Selçuk Üniversitesi Tıp Fakültesi Hastanesinde 2012-2015 yılları arasında görülen Vankomisine dirençli Enterokokların dağılımı ve irdelenmesi
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Tarih
2017
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info:eu-repo/semantics/openAccess
Özet
Giriş: Son yıllarda hastane infeksiyonu etkeni olarak giderek artan oranda görülen vankomisine dirençli enterokok (VRE) infeksiyonları ülkemizde ve tüm dünyada ciddi bir sorun olarak karşımıza çıkmaktadır. Bu çalışmada hastanemizdeki VRE sorununun gözden geçirilmesi amaçlandı.Materyal ve Metod: Bu çalışmada, 01 Ocak 2012-31 Aralık 2015 tarihleri arasında Selçuk Üniversitesi Tıp Fakültesi Hastanesi servis ve yoğun bakımlarında takip edilen, çeşitli kültürlerinde VRE üreyen 112 olgunun verileri retrospektif olarak hasta dosyaları taranarak değerlendirildi.Bulgular: Yıllara göre VRE olgularının dağılımına bakıldığında; 2013 yılında 13 (%11.6) olgu, 2014 yılında 23 (%20.5) olgu, 2015 yılında ise 76 (%67.9) olgu saptandı. Olguların 71 (%63.4)'i kolonize, 15 (%13.4)'i infekte, 26 (%23.2)'sı ise hem kolonize hem de infekte olarak belirlendi. 2013 yılındaki infekte olguların oranının daha fazla olduğu ve bu durumun istatistiksel olarak anlamlı olduğu gözlendi (p 0.001). VRE saptanan 112 olgunun 36 (%32.1)'sı kliniklerde, 76 (%67.9)'sı yoğun bakımlarda izlendi. Kliniklerde yatan olguların 30 (%83.3)'u dahili, 6 (%16.7)'sı cerrahi bölümlerde takip edildi. Yoğun bakım ünitelerinde takip edilen olgularda kolonizasyon oranı serviste takip edilen olgulara göre daha fazla tespit edildi. Bu durum istatistiksel olarak anlamlıydı (p 0.015). VRE saptanan 112 olgunun 109 (%97.3)'unda altta yatan bir veya daha fazla hastalık, 102 (%91.1)'sinde antibiyotik kullanım öyküsü, 102 (%91.1)'sinde üriner kateter varlığı, 86 (%76.7)'sında hastanede yatış öyküsü vardı. Buna göre; hastanede yatış öyküsü varlığı, altta yatan hastalık varlığı, antibiyotik kullanım öyküsü olması ve üriner kateter varlığı VRE infeksiyonu açısından istatistiksel olarak anlamlı saptanan risk faktörleri olarak belirlendi (p değerleri sırasıyla 0.01, 0.02, 0.01, 0.01). VRE tespit edilen 141 izolatın 137'sinde Enterococcus faecium saptandı. Antibiyotik duyarlılıklarına bakıldığında linezolid duyarlılığı %95.5, tigesiklin duyarlılığı %99.2 olarak tespit edildi. Ampisilin ve siprofloksasin direnci %100, teikoplanin direnci %95.7, trimetoprim-sülfametoksazol direnci %89.2, yüksek düzey gentamisin direnci %87.5 ve tetrasiklin direnci %80.4 olarak saptandı.Sonuç: Yaptığımız çalışma sonucunda hastanemizde yıllar içinde gittikçe büyüyen bir problem haline gelen VRE infeksiyonlarına yönelik olarak risk faktörlerimiz belirlendi. Önlem olarak risk faktörleri saptanan hastalardan rutin dışkı kültürü alınmasının yararlı olacağı düşünülmektedir.
