The Relation of CTX-M positive Nosocomial Escherichia coli Infections of and Risk Factors.

TEZ9828Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2012.Kaynakça (s. 68-78) var.viii, 83 s. : res., tablo ; 29 cm.Amaç; Hastane ortamında izole edilen Esherichia coli’ lerin beta-laktamazlarının çoğu Genişlemiş spektrumlu beta-laktamazlar’ dır. Bu çalışmanın amacı Esherichia coli’lerde CTX-M sıklığını saptanmak, bu suşlar arası klonal ilişkinin moleküler yöntemlerle belirlenmesi ve bu çok ilaca dirençli Esherichia coli’lerle enfeksiyon gelişimi ile ilişkili risk faktörlerinin belirlenmesi amaçlanmıştır. Materyal-metod; Bu çalışmaya 1 Mart 2011- 31 Mart 2012 tarihleri arasında merkez laboratuvarında izole edilen Esherichia coli izolatlatlarına dayanarak, Centers for Disease Control and Prevention (CDC) kriterlerine göre hastane enfeksiyonu olarak yorumlanan erişkin hastalar dahil edildi. Bu izolatlarda moleküler ve epidemiyolojik yöntemlerle,CTX-M tipi beta-laktamaz üretenlerin prevalansı ve subgrupları grup spesifik polimeraz zincir reaksiyonu (PZR) ile saptandı. Bu suşlar arasındaki muhtemel klonal ilişkinin ve bunların risk faktörleri ile olan ilişkisinin ortaya konulması için Pulsefield gel elecrophoresis (PFGE) yöntemi kullanıldı. Bulgular; Tek değişkenli analizde GSBL üretiminde rolü olduğu düşünülen ve anlamlı bulunan üriner sistem hastalığı, son 3 ayda hastanede yatış öyküsü, son 3 ayda 3.kuşak sefalosporin kullanımı, üriner kateter uygulaması, Pitt bakteriyemi skoru çok değişkenli analizde de GSBL gelişimi yönünden risk faktörü olarak tespit edildi ]sırasıyla; OR(% 95 GA) = 3(1,6-5,5), OR (% 95 GA)= 2,1(1,17-4,01), OR=(% 95 GA)=8(2-38), OR=(% 95 GA)=2(1,2-4), OR=(% 95 GA)= 0,1(0,03-0,36)]. Mortalite yönünden ise GSBL pozitif ve negatif hastalar arasında anlamlı fark saptanmadı (p=0,14). CTX-M pozitifliği % 54,5 tespit edildi. En sık saptanan CTX-M grubu CTX-M-1 (% 85,7) idi. CTX-M pozitif ve CTX-M negatif hasta gruplarının karşılaştırılmasında istatiki olarak anlamlı risk faktörü saptanmadı. PFGE yöntemi ile Esherichia coli suşlarının klonal ilişkisi değerlendirildi ve suşlar arasında hastane kaynaklı bir bulaşı düşündürecek anlamlı bir klonal ilişki saptanmadı. Sonuç; GSBL taşıyan türlerin toplum içerisinde yayılımları, bulaş yolları ve muhtemel risk faktörlerinin tespiti bu tür çok ilaca dirençli mikroorganizmalarla oluşacak enfeksiyonların önlenmesinde önemlidir. Akılcı antibiyotik kullanımı GSBL pozitif mikroorganizmalarla oluşan enfeksiyonları azaltmada önem taşımaktadır. Bu nedenle, GSBL’lerin doğru antibiyotik kullanımı ve enfeksiyon kontrol önlemleri ile yayılımını ve sayısını kısıtlamak mümkün olabilir.Aim; Most of beta-lactactamases among nosocomial Escherichia coli isolates are Extended spectrum beta-lactamases (ESBL’s). Aim of this study was to determine the CTX-M frequency among Escherichia coli isolates with moleculer methods clonal relation between multidrug-resistant Escherichia coli and determine the risk factors associated with the development of infection with those microorganisms. Material-Method; This study included the isolated Escherichia coli strains at central laboratory from adult patients defined as hospital-acquired infection on the basis of Centers for Disease Control and Prevention (CDC) criteria between 1 st March 2011 and 31 st March 2012. The prevalence of CTX-M-type beta-lactamase producers were identified with the molecular and epidemiological methods on these isolates. Than CTX-M subgroups rates was determined with groups specific polymerase chain reaction (PZR). PFGE (pulse field gel electrophoresis) was use to determine a probable clonal relation between these strains and their risk factors. Findings; Risk factors were evaluated by multivariate analyzes. Urinary tract diseases, history of hospitalization in the last 3 months, the 3rd generation cephalosporin use the last 3 months, urinary catheterization, Pitt bacterimia score found significant in the univariate analysis was also found to be a significant risk factor in the multivariate analysis. [respectively; OR (95 % CI) = 3 (1,6-5,5), OR (95 % CI) = 2,1 (1,17-4,01), OR (95 % CI) =8 (2-38), OR (95 % CI) = 2 (1,2-4), OR (95 % CI) = 0,1 (0,03-0,36)]. Mortality were not significantly different between patients with ESBL-positive and ESBL-negative group. CTX-M type enzymes were positive 54,5 % of the isolates as a result of molecular analysis. The most frequently detected CTX-M group were CTX-M-1 with rate of 85,7 %. Between CTX-M positive and CTX-M negative patients there was no statistically significant difference on relation of risk factors. Between CTX-M-positiveand negative patients groups no determined statisticaly significant risk factor was determined. Conclusion; The spread of ESBL positive species in the community, transmission routes, and identification of possible risk factors are important in the prevention of infections occur in this kind of multi-drug-resistant microorganisms. Rational use of antibiotics is important in reducing infections of ESBL-positive microorganisms. Therefore, the spread of ESBL's and number of ESBL’s may be able to be restricted with the proper use of antibiotics and infection control measures

Is Nurse Workforce Sufficient in Intensive Care Units in Turkey. Results of the Multicenter Karia Study

Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study. Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH. Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was 2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was <0.0001 at all time points except summer weekend night shift (p=0.002). Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing