Öz
Giriş: Kan dolaşımı enfeksiyonları (KDE), yanık hastalarında önemli bir morbidite ve mortalite nedenlerdendir. Bu nedenle olası etkenlere yönelik erken ampirik antibiyotik tedavisi çok önemlidir. Bu hasta grubunda KDE ile ilgili çalışmalar sınırlıdır. Bizde çalışmamızda yanık ünitesinde KDE saptanan ağır yanık olguların epidemiyolojik, klinik, laboratuvar özelliklerinin ve mortaliteye etki eden faktörlerin incelenmesi amaçlandı.
Gereç ve Yöntem: Çalışmamızda, hastanemiz yanık ünitesinde 2014-2018 yılları arasında yatarak tedavi gören ve bakteremi saptanan 68 olgu retrospektif olarak incelendi.
Bulgular: Çalışmaya alınan 68 olgunun çoğu (%73,5) erkek olup yaş ortancası 38 olarak belirlendi. Olguların %25’inde ikinci derece, %75’inde üçüncü derece yanık olduğu ve yanık alanı ortancası %36 olarak belirlendi. Altmış sekiz olguda 86 bakteremi epizodu tespit edildi. Seksen altı etkenin çoğunun (%75,5) Gram-negatif olduğu (en sık Pseudomonas spp. ve Acinetobacter spp.) saptandı. Gram-negatif bakterinin %63’ünde karbapenem direnci belirlendi. Mortalite %35,3 (24/68) belirlendi. Eksitus olan olgularda bakteremi ile mortalite arası süre ortancası 3,5 gün saptandı. Toplam yanık yüzey alanı >%40 üzeri ve trombositopenisi olan olgularda mortalite istatistiksel olarak anlamlı olarak daha yüksek bulundu (p<0,05). Non-fermantatif bakterilerde ve Enterobacteriaceae’larda mortalite sırasıyla %42,1 ve %30,8 olup non-fermentatif bakterilerde mortalite daha yüksek saptandı. Ayrıca Pseudomonas spp. de mortalite Pseudomonas spp. dışı non-fermentatif bakterilere göre (%48) daha yüksek olduğu belirlendi.
Sonuç: Yanık hastaları enfeksiyon açısından yüksek risk altındadır. Enfeksiyon geliştiğinde de etkenlerin karbapenem direnci yüksek olması nedeniyle tedavi için antibiyotik tedavisi seçenekleri kısıtlı olmaktadır. Ayrıca olgularda yüksek toplam yanık yüzey alanı ve trombositopeni varlığı mortalitede önemli prognostik faktördür. Bu nedenle enfeksiyon kontrol önlemleri üst düzeyde olmalı ve ampirik başlanacak antibiyotiğin geniş spektrumlu olması önemlidir.
Anahtar Kelimeler: Kan dolaşımı enfeksiyonu, yanık hastaları, risk faktör, mortalite
Kaynakça
Erol S, Altoparlak U, Akcay MN, Celebi F, Parlak M. Changes of microbial flora and wound colonization in burned patients. Burns. 2004;30:357-61.
Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev. 2006;19:403-34.
Barret JP, Herndon DN. Effects of burn wound excision on bacterial colonization and invasion. Plast Reconstr Surg. 2003;111:744-50; discussion 751-2.
Ansermino M, Hemsley C. Intensive care management and control of infection. BMJ. 2004;329:220-3.
Pruitt BA Jr, McManus AT, Kim SH, Goodwin CW. Burn wound infections: current status. World J Surg. 1998;22:135-45.
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;54:959-66.
Branski LK, Al-Mousawi A, Rivero H, Jeschke MG, Sanford AP, Herndon DN. Emerging infections in burns. Surg Infect (Larchmt). 2009;10:389-97.
Hospital and prehospital resources for optimal care of patients with burn injury: guidelines for development and operation of burn centers. American Burn Association. J Burn Care Rehabil. 1990;11:98-104.
American Burn Association. Burn Center Transfer Criteria; 2017. Last Accessed Date: October 27, 2022. Available from: https://ameriburn.org/wp-content/uploads/2017/05/burncenterreferralcriteria.pdf
Wayne PA. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI Document M100-S21. Inform Suppl. 2011;31:100-21.
Miller JM, Binnicker MJ, Campbell S, Carroll KC, Chapin KC, Gilligan PH, Gonzalez MD, Jerris RC, Kehl SC, Patel R, Pritt BS, Richter SS, Robinson-Dunn B, Schwartzman JD, Snyder JW, Telford S 3rd, Theel ES, Thomson RB Jr, Weinstein MP, Yao JD. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018;67:e1-94.
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;50:625-63.
Laupland K, Gregson DB, Kirkpatrick AW, Kortbeek JB, Zygun DA, Findlay C, Hameed SM. Bloodstream infection complicating trauma. Clin Invest Med. 2004;27:253-8.
