Yanık Hastalarında Antimikrobiyal Dirençli Enfeksiyonlarda Epidemiyoloji, Risk Faktörleri, Predikte Ettirici Faktörler ile Mortalite Oranlarının Değerlendirilmesi
Öz
Amaç: Hastane kaynaklı enfeksiyonlar, ilk resüsitasyon evresini takiben yanık yaralanmalarında önde gelen ölüm nedenidir. Yanık hastalarında
sağlık bakımıyla ilişkili antimikrobiyallere dirençli enfeksiyonlarla ilgili çalışmalar sınırlıdır. Bu çalışmada, optimal enfeksiyon kontrol yaklaşımları ve
antimikrobiyal yönetim ihtiyacını vurgulamak amacıyla yanık hastalarında çok ilaca dirençli enfeksiyonların ana risk faktörlerini ve predikte ettiren
faktörleri değerlendirmeyi amaçladık.
Gereç ve Yöntem: Bu retrospektif olgu-kontrol çalışmasına Ocak 2015 ile Aralık 2018 tarihleri arasında hastanemizin yanık bakım bölümüne
başvuran yanık yaralanmalı 92 erişkin hasta dahil edildi.
Bulgular: Yanık hastalarının %47,8’inde (44/92) enfeksiyon geliştiği gözlendi ve bu 44 hastada 84 enfeksiyon epizodu kaydedildi. Lojistik regresyon
analizi sonrası değerlendirilen parametreler içerisinde sadece C-reaktif protein/albümin oranının enfeksiyon varlığı için anlamlı olduğu bulundu.
En sık Gram-pozitif mikroorganizmalar izole edilirken (42/84, %50), Gram-negatifler ikinci sıklıkta saptandı (39/84, %46). Çok ilaca dirençli
enfeksiyonlar, 14 hastada atakların %27’sini (23/84) oluşturuyordu. Bu enfeksiyonların en sık görüldüğü yer alt solunum yoluydu. Dirençli bakteriler,
solunum örneklerinin yaklaşık %80’inden izole edildi. Geniş spektrumlu ve çoklu antimikrobiyal kullanımı, çok ilaca dirençli enfeksiyonların gelişimi
için bağımsız risk faktörleri olarak bulundu ve dirençli enfeksiyonun varlığı ölüm için tek bağımsız risk faktörü olarak saptandı (p=0,001; odds oranı
10,4; %95 güven aralığı 1.923-56.359).
Sonuç: Bu çalışma, çoklu ilaç direncinin yanık hastalarında ölüm için bağımsız risk faktörü olduğunu göstermektedir. Antimikrobiyal direncin
gelişimini ve yayılımını sınırlamada en etkili yol olan enfeksiyon kontrolü önlemlerine sıkı uyum ve etkin antimikrobiyal yönetim programları, yanık
hastalarında ölüm oranını azaltabilecek temel yaklaşımdır.
Anahtar Kelimeler
Etik Beyan
Study approval was granted by the Başkent University Institutional Review Board (KA/18/273; 11.09.2018). Informed Consent: Retrospective case-control study. Peer-reviewed: Externally peer-reviewed.
Destekleyen Kurum
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Proje Numarası
-
Teşekkür
-
Kaynakça
- 1.CK M. Burns. In: Bennett JE, editor. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases 8 th ed: Elsevier; 2015.
- 2. Lachiewicz AM, Hauck CG, Weber DJ, et al. Bacterial Infections After Burn Injuries: Impact of Multidrug Resistance. Clin Infect Dis. 2017;65:2130-2136.
- 3. National Burn Repository 2017 Report. Chicago, IL: American Burn Association. 2017.
- 4. ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee. ISBI Practice Guidelines for Burn Care. Burns. 2016;42:953- 1021.
- 5. Criteria. ABABCR, Resources for Optimal Care of the Injured Patient 2006, Committee on Trauma ACoS. Guidelines for the Operation of Burn Centers. 2006.
