Faktori rizika od nastanka bolničkih infekcija i smrtnog ishoda u neurološkoj jedinici intenzivnog lečenja u tercijarnoj bolnici u Beogradu, Srbija: prospektivna kohortna studija
Sažetak
Uvod/Cilj. Bolesnici u neurološkim jedinicama intenzivnog lečenja (JIL) su u posebnom riziku od nastanka bolničkih infekcija (BI). BI uzrokuju značajan morbiditet i mortalitet. Cilj ovog istraživanja bio je da se utvrdi incidencija BI, identifikuju faktori rizika (FR) i uzročnici BI, kao i da se ustanove FR za smrtni ishod u neurološkoj JIL. Metode. U šestokrevetnoj JIL Klinike za neurologiju Vojnomedicinske akademije u Beogradu sprovedena je prospektivna kohortna studija od januara 2014. godine do decembra 2016. godine. Rezultati. U studiju je bilo uključeno 148 bolesnika praćenih tokom 2 708 bolesnik-dana. Registrovano je ukupno 49 BI kod 39 bolesnika. Incidencija BI bila je 26,3%, a gustina incidencije 18.1 na 1000 bolesnik-dana. Najčešće BI bile su: infekcije mokraćnog sistema (15,5%), pneumonija (10,1%) i sepsa (4%). FR povezani sa nastankom BI u neurološkoj JIL bili su primena urinarnog katetera [risk ratio (RR): 5,6; 95% confidence interval (CI): 1,153–27,632), dani primene urinarnog katetera (RR: 1,1; 95% CI: 1,057–1,188), dani primene centralnog vaskularnog katetera (RR: 1,1; 95% CI: 1,010–1,150) i primena mehaničke ventilacije (RR: 0,3; 95% CI: 0,079–0,859). Najčešće registrovani uzročnik BI bila je Klebsiella spp. FR povezani sa smrtnim ishodom u neurološkoj JIL su bili: mehanička ventilacija (RR: 6,5; 95% CI: 2,868–14,116), Glasgov koma skor (RR: 2,7; 95% CI: 1,135 – 6,396) i starost bolesnika (RR: 1,03; 95% CI: 1,005–1,055). Zaključak. Upotreba invazivnih pomagala tokom boravka u neurološkoj JIL nosi značajan rizik od nastanka BI. U neurološkoj JIL BI su najčešće uzrokovane Gram negativnim bakterijama, koje ispoljavaju učestalu rezistenciju na antibiotike. Ovi rezultati naglašavaju značaj prevencije BI.
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