{"id":25465,"date":"2022-09-28T11:00:55","date_gmt":"2022-09-28T08:00:55","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=25465"},"modified":"2022-09-28T14:53:15","modified_gmt":"2022-09-28T11:53:15","slug":"covid-19-ve-kan-dolasimi-infeksiyonlari","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/09\/28\/covid-19-ve-kan-dolasimi-infeksiyonlari\/","title":{"rendered":"COVID-19, Santral Ven\u00f6z Kateter \u0130li\u015fkili Kan Dola\u015f\u0131m\u0131 \u0130nfeksiyon Riskini Art\u0131r\u0131yor mu?"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

COVID-19 pandemisinde yat\u0131\u015f gerektiren ve \u00f6zellikle mekanik ventilasyon ihtiyac\u0131 olan kritik hasta say\u0131s\u0131nda k\u00fcresel d\u00fczeyde ciddi art\u0131\u015f g\u00f6r\u00fcld\u00fc (1). Sa\u011fl\u0131k kurumlar\u0131, bu beklenmedik hasta ak\u0131\u015f\u0131n\u0131n y\u00f6netimine h\u0131zla uyum sa\u011flamakla birlikte infeksiyon \u00f6nleme ve kontrol\u00fc uygulamalar\u0131na uyum ve bunun s\u00fcrd\u00fcr\u00fclebilirli\u011fi daha da zorla\u015ft\u0131. Bu durum sa\u011fl\u0131k bak\u0131m\u0131 ili\u015fkili infeksiyon (SB\u0130\u0130) riskinde art\u0131\u015f\u0131 da beraberinde getirdi. Pandemi d\u00f6neminde SB\u0130\u0130 h\u0131zlar\u0131n\u0131 etkileyen temel fakt\u00f6rler olarak; daha uzun yat\u0131\u015f ve cihaz kullan\u0131m s\u00fcrelerinin yan\u0131 s\u0131ra yo\u011fun bak\u0131m \u00fcniteleri (YB\u00dc)\u2019nde zorunlu olarak uygulanan yeniden yap\u0131lanmalar, de\u011fi\u015fen personel say\u0131s\u0131 ve d\u00fczeniyle birlikte ki\u015fisel koruyucu ekipmanlar\u0131n uygunsuz kullan\u0131mlar\u0131 say\u0131labilir.<\/p>\n

COVID-19 pandemisi \u00f6ncesinde, uygulanan etkili infeksiyon kontrol programlar\u0131 ile SB\u0130\u0130 h\u0131zlar\u0131nda \u00fclkeler d\u00fczeyinde yayg\u0131n azalmalar kaydedilmi\u015ftir (2). Ancak 2020 y\u0131l\u0131nda araya giren pandemi nedeniyle kateter-ili\u015fkili kan dola\u015f\u0131m\u0131 infeksiyonlar\u0131 (K\u0130-KD\u0130)\u2019nda yeniden art\u0131\u015f oldu\u011fu ve bu art\u0131\u015f\u0131n YB\u00dc\u2019lerde \u00e7ok daha y\u00fcksek oranlara ula\u015ft\u0131\u011f\u0131 bildirilmektedir (3). COVID-19\u2019un d\u00fc\u015f\u00fck orta gelir d\u00fczeyine sahip \u00fclkelerde SB\u0130\u0130 insidans\u0131na etkisini kapsaml\u0131 olarak g\u00f6steren bir \u00e7al\u0131\u015fmada, 2020 y\u0131l\u0131 verileri 2019 y\u0131l\u0131 ile kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f olup YB\u00dc mortalitesinde, YB\u00dc\u2019de kal\u0131\u015f s\u00fcresinde ve K\u0130-KD\u0130 oran\u0131nda \u00f6nemli art\u0131\u015flar oldu\u011fu g\u00f6sterilmi\u015ftir. S\u00f6z konusu \u00e7al\u0131\u015fmada; K\u0130-KD\u0130\u2019deki art\u0131\u015f\u0131n nedeni olarak, COVID-19\u2019dan korunma faaliyetlerinin kateter yerle\u015ftirme ve bak\u0131m uygulamalar\u0131n\u0131 etkilemi\u015f olabilece\u011fi de\u011ferlendirmesi yap\u0131lm\u0131\u015ft\u0131r (1).<\/span><\/p>\n

T\u00fcrkiye\u2019nin 10 y\u0131ll\u0131k ulusal verilerinin analizine g\u00f6re; 2017 y\u0131l\u0131 2008 ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda K\u0130-KD\u0130\u2019de %50 oran\u0131nda azalma kaydedilmi\u015ftir (4). \u00dclkemizden yap\u0131lan ve 24 merkezin kat\u0131ld\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada; en s\u0131k g\u00f6r\u00fclen SB\u0130\u0130 t\u00fcr\u00fcn\u00fcn K\u0130-KD\u0130 oldu\u011fu, 2015 y\u0131l\u0131 ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda 2018 y\u0131l\u0131nda K\u0130-KD\u0130\u2019de art\u0131\u015f g\u00f6r\u00fcld\u00fc\u011f\u00fc ve K\u0130-KD\u0130\u2019ye ba\u011fl\u0131 30 g\u00fcnl\u00fck fatalite oran\u0131n\u0131n %27 oldu\u011fu bildirilmi\u015ftir (5). T\u00fcrkiye\u2019de pandeminin SB\u0130\u0130 \u00fczerine etkilerini g\u00f6steren kapsaml\u0131 ulusal bir \u00e7al\u0131\u015fma bildi\u011fimiz kadar\u0131 ile hen\u00fcz yap\u0131lmam\u0131\u015ft\u0131r.<\/span><\/p>\n

YB\u00dc\u2019de yatan hastalarda prognozu belirleyen en \u00f6nemli fakt\u00f6rlerden biri olan SB\u0130\u0130\u2019ye ba\u011fl\u0131 morbidite ve mortalitenin \u00f6nlenmesi ve sa\u011fl\u0131k bak\u0131m kalitesinin art\u0131r\u0131lmas\u0131 i\u00e7in kurum verilerinin bilinmesi \u00f6nem arz etmektedir. Literat\u00fcre bak\u0131ld\u0131\u011f\u0131nda pandemi d\u00f6neminde SB\u0130\u0130 aras\u0131nda en b\u00fcy\u00fck art\u0131\u015f\u0131n K\u0130-KD\u0130\u2019de oldu\u011fu g\u00f6r\u00fclmektedir (1, 6).\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, COVID-19 YB\u00dc ile genel YB\u00dc\u2019de yatan hastalar aras\u0131nda K\u0130-KD\u0130 h\u0131zlar\u0131n\u0131, etki eden risk fakt\u00f6rlerini ve etken da\u011f\u0131l\u0131mlar\u0131n\u0131 kar\u015f\u0131la\u015ft\u0131rman\u0131n yan\u0131 s\u0131ra COVID-19 YB\u00dc\u2019de takip edilen hastalarda COVID-19 infeksiyonunun K\u0130-KD\u0130 oranlar\u0131na etkisini ve etki eden fakt\u00f6rleri tespit etmeyi ama\u00e7lad\u0131k.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, 2021 y\u0131l\u0131 boyunca \u00fc\u00e7\u00fcnc\u00fc d\u00fczey eri\u015fkin YB\u00dc\u2019lerde SVK\u0130-KD\u0130 tan\u0131s\u0131 alan hastalar retrospektif olarak de\u011ferlendirildi. SVK\u0130-KD\u0130 tan\u0131s\u0131, \u201cUlusal Sa\u011fl\u0131k Bak\u0131m\u0131 \u0130li\u015fkili Enfeksiyonlar S\u00fcrveyans Rehberi\u201d kriterlerine g\u00f6re laboratuvar ve klini\u011fe dayal\u0131 aktif s\u00fcrveyans yap\u0131larak koyuldu (7). Yat\u0131\u015flar\u0131 s\u0131ras\u0131nda birden fazla SVK\u0130-KD\u0130 tan\u0131s\u0131 alan hastalar\u0131n sadece ilk infeksiyon tan\u0131s\u0131ndaki verileri \u00e7al\u0131\u015fmaya dahil edildi. YB\u00dc\u2019ye kabulden sonra geli\u015fen ilk K\u0130-KD\u0130 tan\u0131s\u0131 olan hasta \u00e7al\u0131\u015fmaya al\u0131nd\u0131\u011f\u0131 i\u00e7in dahil edilen hastalar\u0131n tan\u0131 \u00f6ncesinde kan k\u00fclt\u00fcrlerinde etken olan bir mikroorganizma \u00fcremesi mevcut de\u011fildi. SVK\u0130-KD\u0130 tan\u0131s\u0131 alan ve iki etken tespit edilen hastalarda her iki etken de \u00e7al\u0131\u015fmaya dahil edildi. E\u015f zamanl\u0131 ikinci bir SB\u0130\u0130 tan\u0131s\u0131 olan ve\/veya sekonder KD\u0130 olan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131.<\/p>\n