- 6. Greenhalgh DG, Saffle JR, Holmes JH 4th, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007;28:776-790.
- 7. Rodríguez JC, Sirvent E, López-Lozano JM, et al. Criteria of time and antibiotic susceptibility in the elimination of duplicates when calculating resistance frequencies. J Antimicrob Chemother. 2003;52:132-134.
- 8. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268-281.
- 9. Öncül O, Öksüz S, Acar A, et al. Nosocomial infection characteristics in a burn intensive care unit: analysis of an eleven-year active surveillance. Burns. 2014;40:835-841.
- 10. Haberal M, Uçar N, Bilgin N. Epidemiological survey of burns treated in Ankara, Turkey and desirable burn-prevention strategies. Burns. 1995;21:601-606.
- 11. Church D, Elsayed S, Reid O, et al. Burn wound infections. Clin Microbiol Rev. 2006;19:403-434.
- 12. Bailey ME, Sagiraju HKR, Mashreky SR, et al. Epidemiology and outcomes of burn injuries at a tertiary burn care center in Bangladesh. Burns. 2019;45:957-963.
- 13. ALfadli M, El-Sehsah EM, Ramadan MA. Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection. Germs. 2018;8:199-206.
- 14. Wanis M, Walker SAN, Daneman N, et al. Impact of hospital length of stay on the distribution of Gram negative bacteria and likelihood of isolating a resistant organism in a Canadian burn center. Burns. 2016;42:104-111.
- 15. Lumenta DB, Hautier A, Desouches C, et al. Mortality and morbidity among elderly people with burns--evaluation of data on admission. Burns. 2008;34:965-974.
- 16. Lin JC, Chen ZH, Chen XD. Elevated serum procalcitonin predicts Gramnegative bloodstream infections in patients with burns. Burns. 2020;46:182- 189.
- 17. Wineberg D, Moore R, Kruger D. Procalcitonin and Bacterial Sepsis in Burn Patients in South Africa. J Surg Res. 2020;246:490-498.
- 18. Munoz B, Suarez-Sanchez R, Hernandez-Hernandez O, et al. From traditional biochemical signals to molecular markers for detection of sepsis after burn injuries. Burns. 2019;45:16-31.
- 19. Kim MH, Ahn JY, Song JE, et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy. PLoS One. 2015;10:e0132109.
- 20. Park JE, Chung KS, Song JH, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018;7:333.
- 21. Fitzwater J, Purdue GF, Hunt JL, O’Keefe GE. The risk factors and time course of sepsis and organ dysfunction after burn trauma. J Trauma. 2003;54:959- 966.
Evaluation of the Epidemiology, Risk Factors, Predictors and Fatality Associated with Extremely Drug-Resistant Infections in Burn Patients
Öz
Objectives: Hospital-acquired infections are the leading causes of mortality in burn injuries following the initial resuscitation phase. Studies on
healthcare associated antimicrobial-resistant infections in burn patients are limited. In this study, we aimed to evaluate the main risk factors and
predictors of extremely drug-resistant infections in burn patients to highlight the need for optimal infection control approaches and antimicrobial
stewardship.
Materials and Methods: This retrospective case-control study enrolled 92 adult patients with burn injuries admitted to the burn care department
of our hospital from January 2015 to December 2018.
Results: Infection was observed in 47.8% of the burn patients (44/92), with 84 infection episodes noted among these patients. For the prediction
of infection, only C-reactive protein/albumin ratio cut-off value was found to be a predictor after logistic regression analysis. Extremely drugresistant
infections accounted for 27% (23/84) of the episodes in 14 patients. The most common site of these infections was the lower respiratory
tract. Extremely drug-resistant bacteria were isolated from nearly 80% of the respiratory samples. Broad spectrum and multiple antimicrobial usage
were independent risk factors for the development of extremely drug-resistant infections and the presence of the resistant infection was the only
independent risk factor for fatality (p=0.001; odds ratio 10.4; 95% confidence interval 1,923-56,359).
