The problem of antimicrobial resistance in nosocomial medical and surgical intensive care units infections in a university hospital; a two-year prospective study

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dc.authorid0000-0002-8335-1927en_US
dc.contributor.authorİncecik, Şaban
dc.contributor.authorSaltoğlu, Neşe
dc.contributor.authorYaman, Akgün
dc.contributor.authorKarayaylalı, İbrahim
dc.contributor.authorÖzalevli, Mehmet
dc.contributor.authorGündüz, Murat
dc.contributor.authorBurgut, Hüseyin Refik
dc.date.accessioned2024-07-12T21:11:54Z
dc.date.available2024-07-12T21:11:54Z
dc.date.issued2009en_US
dc.departmentFakülteler, Tıp Fakültesien_US
dc.description.abstractAim: To determine the frequency of nosocomial infections (NIs) and the antimicrobial resistance of pathogens isolated from patients admitted to 4 intensive care units (ICUs) at a university hospital. Materials and Methods: The patients were prospectively followed over 2 years in medical, surgical, and reanimation ICUs. The isolates were collected from patients with NI determined by the Center for Diseases Control and Prevention criteria. The identification was performed and susceptibility to antibiotics was determined in an automated system Sceptor (Becton Dickinson) as described by the CCLS. Results: Among the 3962 patients in the ICUs, total NI incidence was 6.9%, with the highest rate in the reanimation ICU (14.7%) and the lowest rate in the surgical ICU (2.5%). In all, 492 NI episodes were diagnosed in 272 patients. The incidence of NIs was 13.1 per 1000 patient days. The NIs were urinary tract infections (32%), primary blood stream infections (24%), pneumonia (20%), surgical-site infections (13%), and other infections (11%). Pneumonia was the most common NI in the reanimation ICU (54%). The pathogens were 39% gram-positive bacteria, 52% gram-negative bacteria, and 9% Candida species. S. aureus (18%) was the most frequently isolated bacteria, followed by P. aeruginosa (16%), Acinetobacter spp. (10%), coagulase negative staphylococcus (CNS) (10%), Klebsiella (9%), E. coli (9%), and Enterococcus spp. (9%). Resistance to methicillin was 90% in S. aureus isolates and was 95% in the CNS isolates; no resistance was detected to vancomycin in S. aureus and CNS isolates. Eight percent of Enterococcus isolates were resistant to vancomycin. Against the gramnegative bacteria the carbapenems were most active, followed by amikacin and ciprofloxacin. Five percent of P. aeruginosa and 15% of Acinetobacter spp. were resistant to all antibiotics. The most active antimicrobial agents against Acinetobacter spp. were imipenem (73%) and tobramycin (46%); against Pseudomonas spp. were ticarcillin/clavulanate (56%), piperacillin (44%), and imipenem (33%); against Klebsiella spp. was imipenem (92%); against E. coli were imipenem (94%), amikacin (94%), and ciprofloxacin (74%); and against Enterobacter spp. were ciprofloxacin (89%) and imipenem (78%). Conclusions: The high rates of resistant pathogens responsible for NI in ICUs suggest that infection preventive procedures should be implemented and antimicrobial agents must be used appropriately.en_US