SVK\u0130-KD\u0130 tan\u0131s\u0131 alan hastalar COVID-19 YB\u00dc\u2019de ve genel YB\u00dc\u2019de yatanlar olmak \u00fczere iki gruba ayr\u0131larak, demografik ve klinik \u00f6zellikleri, infeksiyon h\u0131zlar\u0131, risk fakt\u00f6rleri ve etken da\u011f\u0131l\u0131mlar\u0131 a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. \u00c7al\u0131\u015fmaya dahil edilen hastalardan COVID-19 YB\u00dc\u2019de takip edilen 22 hastan\u0131n tamam\u0131, genel YB\u00dc\u2019de takip edilen 32 hastan\u0131n ise 29\u2019unun mekanik ventilasyon gereksinimi mevcuttu. Veriler, \u201cEnfeksiyon Kontrol Komitesi Ulusal Sa\u011fl\u0131k Hizmeti \u0130li\u015fkili Enfeksiyonlar S\u00fcrveyans A\u011f\u0131\u201d kay\u0131tlar\u0131ndan ve hastane kay\u0131t sisteminden retrospektif olarak elde edildi.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fma i\u00e7in, Sa\u011fl\u0131k Bilimleri \u00dcniversitesi \u0130stanbul Kartal Dr. L\u00fctfi K\u0131rdar \u015eehir Hastanesi Etik Kurulu\u2019ndan 28 Ocak 2022 tarih ve 2022\/514\/218\/33 karar numaras\u0131yla onay al\u0131nd\u0131.\u00a0<\/span><\/p>\n

\u0130statistiksel Analizler<\/h3>\n

Verilerin analizi SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 23.0 program\u0131 kullan\u0131larak yap\u0131ld\u0131. Tan\u0131mlay\u0131c\u0131 istatistikler, kategorik de\u011fi\u015fkenler i\u00e7in say\u0131 ve y\u00fczde; say\u0131sal de\u011fi\u015fkenler i\u00e7in ortalama \u00b1 standart sapma veya medyan (Q1-Q3) de\u011ferleri verildi. De\u011fi\u015fkenlerin normal da\u011f\u0131l\u0131ma uygunlu\u011fu Kolmogorov-Smirnov testi ile de\u011ferlendirildi. Normal da\u011f\u0131l\u0131ma uymayan de\u011fi\u015fkenlerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda Mann-Whitney U testi kullan\u0131ld\u0131. Kategorik de\u011fi\u015fkenler i\u00e7in ba\u011f\u0131ms\u0131z gruplar aras\u0131nda kar\u015f\u0131la\u015ft\u0131rma analizleri \u03c72<\/i><\/span> testi ile yap\u0131ld\u0131. Testlerin anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 olarak kabul edildi.<\/p>\n

BULGULAR<\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> Yo\u011fun Bak\u0131m \u00dcnitelerinde 2021 Y\u0131l\u0131 SVK\u0130-KD\u0130 H\u0131z ve Dansiteleri<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong>Kateterle \u0130li\u015fkili Kan Dola\u015f\u0131m\u0131 \u0130nfeksiyonu Tan\u0131s\u0131 Alan Hastalar\u0131n Demografik ve Klinik \u00d6zelliklerinin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong> Kateterle \u0130li\u015fkili Kan Dola\u015f\u0131m\u0131 \u0130nfeksiyonu Tan\u0131s\u0131 Alan Hastalar\u0131n Yo\u011fun Bak\u0131m \u00dcnitesi Kaynakl\u0131 Risk Fakt\u00f6rlerinin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 4.<\/strong>Kateterle \u0130li\u015fkili Kan Dola\u015f\u0131m\u0131 \u0130nfeksiyonu Tan\u0131s\u0131 Alan Hastalarda Etken Da\u011f\u0131l\u0131mlar\u0131n\u0131n Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131*<\/p><\/div>\n

