The effect of moving hospital to microbial agents of nosocomial intensive care unit

YÖK Tez No: 272448Yoğun bakım ünitelerinde nozokomiyal enfeksiyonlar hastanenin diğer bölümlerine oranla daha sık görülmektedir. Bu çalışma Düzce Üniversitesi Araştırma ve Uygulama Hastanesi'nde, yeni binaya taşınmanın yoğun bakım enfeksiyonları üzerine etkisini araştırmak amacıyla yapılmıştır. Çalışma;hastanenin yeni binasına taşındığı Şubat 2009'dan önceki bir yılı için retrospektif, taşınmadan sonraki bir yılı için ise prospektif olarak yapılmıştır. Araştırma, hasta ve laboratuar kaynaklı olarak aktif sürveyans yöntemiyle gerçekleştirilmiştir. Enfeksiyonlar hem genel olarak hem de alet ilişkili olarak hesaplanmıştır. Genel enfeksiyon oranları karşılaştırıldığında yeni hastanede pnömoni enfeksiyonlarının anlamlı oranda arttığı saptanmıştır (eski hastanede pnömoni hızı binde 14.47, yeni hastanede binde 22.65, p=0.013). Yeni hastanede Dahiliye yoğun bakım ünitesinde ventilatör kullanım oranının düşmüş olmasına rağmen (eski hastane 0.9, yeni hastane 0.73) pnömoni enfeksiyonlarında anlamlı artış saptanmıştır (eski hastane pnömoni hızı binde 9.8, yeni hastane binde 19.7, (p=0.017). Dahiliye yoğun bakım ünitesinde hemşire ve lavabo başına düşen hasta sayısı (3) artmış ve bu birimde çalışan personelin önemli bir kısmı yeni personellerden oluşmuştur. Yeni Nöroşirürji yoğun bakım ünitesinde, dahiliye yoğun bakım ünitesinde olan olumsuzluklar yaşanmamış ve genel enfeksiyon oranının düştüğü saptanmıştır (p=0.008). Sonuç olarak, bina değişikliğinin yoğun bakım enfeksiyon etkenlerinin dağılımı üzerine anlamlı etkisi görünmemektedir.Daha fazla çalışmaya gereksinim olmakla beraber; bina değişikliğinden ziyade personel sayısı venpersonelin yoğun bakım tecrübesi ile lavabo başına düşen hasta sayısı yoğun bakım enfeksiyonları üzerine daha fazla etki ediyor gibi görünmektedir.Intensive care units are the parts of the hospital where the nosocomial infections are more common than the other parts. This study was designed to investigate the effect of the moving to the new building, on the intensive care unit infections in Duzce University Research and Application Hospital. This study includes the year before the hospital moved to its new building in February 2009 retrospectively and the year after prospectively. This study was carried out with the method of active surveillance from the patient and the laboratory as a source. Infection rates were calculated either for overall or instrument raleted. When overall infection rates compared, there was significantly increase in pneumonia infection (in respiratory tract infection) rates, in the new building (incidence density in the old building 14.47 per thousand, in the new building 22.65 per thousand, p=0.013). Although the use of ventilator rates were decrease in the new building, in internal intensive care unit (in the old building 0.9, in the new building 0.73), there was a significantly increase in pnomonia rates (in the old building 9.8 per thousand, in the new building 19.7 per thousand, p=0.017). In the new building, in internal intensive care unit, the number of patients per nurse and basin were increased (3) and also the majority of these staff were new. In the new Neurosurgery intensive care unit overall infection rates were increased (p=0.008), and also the problems which were detected in internal care unit were not seen in this unit. As a result, moving to the new building was not a significant effect on the range of intensive care unit infections. Although more studies are needed, rather than the change in building, the number of staff and their experience in internal care unit and number of patients per basin are seem to have more effects on the intensive care unit infections

Does acute checystitis be a complication of acute pyelonephritis?