Conclusion: This study showed that extremely drug resistance was the major risk factor for fatality in burn patients. Infection control and
antimicrobial stewardship programmes, which are crucial for limiting the development and spread of antimicrobial resistance, may decrease fatality
in burn patients. We are able to cope with most of these factors with the infection control procedures.
Anahtar Kelimeler
Etik Beyan
-
Destekleyen Kurum
-
Proje Numarası
-
Teşekkür
-
Kaynakça
- 1.CK M. Burns. In: Bennett JE, editor. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases 8 th ed: Elsevier; 2015.
- 2. Lachiewicz AM, Hauck CG, Weber DJ, et al. Bacterial Infections After Burn Injuries: Impact of Multidrug Resistance. Clin Infect Dis. 2017;65:2130-2136.
- 3. National Burn Repository 2017 Report. Chicago, IL: American Burn Association. 2017.
- 4. ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee. ISBI Practice Guidelines for Burn Care. Burns. 2016;42:953- 1021.
- 5. Criteria. ABABCR, Resources for Optimal Care of the Injured Patient 2006, Committee on Trauma ACoS. Guidelines for the Operation of Burn Centers. 2006.
- 6. Greenhalgh DG, Saffle JR, Holmes JH 4th, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007;28:776-790.
- 7. Rodríguez JC, Sirvent E, López-Lozano JM, et al. Criteria of time and antibiotic susceptibility in the elimination of duplicates when calculating resistance frequencies. J Antimicrob Chemother. 2003;52:132-134.
- 8. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268-281.
- 9. Öncül O, Öksüz S, Acar A, et al. Nosocomial infection characteristics in a burn intensive care unit: analysis of an eleven-year active surveillance. Burns. 2014;40:835-841.
- 10. Haberal M, Uçar N, Bilgin N. Epidemiological survey of burns treated in Ankara, Turkey and desirable burn-prevention strategies. Burns. 1995;21:601-606.
- 11. Church D, Elsayed S, Reid O, et al. Burn wound infections. Clin Microbiol Rev. 2006;19:403-434.
- 12. Bailey ME, Sagiraju HKR, Mashreky SR, et al. Epidemiology and outcomes of burn injuries at a tertiary burn care center in Bangladesh. Burns. 2019;45:957-963.
- 13. ALfadli M, El-Sehsah EM, Ramadan MA. Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection. Germs. 2018;8:199-206.
- 14. Wanis M, Walker SAN, Daneman N, et al. Impact of hospital length of stay on the distribution of Gram negative bacteria and likelihood of isolating a resistant organism in a Canadian burn center. Burns. 2016;42:104-111.
- 15. Lumenta DB, Hautier A, Desouches C, et al. Mortality and morbidity among elderly people with burns--evaluation of data on admission. Burns. 2008;34:965-974.
- 16. Lin JC, Chen ZH, Chen XD. Elevated serum procalcitonin predicts Gramnegative bloodstream infections in patients with burns. Burns. 2020;46:182- 189.
- 17. Wineberg D, Moore R, Kruger D. Procalcitonin and Bacterial Sepsis in Burn Patients in South Africa. J Surg Res. 2020;246:490-498.
- 18. Munoz B, Suarez-Sanchez R, Hernandez-Hernandez O, et al. From traditional biochemical signals to molecular markers for detection of sepsis after burn injuries. Burns. 2019;45:16-31.
- 19. Kim MH, Ahn JY, Song JE, et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy. PLoS One. 2015;10:e0132109.
- 20. Park JE, Chung KS, Song JH, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018;7:333.
- 21. Fitzwater J, Purdue GF, Hunt JL, O’Keefe GE. The risk factors and time course of sepsis and organ dysfunction after burn trauma. J Trauma. 2003;54:959- 966.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Mikrobiyoloji |
| Bölüm | Makaleler |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 30 Haziran 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 75 Sayı: 2 |