Introduction: Prevailing at increasing rates as a cause of hospital infections in recent years, vancomycin resistant enterococcus (VRE) infections pose a serious problem in our country and across the world. This study aims at providing an overview of the VRE problem in our hospital. Materials and Methods: The data of 112 patients monitored in the clinics and intensive care units of Selcuk University Medical School Hospital between 1 January 2012 and 31 December 2015 and who had growth of VRE in their various cultures were reviewed retrospectively by going through patient files. Results: Looking at the distribution of VRE cases by years, it was seen that there were 13 cases in 2013 (11.6%), 23 cases in 2014 (20.5%) and 76 cases in 2015 (67.9%). Of these cases, 71 (63.4%) were colonized, 15 (13.4%) infected and 26 (23.2%) were both colonized and infected. The rate of infected cases was observed to be more in 2013, which was statistically significant (p< 0.001). From the 112 cases involving VRE, 36 (32.1%) were monitored in the clinics and 76 (67.9%) in the intensive care units. Thirty (83.3%) of the patients hospitalized in clinics were followed in the internal medicine clinics and 6 (16.7%) in surgical departments. The rate of colonization in patients treated in the intensive care units was higher than in those treated in clinics, which was statistically significant (p 0.015). There was one or more underlying diseases in 109 (97.3%) of the 112 patients found to have VRE, a history of antibiotic use in 102 of them (91.1%), presence of urinary catheter in 102 (91.1%), and a history of hospitalization in 86 (76.7%). Therefore, history of hospitalization, history of underlying disease, history of antibiotic use, and presence of a urinary catheter were considered statistically significant risk factors for VRE infections (p values 0.01, 0.02, 0.01 and 0.01, respectively). E. faecium was found in 137 of the 141 isolates with VRE. Their susceptibility to antibiotics was 95.5% for linezolid and 99.2% for tigecycline. Their resistance to ampicillin and ciprofloxacin were 100%, to teicoplanin 95.7%, to trimethoprim sulfamethoxazole 89.2%, to high levels of gentamicin 87.5% and of tetracycline 80.4%. Conclusion: As a result of our study, risk factors for VRE infections were identified, which had become a growing problem in years in our hospital. It is to our belief that it would be useful, as a precaution, to take routine stool cultures from patients found to carry these risk factors.
Introduction: Prevailing at increasing rates as a cause of hospital infections in recent years, vancomycin resistant enterococcus (VRE) infections pose a serious problem in our country and across the world. This study aims at providing an overview of the VRE problem in our hospital. Materials and Methods: The data of 112 patients monitored in the clinics and intensive care units of Selcuk University Medical School Hospital between 1 January 2012 and 31 December 2015 and who had growth of VRE in their various cultures were reviewed retrospectively by going through patient files. Results: Looking at the distribution of VRE cases by years, it was seen that there were 13 cases in 2013 (11.6%), 23 cases in 2014 (20.5%) and 76 cases in 2015 (67.9%). Of these cases, 71 (63.4%) were colonized, 15 (13.4%) infected and 26 (23.2%) were both colonized and infected. The rate of infected cases was observed to be more in 2013, which was statistically significant (p< 0.001). From the 112 cases involving VRE, 36 (32.1%) were monitored in the clinics and 76 (67.9%) in the intensive care units. Thirty (83.3%) of the patients hospitalized in clinics were followed in the internal medicine clinics and 6 (16.7%) in surgical departments. The rate of colonization in patients treated in the intensive care units was higher than in those treated in clinics, which was statistically significant (p 0.015). There was one or more underlying diseases in 109 (97.3%) of the 112 patients found to have VRE, a history of antibiotic use in 102 of them (91.1%), presence of urinary catheter in 102 (91.1%), and a history of hospitalization in 86 (76.7%). Therefore, history of hospitalization, history of underlying disease, history of antibiotic use, and presence of a urinary catheter were considered statistically significant risk factors for VRE infections (p values 0.01, 0.02, 0.01 and 0.01, respectively). E. faecium was found in 137 of the 141 isolates with VRE. Their susceptibility to antibiotics was 95.5% for linezolid and 99.2% for tigecycline. Their resistance to ampicillin and ciprofloxacin were 100%, to teicoplanin 95.7%, to trimethoprim sulfamethoxazole 89.2%, to high levels of gentamicin 87.5% and of tetracycline 80.4%. Conclusion: As a result of our study, risk factors for VRE infections were identified, which had become a growing problem in years in our hospital. It is to our belief that it would be useful, as a precaution, to take routine stool cultures from patients found to carry these risk factors.
Açıklama
Anahtar Kelimeler
Vankomisine dirençli enterokok, Hastane infeksiyonu, Vancomycin resistant enterococcus, Hospital infection
Kaynak
Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
22
Sayı
2
Künye
Torun, A., Sümer, Ş., Ural, O., Demir, N. A. (2017). Selçuk Üniversitesi Tıp Fakültesi Hastanesinde 2012-2015 Yılları Arasında Görülen Vankomisine Dirençli Enterokokların Dağılımı ve İrdelenmesi. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 22(2), 78-86.
