Öz
Giriş
Santral venöz kateterle ilişkili kan dolaşımı enfeksiyonu (SVKİ-KDE), venöz erişimin yaygın bir komplikasyonudur. SVKİ-KDE oranlarının, yüksek gelirli ülkelere kıyasla orta gelirli ülkelerde daha yüksek olduğu bildirilmektedir. Güney Afrika’da SVKİ-KDE ile ilgili veriler yetersizdir. Bu çalışmada, Dora Nginza Hastanesi’nde SVKİ-KDE prevalansını ve bununla ilişkili faktörleri değerlendirmeyi amaçladık.
Yöntemler
Ocak 2019 ile Aralık 2019 tarihleri arasında merkezi venöz kateter takılan tüm çocuk yoğun bakım ünitesi (ÇYBÜ) hastalarının tıbbi ve laboratuvar kayıtlarını retrospektif olarak inceledik. SVKİ-KDE, hastalık kontrol ve önleme merkezleri kılavuzlarına göre tanımlandı. Çalışmaya dahil edilme kritelerine göre uygun hastalara, SVKİ-KDE gelişiminden iki gün önce merkezi venöz kateter takılmış olmalıydı. Merkezi kateterin türü, ilişkili faktörler, septik belirteçler ve kültürlenen organizmalarla ilgili bilgiler kayıtlardan elde edildi. Etik onay, Walter Sisulu Üniversitesi Kurumsal İnceleme Kurulu tarafından verildi.
Bulgular
Çalışma süresince ÇYBÜ'ye toplam 289 hasta yatırıldı ve 131’inde santral venöz kateter kullanıldı. Çalışmada 107 çocuğun dosyaları kullanıldı ve toplam 598 kateter günü kaydedildi. 107 katılımcı arasında 19 SVKİ-KDE olgusu tespit edildi ve bu da 1000 kateter günü başına 31,7 SVKİ-KDE oranı anlamına geliyordu. SVKİ-KDE olan hastalar, SVKİ-KDE gelişmeyen hastalara göre daha fazla santral kateter ile gün geçirdiler (p<0,01). Kan transfüzyonu da bu çalışmada SVKİ-KDE için bir risk faktörüydü. Antibiyotikler, kateter bölgesi, total parenteral beslenme, malnütrisyon gibi diğer bilinen risk faktörlerinin bu çalışmada anlamlı bir ilişkisi bulunmamıştır. SVKİ-KDE’nin nedenleri arasında Gram-negatif (n=10, %52) en yaygın olanıydı, bunu mantar (n=5, %26) ve Gram-pozitif (n=3, %15,8) izledi.
Sonuç
Dora Nginza Hastanesi’nde SVKİ-KDE prevalansı, orta gelirli ülkelerde bildirilen oranlara kıyasla yüksektir. SVKİ-KDE prevalansını azaltmak için önleme paketlerine sıkı sıkıya uyulması gerekmektedir.
Anahtar Kelimeler: Santral venöz kateterine bağlı kan dolaşımı enfeksiyonları, çocuklar, Güney Afrika
Kaynakça
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