\u00c7al\u0131\u015fmaya, 2021 y\u0131l\u0131nda YB\u00dc\u2019de tedavi g\u00f6ren ve SVK\u0130-KD\u0130 tan\u0131s\u0131 alan toplam 54 eri\u015fkin hasta dahil edildi; COVID-19 YB\u00dc\u2019de yatan hasta say\u0131s\u0131 22, genel YB\u00dc\u2019de yatan hasta say\u0131s\u0131 32 idi.\u00a0<\/span><\/p>\n

K\u0130-KD\u0130 h\u0131z\u0131 COVID-19 YB\u00dc\u2019de 2.05 ve genel YB\u00dc\u2019de 1.03; insidans dansitesi ise s\u0131ras\u0131yla 2.7 ve 1.1 olarak tespit edildi (Tablo 1). Hastalar\u0131n demografik ve klinik \u00f6zellikleri Tablo 2\u2019de verildi. YB\u00dc\u2019ye kabulden K\u0130-KD\u0130 tan\u0131s\u0131 alana kadar ge\u00e7en s\u00fcre COVID-19 YB\u00dc\u2019deki hastalarda 8.5 g\u00fcn, genel YB\u00dc\u2019de ise 24 g\u00fcn olarak saptand\u0131. YB\u00dc\u2019de kal\u0131\u015f s\u00fcresi COVID-19 YB\u00dc\u2019de 13 g\u00fcn, genel YB\u00dc\u2019de 52.5 g\u00fcnd\u00fc. YB\u00dc kaynakl\u0131 risk fakt\u00f6rleri a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda; COVID-19 YB\u00dc\u2019deki hastalarda endotrakeal ent\u00fcbasyon, periferik arter kateterizasyon, dek\u00fcbitus \u00fclseri ve imm\u00fcnos\u00fcpresyon oran\u0131 anlaml\u0131 d\u00fczeyde daha y\u00fcksekti (Tablo 3). Mortalite oran\u0131 COVID-19 YB\u00dc\u2019de %77.3, genel YB\u00dc\u2019de %68.8\u2019di.<\/p>\n

COVID-19 YB\u00dc\u2019de, K\u0130-KD\u0130 etkenlerinin da\u011f\u0131l\u0131m\u0131na bak\u0131ld\u0131\u011f\u0131nda %55.2 oran\u0131nda Gram-negatif bakteriler saptand\u0131. Bunlar aras\u0131nda ilk s\u0131rada Acinetobacter baumannii <\/i>(%41.4) olup bunu Klebsiella<\/i> t\u00fcrleri (%3.4) ve Pseudomonas aeruginosa<\/i> (%3.4) takip etmektedir. Gram-pozitif mikroorganizmalar\u0131n g\u00f6r\u00fclme oran\u0131 ise COVID-19 YB\u00dc\u2019de %34.5, genel YB\u00dc\u2019de %27.5\u2019ti. COVID-19 YB\u00dc\u2019de %34.5, genel YB\u00dc\u2019de %27.5 oranlar\u0131yla Gram-pozitif etken olarak en s\u0131k Enterokoklar saptand\u0131. COVID-19 YB\u00dc\u2019de Candida<\/i>\u2019lar\u0131n g\u00f6r\u00fclme oran\u0131 %10.3 olup en s\u0131k g\u00f6r\u00fclen Candida<\/i> t\u00fcr\u00fc Candida parapsilosis<\/i>\u2019ti. Genel YB\u00dc\u2019de ise Candida<\/i>\u2019lar\u0131n g\u00f6r\u00fclme oran\u0131 %27.5 olup en s\u0131k g\u00f6r\u00fclen Candida<\/i> t\u00fcr\u00fc Candida albicans<\/i> oldu (Tablo 4).\u00a0<\/span><\/p>\n

