Öz
Giriş
Clostridioides difficile sıklıkla antibiyotik kullanımı sonrası mikrobiyotadaki değişiklikler sonucu gelişmektedir ve özellikle hastanede yatan hastalarda fatal olabilir. Çalışmamızda hastanede yatarak takip edilen hastalarda C. difficile enfeksiyonu sonrası gelişen ölüm oranı ve ilişkili faktörler araştırılmıştır.
Gereç ve Yöntem
Bu vaka-kontrol çalışmasında vaka grubunu 30 gün içinde ölenler, kontrol grubunu ise hayatta kalanlar oluşturmaktaydı. İki grup arasında, demografik ve klinik veriler karşılaştırıldı. Otuz günlük fatalite için risk faktörleri lojistik regresyon analizi ve Kaplan-Meier (KM) sağkalım analizi ile araştırıldı.
Bulgular
Toplam 67 erişkin hasta çalışmaya dahil edildi. Tanıdan sonraki 30 gün içinde 14 (%20.9) hastada tüm nedenlere bağlı ölüm meydana geldi. Atak başlangıcında prokalsitonin >0,5 ng/ml olması [olasılık oranı (OR): 7,407 (1,487-39,906)], C.difficile enfeksiyonu tanısı sonrası C. difficile enfeksiyonu dışındaki enfeksiyonlar için devam eden antibiyotik tedavisi [OR: 5,927 (1,053-33,357)] ve C. difficile enfeksiyonu atağının yoğun bakım ünitesinde gelişmesi [OR: 4,800 (1,066-21,609)] tüm sebeplere bağlı 30 günlük fatalite için bağımsız risk faktörleri olarak saptandı. Bu üç değişkenin 30 günlük fatalite üzerine etkisi KM sağkalım analizi ile de gösterildi (log-rank testi, p<0,05).
Sonuç
Sonuç olarak hastanede yatan hastalarda gelişen C. difficile enfeksiyonu ölüme sebep olabilmesi nedeniyle önemlidir. C. difficile enfeksiyonu atağının yoğun bakım ünitesinde yatarken gelişmesi ve atak başlangıcındaki prokalsitonin yüksekliği, kötü sonuçlar için öngördürücü olabilir. C. difficile enfeksiyonu atağına sebep olan antibiyotik kullanımının, C. difficile enfeksiyonu gelişimi sonrası uygun yönetimi sağkalıma fayda sağlayabilir.
Anahtar Kelimeler: Clostridioides difficile, fatalite, prokalsitonin
Kaynakça
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