-63.
  • 9. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, Scheld M, Spellberg B, Bartlett J. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(1):1-12.
  • 10. Rosenthal VD, Maki DG, Salomao R, Mehta Y, Higuera F, Cuellar LE, et al. Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries [Internet]. 2006. Available from: www.inicc.org
  • 11. McDonald EG, Dendukuri N, Frenette C, Lee TC. Time-Series Analysis of Health Care-Associated Infections in a New Hospital with All Private Rooms. JAMA Intern Med. 2019;179(11):1501–6.
  • 12. Teerawattanapong N, Kengkla K, Dilokthornsakul P, Saokaew S, Apisarnthanarak A, Chaiyakunapruk N. Prevention and control of multidrug-resistant Gram-negative bacteria in adult intensive care units: A systematic review and network meta-analysis. Vol. 64, Clinical Infectious Diseases. Oxford University Press; 2017. p. S51–60.
  • 13. Al-Kadmy IMS, Ibrahim SA, Al-Saryi N, Aziz SN, Besinis A, Hetta HF. Prevalence of Genes Involved in Colistin Resistance in Acinetobacter baumannii: First Report from Iraq. Microbial Drug Resistance. 2020;26(6):616–22.
  • 14. Ko KS, Suh JY, Kwon KT, Jung SI, Park KH, Kang CI, et al. High rates of resistance to colistin and polymyxin B in subgroups of Acinetobacter baumannii isolates from Korea. Journal of Antimicrobial Chemotherapy. 2007;60(5):1163–7.
  • 15. Yelken B, Erkasap N, Bayram B, Us T, Ceylan I, Aslan G. Epidemiology of Acinetobacter baumannii isolates from patients with severe sepsis in anesthesia intensive care unit. Vol. 36, J. Pharm. Sci. 2011.
  • 16. Hussein NH, AL-Kadmy IMS, Taha BM, Hussein JD. Mobilized colistin resistance (mcr) genes from 1 to 10: a comprehensive review. Vol. 48, Molecular Biology Reports. Springer Science and Business Media B.V.; 2021. p. 2897–907.
  • 17. Karakoç, Ebru; Ayyıldız, Ayşe; Yelken, Birgül. Antibiotic resistance of acinetobacter strains in our intensive care unit: a retrospective study. Acta Medica Nicomedia, 2023, 6.1: 60-64
  • 18. Chowdhury D, Duggal AK. Intensive care unit models: Do you want them to be open or closed? A critical review. Neurol India. 2017;65(1):39-45.
  • 19. Deniz A, Erhan ÖL, Bayar MK, Karatepe Ü, Demirel İ. Examination of Changes in Infection Rates in a Restructured Anaesthesia Intensive Care Unit: A Retrospective Study. Turk J Anaesthesiol Reanim. 2017;45(6):353-360.
  • 20. Montrucchio G, Sales G, Catozzi G, et al. Effectiveness of an Active and Continuous Surveillance Program for Intensive Care Units Infections Based on the EPIC III (Extended Prevalence of Infection in Intensive Care) Approach. J Clin Med. 2022;11(9):2482
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Anesteziyoloji
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Ferda Yaman 0000-0001-6847-1720

Gizem Kurada 0000-0002-0008-1811

Serdar Ekemen 0000-0002-9145-2891

Birgül Yelken 0000-0001-9677-9028

Yayımlanma Tarihi 16 Ocak 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 46 Sayı: 1

Kaynak Göster

Vancouver Yaman F, Kurada G, Ekemen S, Yelken B. Yeniden Yapılandırılan Anestezi Yoğun Bakım Ünitesinde Enfeksiyon Oranlarındaki Değişimlerin İncelenmesi. Osmangazi Tıp Dergisi. 2024;46(1):59-67.


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