\u0130RDELEME<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, COVID-19 YB\u00dc\u2019de ortalama kal\u0131\u015f s\u00fcresi daha k\u0131sa olmas\u0131na ra\u011fmen SVK\u0130-KD\u0130 h\u0131z\u0131 ve insidans dansitesi genel YB\u00dc ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda daha y\u00fcksek saptand\u0131. Sonu\u00e7lar\u0131m\u0131za g\u00f6re, \u00f6zellikle YB\u00dc\u2019ye kabulden d\u00f6rt g\u00fcn sonra COVID-19 hastalar\u0131nda K\u0130-KD\u0130 riskinde art\u0131\u015f ba\u015flamaktad\u0131r. Benzer \u015fekilde Fransa\u2019da yap\u0131lan \u00e7ok merkezli prospektif bir kohort \u00e7al\u0131\u015fmas\u0131nda da K\u0130-KD\u0130 g\u00f6r\u00fclme oran\u0131 COVID-19 grubunda %14.9 iken COVID-19 olmayan grupta %3.4 bulunmu\u015f ve aradaki fark\u0131n istatistiksel olarak anlaml\u0131 d\u00fczeyde oldu\u011fu g\u00f6sterilmi\u015ftir. S\u00f6z konusu \u00e7al\u0131\u015fmada, COVID-19 hastalar\u0131nda YB\u00dc\u2019de KD\u0130 geli\u015fme riski COVID-19 olmayan gruptan 4.5 kat daha y\u00fcksek saptanm\u0131\u015ft\u0131r (8). ABD\u2019de 78 hastanenin kat\u0131l\u0131m\u0131 ile yap\u0131lan bir ba\u015fka \u00e7al\u0131\u015fmada, yatan hastalarda COVID-19 prevalans\u0131n\u0131n >%10 oldu\u011fu aylarda <%5 oldu\u011fu aylara g\u00f6re K\u0130-KD\u0130\u2019nin 2.4 kat daha y\u00fcksek oldu\u011fu g\u00f6sterilmi\u015f; pandemi \u00f6ncesi d\u00f6nem ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda pandemi d\u00f6neminde K\u0130-KD\u0130 insidans\u0131n\u0131n %51 artt\u0131\u011f\u0131 bildirilmi\u015ftir (9).<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, SVK\u0130-KD\u0130\u2019nin YB\u00dc\u2019de takip edilen COVID-19 hastalar\u0131nda, di\u011fer YB\u00dc hastalar\u0131na g\u00f6re daha k\u0131sa s\u00fcrede geli\u015fti\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. COVID-19 YB\u00dc\u2019de imm\u00fcnos\u00fcpresif hasta oran\u0131n\u0131n di\u011fer YB\u00dc\u2019den istatistiksel olarak daha fazla olmas\u0131 K\u0130-KD\u0130\u2019nin daha fazla g\u00f6r\u00fclmesine ve daha h\u0131zl\u0131 geli\u015fmesine katk\u0131da bulunmu\u015f olabilir. COVID-19 YB\u00dc\u2019deki hastalarda klinik a\u011f\u0131rl\u0131\u011f\u0131 g\u00f6steren endotrakeal ent\u00fcbasyon oran\u0131n\u0131n anlaml\u0131 d\u00fczeyde daha y\u00fcksek olmas\u0131 infeksiyon h\u0131zlar\u0131n\u0131 etkileyen bir di\u011fer fakt\u00f6rd\u00fcr. Ancak, COVID-19 \u00f6nleme ve kontrol\u00fc faaliyetlerinin yan\u0131 s\u0131ra yo\u011fun stresli \u00e7al\u0131\u015fma ortam\u0131n\u0131n kateter yerle\u015ftirme ve bak\u0131m uygulamalar\u0131n\u0131 etkileyebilecek olmas\u0131n\u0131n sonuca katk\u0131s\u0131 mutlaka g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 gereken en \u00f6nemli fakt\u00f6r olabilir. COVID-19 YB\u00dc\u2019de sabit olarak \u00e7al\u0131\u015fan personel olmamas\u0131 ve di\u011fer YB\u00dc\u2019de de personelin rotasyonla \u00e7al\u0131\u015fmas\u0131n\u0131n infeksiyon kontrol\u00fcnde zorluklara neden oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. COVID-19 hastalar\u0131n\u0131 takip eden sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n solunum ve damlac\u0131k \u00f6nlemleri ile birlikte el hijyeni ve maksimum bariyer \u00f6nlemlerine uyumunun art\u0131r\u0131lmas\u0131 ve bunun s\u00fcrd\u00fcr\u00fclmesi SVK\u0130-KD\u0130\u2019nin \u00f6nlenmesi a\u00e7\u0131s\u0131ndan \u00e7ok \u00f6nemlidir.\u00a0<\/span><\/p>\n