Üriner sistem enfeksiyonları toplumda en sık görülen enfeksiyonlardandır. Akut pyelonefrit bir üst üriner sistem enfeksiyonudur. Akut pyelonefrit (APN) yan ağrısı veya hassasiyeti veya her ikiside, ateş, idrar yaparken yanma-sızı, idrar kaçırma ve sık idrara çıkma şikâyetleri ile karakterize bir hastalıktır. Bu semptomlar enfeksiyon olmadan da bulunabilir (Ör: Renal enfakt, renal kalkül). En sık etken Escherichia coli’dir. Akut pyelonefrit geçiren hastalarda; renal abse, perirenal abse, karın içi abseler ve sepsis gibi komplikasyonlar gelişebilir (1). Akut kolesistit (AK); safra kesesi iltihabıdır. En sık nedeni safra yolları tıkanıklığıdır. Hastalar sıklıkla sağ üst kadran ağrısıyla başvururlar fakat bazı hastalarda lokalize bulgular bulunmayabilir. Hastalarda ateş, taşikardi sık görülen bulgulardandır. AK tanısı için ilk olarak ve en sık yapılması gereken görüntüleme metodu ultrasonografidir (US). Komplikasyondan şüphelenilen durumlarda bilgisayarlı tomografi (BT) çekilebilir (2).Urinary tract infections are one of the most common infections in outpatient. Acute pyelonephritis is an upper urinary tract infection. Infections of the biliary tract are most often associated with obstruction to the flow of bile. Twenty-four years old female patient admitted to emergency clinic with complaints of fever, chill, shivering, myalgia, arthralgia, nausea, vomitting and right sided abdominal pain. In her past medical history, there was no disease other than nephrolithiasis. In her vital signs, body temperature was 39.8°C. In physical examination, there were pain at deep palpation of right upper quadrant of abdomen and right costovertebral angle. Also, there was Murphy sign. Other system examination was normal. At the admission time, in laboratory examination; white blood count was 15.270/mm3 with 90 % of neutrophile. Microscobic examination of urine showed puyuria. Abdominal ultrasound revealed edema and thickening of fundus (5.3 mm) of gall bladder and dilatation of right proximal urether and mucosal edema of right renal pelvis and proximal urether. Abdominal computerize tomography showed 2x2.5x5 cm hypodense lesion with irregular border at the cortical region of the middle zone of right kidney and hypodense effussion around the gall bladder. With the diagnosis of pyelonephritis, renal abscess and acute cholecystitis treatment of ceftriaxone 2x1 gr/day and ornidasole 2x500 mg/day was given for 3 weeks. There were no other complaints in 6 months of follow

Primary Bacteremia Associated With Sphingomonas paucimobilis During the Late Period in a Patient With Ventriculoperitoneal Shunt After Neurosurgery With Literature Review

Hakyemez, Ismail/0000-0001-6133-9604WOS: 000300408500009Sphingomonas paucimobilis is a Gram-negative aerobic rod, which is nonfermentative, nonspore forming, catalase positive, and oxidase positive. It is believed that the natural habitat of this organism is the natural environment, and it is also found in hospital settings. The infections caused by the bacteria are rarely life threatening. A 46-year-old woman was admitted to our clinic with right flank pain, groin pain, and fever. On clinical examination, right costovertebral angle pain and an operation scar in the temporal region were observed. A review of her medical history revealed an operation for subarachnoid hemorrhage secondary to aneurysm and a ventriculoperitoneal shunt 6 weeks before admission. Ceftriaxone 2 x 1 g/day was started. No growth was detected in urine, cerebrospinal fluid, and temporal fluid cultures; however, a Gram-negative rod grew in one of the blood cultures on the second day of treatment. Intravenous ciprofloxacin 400 mg 2 x 1/day was added to treatment. Ceftriaxone treatment was switched to cefoperazon-sulbactam 1 gr 2 x 1/day. No growth was observed in urine and blood control cultures on the third day of treatment. Cefoperazon-sulbactam was stopped on the 10th day, and ciprofloxacin was continued until the 21st day. In English literature, the presence of Sphingomonas paucimobilis bacteremia after neurosurgery has not been previously reported

Impact of antimicrobial drug restrictions on doctors' behaviors

Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had ≤5 years of occupational experience (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did.Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had ≤5 years of occupational experience (junior specialists = JSs) and 942 (49.4%) of them were physicians. Specialists having >5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did

Impact of antimicrobial drug restrictions on doctors' behaviors

Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did

Impact of antimicrobial drug restrictions on doctors' behaviors

WOS: 000368558600006PubMed ID: 27511346Background/aim: Broad-spectrum antibiotics have become available for use only with the approval of infectious disease specialists (IDSs) since 2003 in Turkey. This study aimed to analyze the tendencies of doctors who are not disease specialists (non-IDSs) towards the restriction of antibiotics. Materials and methods: A questionnaire form was prepared, which included a total of 22 questions about the impact of antibiotic restriction (AR) policy, the role of IDSs in the restriction, and the perception of this change in antibiotic consumption. The questionnaire was completed by each participating physician. Results: A total of 1906 specialists from 20 cities in Turkey participated in the study. Of those who participated, 1271 (67.5%) had 5 years of occupational experience in their branch expressed that they followed the antibiotic guidelines more strictly than the JSs (P < 0.05) and 755 of physicians (88%) and 720 of surgeons (84.6%) thought that the AR policy was necessary and useful (P < 0.05). Conclusion: This study indicated that the AR policy was supported by most of the specialists. Physicians supported this restriction policy more so than surgeons did