INTRAHOSPITALNA I MIKROBIOLOŠKA ANALIZA NA KLINICI ZA ANESTEZIOLOGIJU I INTENZIVNU TERAPIJU TERCIJARNE ZDRAVSTVENE USTANOVE U JEDNOGODIŠNJEM PERIODU
Abstract
Naziv intrahospitalne infekcije ili nozokomijalne infekcije podrazumeva infekcije koje se javljaju kod pacijenata u zdravstvenim ustanovama a nisu bile prisutne u vreme njihovog prijema u zdravstvenu ustanovu i manifestuju se u prvih četrdeset osam sati posle prijema. Češće su u zemljama u razvoju (od 5,7% do 19,1%) nego u razvijenim zemljama (od 3,5% do 12%). Antimikrobna rezistencija predstavlja globalni problem koji nastaje kao posledica upotrebe antimikrobnih lekova. Neopravdana upotreba antibiotika dovodi do razvoja bakterijske rezistencije i promene uzročnika infekcije odgovornih za intrahospitalne infekcije. Ove vrste infekcija produžavaju dužinu bolničkog lečenja, dovode do invaliditeta i povećavaju morbiditet i mortalitet. Najčešći tipovi intrahospitalnih infekcija jesu pneumonija povezana sa upotrebom respiratora, infekcije krvi izazvane upotrebom centralnog venskog katetera, urinarne infekcije uzrokovane kateterom i infekcije hirurških rana.
Cilj ove studije bio je da se odrede najčešći bakterijski uzročnici intrahospitalnih infekcija, kao i da se prikaže distribucija uzročnika prema vrsti biološkog materijala.
Ova retrospektivna studija se sprovodila na Klinci za anesteziologiju i intenzivnu terapiju Univerzitetskog kliničkog centra u Nišu od početka do kraja 2024. godine. Od pacijenata se uzimao biološki materijal: krv, bris prepona, bris usne duplje, bris rane, bris pazuha, bris čmara, urin, endotrahealni aspirat, bris nosa, obični aspirat, sadržaj drena, saržaj trbušne duplje, vrh centralnog venskog katetra, vrh drena, bronhoaspirat i drugo. Sav biološki materijal poslat je u mikrobiološku laboratoriju radi dobijanja biograma i antibiograma.
Pokazalo se da je ukupan broj materijala bio 1464: 232 (15,85%) uzorka krvi, 179 (12,23%) briseva prepona, 166 (11,34%) briseva usne duplje, 132 (9,02%) brisa rane, 122 (8,33%) brisa čmara, 108 (7,38%) briseva pazuha, 106 (7,24%) uzoraka urina, 94 (6,42%) endotrahealna aspirata, 63 (4,30%) brisa nosa, 56 (3,83%) aspirata, 43 (2,94%) sadržaja drenova, 15 (1,02%) sadržaja trbušne duplje, 15 (1,02%) vrhova centralnih venskih katetera, 11 (0,75%) vrhova drena, 10 (0,68%) aspirata iz bronhija i 112 (7,65%) ostalih uzoraka.
Distribucija bakterija prema vrsti bila je sledeća: Klebsiella sp. 20,15%, Enterooccus faecalis 19,26%, Acinetobacter sp. 14,41%, Pseudomonas aeruginosa 7,9%, Escherichia coli 7,17%, Staphylococcus epidermidis 4,99%, Proteus mirabilis 3,96%, Enterococcus faecium 2,94%, Enetrobacter sp. 2,94% i Staphylococcus sp. 2,19%. Klebsiella sp. je bila dominantno prisutna u brisu usne duplje (3,28%), Enterococcus faecium u brisu prepona (5,60%), Acinetobacter sp. u endotrahealnom aspiratu (1,91%), Pseudomonas aeruginosa u brisu rane (2,25%), a Escherchia coli u brisu čmara (1,84%).
Intrahospitalne infekcije izuzetno loše utiču na hospitalizovane pacijente. Dovode do dugotrajnog invaliditeta, produženog vremena boravka u bolnici i lečenja, povećanja smrtnosti, potrošnje medicinskih resursa i troškova lečenja. Uzročnici ovih infekcija zavise kako od bolničkih uslova, tako i od samih pacijenata i antibiotika koje prepisuju lekari. Trebalo bi da postoje smernice za davanje antibiotika u svakom regionu u skladu sa najčešćim uzročnicima i samom rezistencijom na antibiotike, budući da bi to pomoglo zdravstvenim radnicima pri odabiru najadekvatnije antimikrobne terapije za hospitalizovane pacijente.
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