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MEKANİK VENTİLASYON UYGULAMASI SIRASINDA GELİŞEN NOSOKOMİYAL PNÖMONİLER

Journal Name:

  • Cerrahpaşa Tıp Dergisi

Publication Year:

  • 1999

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
We aimed to point out pneumonia incidence in mechanically ventilated patients and define the prognosis and mortality rate in patients diagnosed to have pneumonia in Intensive Care Unit (ICU). Design.- In our study we reviewed 55 patients who were ventilated for at least 3 days and 28 patients out of 55, diagnosed to have pneumonia are included in the study. We verified pneumonia diagnosis according to infiltrations on chest X-ray and accompanying at least two clinical signs. For each patient studied, the chart is reviewed for the following parameters: ECG, invasive arterial pressure, central venous pressure, body temperature, microbiological analyses of tracheal aspirate, whole blood count, electrolyte, hemocultures, urine culture and pneumonic infiltration shown on chest X-ray. The antibiotic therapy schedule was devised as double or triple therapy according to antibiogram. Results.- Pneumonia incidence is found to be 50.6% and mortality incidence 61%. According to microbiological analyses of tracheal aspirates, S. aureus encountered in 7 cases, P. aeruginosa in 5 cases, enterococus'spp in 4 cases, acinetobacter'spp in 2 cases, Stenotrophomonas maltophilia in one case and H.influenzae in one case. In 7 cases polymicrobial pneumonia was the case. Conclusion.- Nosocomial pneumonia caused by polymicrobial and multiresistant microorganisms, appears as a disease with high mortality rate.
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Abstract (Original Language): 
Yoğun bakım ünitemizde mekanik ventilasyon uyguladığımız hastalarımızdaki pnömoni insidansını saptamayı, pnömoni gelişen olgularımızın prognoz ve mortalitelerini belirlemeyi hedefledik. Çalışmaya en az 3 gün mekanik ventilasyon uyguladığımız 55 olgundan nosokomiyal pnömoni gelişen 28'i dahil edilmişdir. Pnömoni tanısı; akciğer grafisinde yeni veya persistan infiltrasyonların saptanması ve buna eşlik eden en az iki klinik bulgu olması ile konulmuştur. Olgularımızda EKG, invaziv arter basıncı, SVB, vücut ısısı, trakeal aspiratların mikrobiyolojik analizleri, hematokrit, lökosit, trombosit, elektrolit, hemokültür, idrar kültürü, akciğer grafileri takip edildi. APACHE II skorlaması kullanıldı. Olgulara antibiyotik tedavisi kültür antibiyogram sonuçları göz önüne alınarak ikili veya üçlü kombinasyonlar halinde yeniden düzenlenmişdir. Pnömoni gelişme insidansımız %50.6'dır, mortalitemiz %61'dir. Trakeal aspiratlarının mikrobiyolojik analizlerinde; 7 olgumuzda metsiline dirençli staphylococcus aureus, 5 olgumuzda Pseudomonas aeruginosa. 4 olgumuzda enterococcus spp, 2 olgumuzda acinetobacter, 2 olgumuzda stenotrophomonas maltophilia, 1 olgumuzda Haemophilus influenzae üremişdir. Polimikrobiyal pnömoni gelişen 7 olgumuz bulunmaktadır. Nosokomiyal pnömoni, polimkrobiyal ve multirezistan mikroorganizmalar tarafından oluşturulmaları nedeniyle günümüzde mortalitesi %80'lere varan bir hastalık olarak karşımıza çıkmaktadır.
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  • 3
214-220
  • Turkish

REFERENCES

References: 

1. Garnen J, Jarvis WR. CDC Definitions for nosokomiyal infections. Am J Infect Control 1988; 16: 128.
2. Özsüt H. Yoğun bakım ünitesi enfeksiyonları. Enfeksiyon hastalıkları konsültasyonları 1997; 18-19.
3. LeBas S, Grier L. Nosocomial pneumonia. Current opinion in pulmanory medicine 1996; 2: 206.
4. Craven DE, Kunches LM. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986; 133: 792.
5. Baron EJ, Peterson LR, Finegold SM. Bailey and Scott's Diagnostic Microbiology, 9th ed. St Louis:Cv Mosby Co, 1994: 474.
6. Koneman EW, Allen SD, Janda WM. Color Atlas and Textbook of Diagnostic Microbiology 4th ed. Philadelphia: JP Lippincott Co, 1992: 519.
7. Stevens RM, Teres D. Pneumonia in an intensive care ünit; A 30 month experience. Arch Intern Med 1974; 134.
8. Wunderink RG, Woldenberg LS. The radiologic diagnosis of autopsy proven ventilator-associated pneumonia. Chest 1992; 101: 458.
9. Marin K. Ventilator-associated pneumonia; Multivariate analysis. JAMA 1993; 270: 16.
10. Salata RA, Lederman MM. Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis 1987; 135: 426.
11. Dirks MR, Craven DE. Nosocomial pneumonia in intubated patients given sucralfate as compered with antiacids or histamine type 2 blockers. N Engl J Med 1987; 317: 1376.
12. Garibaldi RA, Britt MR. Risk factors for postoperative pneumonia. Am J Med 1981; 70: 677.
13. Pennington JE. Nosocomial respiratory infections. In: Mandell GL,Douglas RG. Principles and practice of infections diseases. NewYork: John Wiley and sons, 1985; 1620.
14. Johnson WG, Pierce AK. Nosocomial respiratory infections with gram negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972; 77: 701.
15. Barrlett JG, O'Keefe P. Bacteriology of hospital acquired pneumonia. Arch Intern Med 1986; 146: 868.
16. Centers for disease control. National nosocomial infections study report, annual summary, 1979 Atlanta: Centers for disease control, 1982.
17. Stamm WE, Martin SM. Hospital-acquired infections. J Infect Dis 1977; 136: 151.
18. Higuchi JH, Coalson JJ. Bacteriologic diagnosis of nosocomial pneumonia in primates. Usefulness of the protected specimen brush. Am Rev Respir Dis 1982; 125:53.
19. Fletcher EC, Mohr JA. Bronchoscopic diagnosis of pulmanary infections. West J Med 1983;138: 364.
20. Chastre J, Viau F. Prospective evaluations of the protected specimen brush for the diagnosis of pulmonary infections in ventilted patients. Am Rev Respir Dis 1984; 130: 924.
21. Tillotson JR, Finland M. Bacterial colonization and clinical superinfections of the respiratory tract complicating antibiotic treatment of pneumonia. J Infect Dis 1969; 119: 597.

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