Akut solunum yetmezli\u011fi sendromu (\u201cacute respiratory distress syndrome \u2013 ARDS\u201d) geli\u015fen hastalarda hipertansiyon tan\u0131s\u0131na daha s\u0131k rastland\u0131\u011f\u0131 daha \u00f6nce yap\u0131lan \u00e7al\u0131\u015fmalarda g\u00f6sterilmi\u015ftir (10). Kan bas\u0131nc\u0131 \u00f6l\u00e7\u00fcm\u00fcn\u00fcn ve arter kan gaz\u0131 takibinin daha s\u0131k yap\u0131ld\u0131\u011f\u0131 genel durumu bozuk hastalarda periferik arter kateterizasyonu s\u0131kl\u0131kla uygulanmaktad\u0131r (11, 12).\u00a0 <\/span>Dolay\u0131s\u0131yla kritik COVID-19 hastalar\u0131n\u0131n YB\u00dc takiplerinde kardiyovask\u00fcler ve pulmoner monit\u00f6rizasyon b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r. Buna ba\u011fl\u0131 olarak \u00e7al\u0131\u015fmam\u0131zda da COVID-19 YB\u00dc\u2019de ARDS nedeni ile izlem yap\u0131lan hastalarda periferik arter kateteri kullan\u0131m oran\u0131 di\u011fer YB\u00dc\u2019den daha y\u00fcksek saptand\u0131. \u00a0<\/span><\/p>\n

YB\u00dc\u2019de takip edilen hastalarda dek\u00fcbitus \u00fclseri geli\u015fim riskini art\u0131ran hastaya ait fakt\u00f6rlerden baz\u0131lar\u0131; v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131, malnutrisyon, ileri ya\u015f, diabetes mellitus ve hipertansiyon gibi kronik hastal\u0131klar olarak s\u0131ralanabilir (13). Bunlar ayn\u0131 zamanda, COVID-19 seyrini, hastalar\u0131n YB\u00dc\u2019de izlem gereksinimlerini ve mortaliteyi belirleyen risk fakt\u00f6rlerinin ba\u015f\u0131nda gelmektedir (14). COVID-19\u2019a ba\u011fl\u0131 a\u011f\u0131r doku hipoksisine ek olarak bu hastalarda immobilizasyon uygulamalar\u0131n\u0131n da olmas\u0131 bas\u0131 travmas\u0131n\u0131 (\u201cpressure injury\u201d) art\u0131rarak dek\u00fcbitus \u00fclseri olu\u015fumunu kolayla\u015ft\u0131rmaktad\u0131r.\u00a0 <\/span>Nitekim \u00e7al\u0131\u015fmam\u0131zda COVID-19 YB\u00dc\u2019de takip edilen hastalarda dek\u00fcbitus \u00fclseri s\u0131kl\u0131\u011f\u0131 anlaml\u0131 olarak daha fazla bulundu.<\/p>\n