Al-Rawajfah OM, Stetzer F, Hewitt JB. Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. Infect Control Hosp Epidemiol. 2009;30:1036-44.
Shupp JW, Pavlovich AR, Jeng JC, Pezzullo JC, Oetgen WJ, Jaskille AD, Jordan MH, Shoham S. Epidemiology of bloodstream infections in burn-injured patients: a review of the national burn repository. J Burn Care Res. 2010;31:521-8.
van Duin D, Strassle PD, DiBiase LM, Lachiewicz AM, Rutala WA, Eitas T, Maile R, Kanamori H, Weber DJ, Cairns BA, Napravnik S, Jones SW. Timeline of health care-associated infections and pathogens after burn injuries. Am J Infect Control. 2016;44:1511-6.
Santucci SG, Gobara S, Santos CR, Fontana C, Levin AS. Infections in a burn intensive care unit: experience of seven years. J Hosp Infect. 2003;53:6-13.
Patel BM, Paratz JD, Mallet A, Lipman J, Rudd M, Muller MJ, Paterson DL, Roberts JA. Characteristics of bloodstream infections in burn patients: An 11-year retrospective study. Burns. 2012;38:685-90.
Wardhana A, Djan R, Halim Z. Bacterial and antimicrobial susceptibility profile and the prevalence of sepsis among burn patients at the burn unit of Cipto Mangunkusumo Hospital. Ann Burns Fire Disasters. 2017;30:107-15.
Fochtmann-Frana A, Freystätter C, Vorstandlechner V, Barth A, Bolliger M, Presterl E, Ihra G, Muschitz G, Mittlboeck M, Makristathis A, Rath T, Radtke C, Forstner C. Incidence of risk factors for bloodstream infections in patients with major burns receiving intensive care: A retrospective single-center cohort study. Burns. 2018;44:784-92.
Sousa D, Ceniceros A, Galeiras R, Pértega-Díaz S, Gutiérrez-Urbón JM, Rodríguez-Mayo M, López-Suso E, Mourelo-Fariña M, Llinares P. Microbiology in burns patients with blood stream infections: trends over time and during the course of hospitalization. Infect Dis (Lond). 2018;50:289-96.
Lee HG, Jang J, Choi JE, Chung DC, Han JW, Woo H, Jeon W, Chun BC. Blood stream infections in patients in the burn intensive care unit. Infect Chemother. 2013;45:194-201.
Neiverth A, Prim LR, Franck CL, Nisihara R. Sepsis in Burned Adult Patients: Study of Serie of Cases in Brazil. J Burn Care Res. 2020;41:900-4.
Raz-Pasteur A, Hussein K, Finkelstein R, Ullmann Y, Egozi D. Blood stream infections (BSI) in severe burn patients--early and late BSI: a 9-year study. Burns. 2013;39:636-42.
Vostrugina K, Gudaviciene D, Vitkauskiene A. Bacteremias in patients with severe burn trauma. Medicina (Kaunas). 2006;42:576‐9.
McManus AT, Mason AD Jr, McManus WF, Pruitt BA Jr. Twenty-five year review of Pseudomonas aeruginosa bacteremia in a burn center. Eur J Clin Microbiol. 1985;4:219-23.
Mahar P, Padiglione AA, Cleland H, Paul E, Hinrichs M, Wasiak J. Pseudomonas aeruginosa bacteraemia in burns patients: Risk factors and outcomes. Burns. 2010;36:1228-33.
Cato LD, Wearn CM, Bishop JRB, Stone MJ, Harrison P, Moiemen N. Platelet count: A predictor of sepsis and mortality in severe burns. Burns. 2018;44:288-97.
Sharma B, Sharma M, Majumder M, Steier W, Sangal A, Kalawar M. Thrombocytopenia in septic shock patients--a prospective observational study of incidence, risk factors and correlation with clinical outcome. Anaesth Intensive Care. 2007;35:874-80.
Gafter-Gvili A, Mansur N, Bivas A, Zemer-Wassercug N, Bishara J, Leibovici L, Paul M. Thrombocytopenia in Staphylococcus aureus bacteremia: risk factors and prognostic importance. Mayo Clin Proc. 2011;86:389-96.
Vandijck DM, Blot SI, De Waele JJ, Hoste EA, Vandewoude KH, Decruyenaere JM. Thrombocytopenia and outcome in critically ill patients with bloodstream infection. Heart Lung. 2010;39:21-6.
Thiery-Antier N, Binquet C, Vinault S, Meziani F, Boisramé-Helms J, Quenot JP; EPIdemiology of Septic Shock Group. Is Thrombocytopenia an Early Prognostic Marker in Septic Shock? Crit Care Med. 2016;44:764-72.
Venkata C, Kashyap R, Farmer JC, Afessa B. Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J Intensive Care. 2013;1:9.
Akca S, Haji-Michael P, de Mendonça A, Suter P, Levi M, Vincent JL. Time course of platelet counts in critically ill patients. Crit Care Med. 2002;30:753-6.