dc.description.abstractAmaç: Bir üniversite hastanesinde dört yoğun bakım ünitesinde yatan hastalarda nozokomiyal infeksiyonların sıklığı ile izole edilen patojenlerde antimikrobiyallere direnci belirleme. Yöntem ve Gereç: Medikal, cerrahi ve reanimasyon yoğun bakım ünitelerinde yatan hastalar prospektif olarak izlendi. İzolatlar CDC kritelerine göre belirlenen nozokomiyal infeksiyonlardan toplandı. İzolatların tanımlanması ve antibiyotiklere duyarlılığı Sceptor (Becton Dickinson) otomatize sistemle CCLS kriterlerine göre yapıldı. Bulgular: YBÜ’lerinde yatan 3962 hastada, nozokomiyal infeksiyon insidansı % 6,9; en yüksek oran reanimasyon YBÜ’nde (% 14,7), en düşük oran cerrahi YBÜ’nde (% 2,5) olarak belirlendi. 272 hastada 492 Nİ epizodu belirlendi. Nİ insidansı 1000 hasta gününe 13,1 olarak saptandı. Nİ oranları, üriner sistem (% 32), primer bakteriyemi (% 24), pnömoni (% 20), cerrahi alan (% 13) ve diğer infeksiyonlar % 11 bulundu. Pnömoni Reanimasyon YBÜ’nde en sık saptanan (% 54) Nİ idi. Etkenlerin % 39’u gram pozitif, % 52’si gram negatif bakteri, % 9’u Candida türleri idi. En sık izole edilen bakteri S. aureus (% 18); bunu P. aeruginosa (% 16), Acinetobacter spp. (% 10), koagülaz negatif stafilokok (KNS) (% 10), Klebsiella (% 9), E. coli (% 9), ve Enterococcus spp. (% 9) izlemekteydi. S. aureus türlerinde metisilin direnci % 90, KNS larda % 95, S. aureus ve KNS larda vankomisine direnç saptanmadı. Enterokokların % 8’i vankomisine dirençli idi. Gram negatiflere en etkili antibiyotik karbapenemi, amikasin ve siprofloksasin izlemekteydi. P. aeruginosa suşlarının % 5’i ile Acinetobacter türlerinin % 15’i tüm antibiyotiklere dirençli bulundu. Acinetobacter türlerine en etkin antibiyotikler imipenem (% 73), tobramisin (% 46); Pseudomonas türlerine tikarsilin/klavulanat (% 56), piperasilin (% 44), imipenem (% 33); Klebsiella türlerine imipenem (% 92), E. coli suşlarına imipenem (% 94), amikasin (% 94), siprofloksasin (% 74); Enterobacter türlerine siprofloksasin (% 89), imipenem (% 78) idi.en_US
dc.identifier.citationİncecik, Ş, Saltoğlu, N., Yaman, A., Karayaylalı, İ., Özalevli, M., Gündüz, M. ve Burgut, H. R. (2009). The problem of antimicrobial resistance in nosocomial medical and surgical intensive care units infections in a university hospital; a two-year prospective study / Bir üniversite hastanesi medikal ve cerrahi yoğun bakım üniteleri nozokomiyal infeksiyonlarında antimikrobiyallere direnç problemi, 2 yıllık prospektif çalışma. 39(2), s. 295-304.en_US
dc.identifier.endpage304en_US
dc.identifier.issn1303-6165
dc.identifier.issue2en_US
dc.identifier.scopusqualityQ3en_US
dc.identifier.startpage295en_US
dc.identifier.urihttps://journals.tubitak.gov.tr/medical/abstract.htm?id=10169
dc.identifier.urihttps://hdl.handle.net/20.500.12415/4428
dc.identifier.volume39en_US
dc.institutionauthorBurgut, Hüseyin Refik
dc.language.isoenen_US
dc.publisherTübitaken_US
dc.relation.ispartofTurkish Journal Of Medical Sciencesen_US
dc.relation.isversionof10.3906/sag-0806-4en_US
dc.relation.publicationcategoryUluslararası Hakemli Dergide Makale - Kurum Öğretim Elemanıen_US
dc.rightsCC0 1.0 Universal*
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.rights.urihttp://creativecommons.org/publicdomain/zero/1.0/*
dc.snmzKY03735
dc.subjectNosocomial infectionsen_US
dc.subjectIntensive care unitsen_US
dc.subjectAntimicrobial resistanceen_US
dc.subjectNozokomiyal infeksiyonen_US
dc.subjectYoğun bakım ünitelerien_US
dc.subjectAntimikrobiyalen_US
dc.titleThe problem of antimicrobial resistance in nosocomial medical and surgical intensive care units infections in a university hospital; a two-year prospective studyen_US
dc.title.alternativeBir üniversite hastanesi medikal ve cerrahi yoğun bakım üniteleri nozokomiyal infeksiyonlarında antimikrobiyallere direnç problemi, 2 yıllık prospektif çalışmaen_US
dc.typeArticle
dspace.entity.typePublication

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