Yap\u0131lan pek \u00e7ok \u00e7al\u0131\u015fmada, COVID-19 YB\u00dc\u2019de en ba\u015fta A. baumannii<\/i> olmak \u00fczere en s\u0131k Gram-negatif bakterilerle K\u0130-KD\u0130 geli\u015fti\u011fi, Enterokok t\u00fcrlerine ba\u011fl\u0131 geli\u015fen KD\u0130\u2019de ise pandemi d\u00f6neminde bir art\u0131\u015f ya\u015fand\u0131\u011f\u0131 bildirilmektedir (15). Enterokoklara ba\u011fl\u0131 geli\u015fen KD\u0130\u2019deki risk art\u0131\u015f\u0131 ciddi COVID-19\u2019lu hastalarda enterik tutulum olmas\u0131 ile ili\u015fkilendirilmektedir (16). Bizim \u00e7al\u0131\u015fmam\u0131zda da K\u0130-KD\u0130 etkenlerinin da\u011f\u0131l\u0131mlar\u0131na bak\u0131ld\u0131\u011f\u0131nda literat\u00fcrle uyumlu olarak her iki grupta da en s\u0131k Gram-negatif bakteriler nedeniyle K\u0130-KD\u0130 geli\u015fti\u011fi ve bunlar aras\u0131nda ilk s\u0131rada A. baumannii <\/i>oldu\u011fu saptand\u0131. \u00dclkemizde pandemi \u00f6ncesinde ger\u00e7ekle\u015ftirilen bir \u00e7al\u0131\u015fmada, K\u0130-KD\u0130\u2019de etken olarak yine en s\u0131k Gram-negatif bakteriler saptanm\u0131\u015ft\u0131r; Gram-pozitif bakterilerden Enterokoklar ise % 4.3 oran\u0131 ile daha az s\u0131kl\u0131kta saptanm\u0131\u015ft\u0131r (17). Bizim \u00e7al\u0131\u015fmam\u0131zda ise her iki grup i\u00e7in de benzer \u015fekilde Gram-pozitif bakteriler aras\u0131nda Enterokok s\u0131kl\u0131\u011f\u0131n\u0131n pandemi d\u00f6neminde artt\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Candida<\/i>\u2019lara ba\u011fl\u0131 geli\u015fen K\u0130-KD\u0130 oran\u0131 genel YB\u00dc\u2019de daha fazla olmakla birlikte aradaki fark istatistiksel olarak anlaml\u0131 d\u00fczeyde de\u011fildi.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, COVID-19 YB\u00dc\u2019de K\u0130-KD\u0130 geli\u015fen hastalarda mortalite oran\u0131 %77.3 iken genel YB\u00dc\u2019de bu oran %68.8 olarak saptand\u0131; aradaki fark istatistiksel olarak anlaml\u0131 d\u00fczeyde de\u011fildi. COVID-19 YB\u00dc\u2019de yatan hastalarda daha k\u0131sa s\u00fcrede K\u0130-KD\u0130 geli\u015fmesine ra\u011fmen mortalitenin di\u011fer YB\u00dc ile benzer oranda oldu\u011fu g\u00f6sterildi. Yunanistan\u2019dan yap\u0131lan bir \u00e7al\u0131\u015fmada da K\u0130-KD\u0130 geli\u015fen hastalarda mortalite oran\u0131n\u0131n de\u011fi\u015fmedi\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (15). \u0130talya\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada ise en s\u0131k g\u00f6r\u00fclen SB\u0130\u0130\u2019nin K\u0130-KD\u0130 oldu\u011fu ve YB\u00dc\u2019de daha uzun yat\u0131\u015f s\u00fcresi ve y\u00fcksek mortalite ile ili\u015fkili oldu\u011fu saptanm\u0131\u015ft\u0131r. S\u00f6z konusu \u00e7al\u0131\u015fmada, \u00f6len ve \u00f6lmeyen hastalar kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, daha y\u00fcksek akut fizyoloji ve kronik sa\u011fl\u0131k de\u011ferlendirmesi (APACHE) II skoru, ARDS varl\u0131\u011f\u0131 ve SB\u0130\u0130 geli\u015fmesi mortalite ile anlaml\u0131 olarak ili\u015fkilidir (18).<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n tek merkezli olmas\u0131 bulgular\u0131n genellenebilirli\u011fini s\u0131n\u0131rlamaktad\u0131r. Ayr\u0131ca COVID-19 pandemisi \u00f6ncesindeki d\u00f6nem ile pandemi d\u00f6nemi aras\u0131nda K\u0130-KD\u0130 oranlar\u0131 a\u00e7\u0131s\u0131ndan bir kar\u015f\u0131la\u015ft\u0131rma da yap\u0131lamam\u0131\u015f olup hastalar\u0131n klinik ciddiyet durumlar\u0131n\u0131 g\u00f6steren ard\u0131\u015f\u0131k organ yetmezli\u011fi (\u201csequential organ failure assessment – SOFA)\u201d ve akut fizyoloji ve kronik sa\u011fl\u0131k de\u011ferlendirmesi APACHE skorlar\u0131na bu \u00e7al\u0131\u015fmada yer verilemedi. Son olarak genel YB\u00dc\u2019de takip edilen hastalar\u0131n kay\u0131tlar\u0131nda, ald\u0131klar\u0131 imm\u00fcnos\u00fcpresif tedavi verilerinde b\u00fcy\u00fck oranda eksikliklerin olmas\u0131 nedeniyle dahil edilen hastalar\u0131n bu kapsamdaki tedavileri detayland\u0131r\u0131lamad\u0131.<\/p>\n

Kar\u015f\u0131la\u015ft\u0131r\u0131lan her iki grup aras\u0131ndaki SB\u0130\u0130 oranlar\u0131n\u0131 etkileme potansiyeli olan fakt\u00f6rleri iyi anlamak amac\u0131yla sadece 2021 y\u0131l\u0131nda K\u0130-KD\u0130 tan\u0131s\u0131 alan olgular \u00e7al\u0131\u015fmam\u0131za dahil edildi. Pandeminin ilk y\u0131l\u0131 olan 2020\u2019de, COVID-19 ve bula\u015f yollar\u0131 ile ilgili bilgilerin az olmas\u0131, ki\u015fisel koruyucu ekipmanlar\u0131n temininde ya\u015fanan aksamalar ve planlamalar\u0131n s\u0131k bir \u015fekilde de\u011fi\u015fmesi sonu\u00e7lar\u0131 etkileyebilecek fakt\u00f6rler olarak de\u011ferlendirildi.\u00a0<\/span><\/p>\n

Hastanemiz, COVID-19 pandemisinin merkezi olan \u0130stanbul\u2019un Anadolu yakas\u0131nda 1205 yatak kapasitesi ve 224 YB\u00dc yata\u011f\u0131 ile hizmet veren b\u00fcy\u00fck bir merkezdir. COVID-19 YB\u00dc yatak say\u0131s\u0131 57, genel \u00fc\u00e7\u00fcnc\u00fc d\u00fczey eri\u015fkin YB\u00dc ise toplam yedi \u00fcnitede olmak \u00fczere 77 yatak kapasitelidir. Bu nedenle COVID-19 pandemi d\u00f6neminde sa\u011fl\u0131k hizmeti verilen pop\u00fclasyonun temsil etti\u011fi b\u00fcy\u00fckl\u00fc\u011f\u00fcn \u00e7al\u0131\u015fmay\u0131 g\u00fc\u00e7lendirdi\u011fi kanaatindeyiz.<\/p>\n

Sonu\u00e7 olarak; COVID-19 YB\u00dc\u2019de takip edilen hastalarda K\u0130-KD\u0130 daha s\u0131k ve daha erken g\u00f6r\u00fclmektedir. Bulgular\u0131m\u0131za g\u00f6re bu durum; mortalite a\u00e7\u0131s\u0131ndan anlaml\u0131 d\u00fczeyde bir farkl\u0131l\u0131k yaratmasa da morbiditede art\u0131\u015f, tedavi s\u00fcresi ve maliyetinde art\u0131\u015f ile birlikte antimikrobiyal kullan\u0131m\u0131nda ve diren\u00e7 oranlar\u0131ndaki art\u0131\u015f ile ili\u015fkilidir. COVID-19 YB\u00dc\u2019de K\u0130-KD\u0130\u2019nin \u00f6nlenmesi ve sa\u011fl\u0131k bak\u0131m kalitesinin iyile\u015ftirilmesi i\u00e7in ek y\u00f6netim stratejilerinin belirlenmesine ve verilerin yak\u0131n takibine ihtiya\u00e7 vard\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e COVID-19 pandemisinde yat\u0131\u015f gerektiren ve \u00f6zellikle mekanik ventilasyon ihtiyac\u0131 olan kritik hasta say\u0131s\u0131nda k\u00fcresel d\u00fczeyde ciddi art\u0131\u015f g\u00f6r\u00fcld\u00fc (1). Sa\u011fl\u0131k kurumlar\u0131, bu beklenmedik hasta ak\u0131\u015f\u0131n\u0131n y\u00f6netimine h\u0131zla uyum sa\u011flamakla birlikte infeksiyon \u00f6nleme ve kontrol\u00fc uygulamalar\u0131na uyum ve bunun s\u00fcrd\u00fcr\u00fclebilirli\u011fi daha da zorla\u015ft\u0131. Bu durum sa\u011fl\u0131k bak\u0131m\u0131 ili\u015fkili infeksiyon (SB\u0130\u0130) riskinde art\u0131\u015f\u0131 da beraberinde getirdi. […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5174,3488,4357,5511,3767],"class_list":["post-25465","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-covid-19","tag-etken-mikroorganizmalar","tag-kan-dolasimi-infeksiyonu","tag-santral-venoz-kateter","tag-yogun-bakim-unitesi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25465","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=25465"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25465\/revisions"}],"predecessor-version":[{"id":25700,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25465\/revisions\/25700"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=25465"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=25465"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=25465"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}