Intubācijas cauruļu bakteriālā kolonizācija intensīvās terapijas nodaļā
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads. Mūsdienās viena no veselības aprūpes sistēmas aktuālākajām problēmām ir nozokomiālās infekcijas, un sevišķi augsts risks to attīstībai ir novērojams intensīvās terapijas nodaļā (ITN). Saskaņā ar Eiropas Slimību profilakses un kontroles centra 2015. gada datiem, iegūtiem no 15 Eiropas valstīm, 6.4% no pacientiem, kuri atradušies ITN ilgāk par divām dienām, bija piedzīvojuši vismaz vienu pneimonijas epizodi, un 97.4% gadījumu tās epizodes bija saistītas ar intubāciju [1].
Mērķis. Šī pētījuma mērķis ir identificēt mikroorganismus uz intubācijas caurulēm no intensīvās terapijas nodaļas.
Materiāli un metodes. Intensīvās terapijas nodaļas intubācijas cauruļu distālās daļas vienu minūti tika apstrādātas sonikatorā ar frekvenci 44kHz, pēc kā vienu minūti tika maisītas ar Vortex 1 aparātu. Izveidojusies bakteriālā suspensija tika kultivēta 37oC temperatūrā uz piecu veidu barotnēm – asins agara, mannitola sāls agara, eozīna metilēnzilā (Levine) agara un Saburo (Sabouraud) agara. Tīras kultūras tika identificētas ar VITEK 2 sistēmu un Lateksa aglutinācijas testu. Baktēriju jūtība pret antibiotikām tika noteikta ar Kirbi-Bauer disku difūzijas metodi.
Rezultāti. Tika analizētas 58 intubācijas caurules (37 no vīriešiem un 21 no sievietēm), 53 (91.4%) no tām bija kontaminētas. Vidējais pacientu vecums bija 63.2 gadi, vidējais intubācijas laiks – 6.5 dienas. Biežākie patogēni bija
A. baumanii et lwofii (36.2%), S. aureus (29.3%) un K. pneumoniae (27.6%). Citi patogēni iekļāva sevī Pseudomonas spp. (13.8%), Ent. faecais et faecium (10.3%), E. coli (8.6%), Sphmon. paucimobilis (8.6%), Ent. cloacae (8.6%), B. cepacia (8.6%) un S. haemolyticus (6.9%). Candida spp. tika atrasta 27.6% gadījumu. Saskaņā ar noteikto antibakteriālo jūtību, 8 no 58 gadījumiem ITN pielietotā antimikrobiālā terapija bijusi neadekvāta. 100% no identificēto S. aureus bija sensitīvi pret visām izmantotām antibiotikām, savukārt 100% K. pnemoniae bija rezistentas pret ampicilīnu, 65% A. baumanii et lwofii bija rezistenti pret gentamicīnu un 95% - pret ciprofloksacīnu.
Secinājumi. Biežākie šī pētījumā identificētie patogēni bija A. baumanii et lwofii (65% rezistence pret gentamicīnu un 95% - pret ciprofloksacīnu), MSSA (100% sensitivitāte pret visām pielietotām antibiotikām) un K. pneumoniae (100% rezistence pret ampicilīnu), kuri tiek uzskatīti par dažiem no galvenajiem nozokomiālās pneimonijas izraisītājiem. Rezultāti parāda, ka intubācijas cauruļu lietošana intensīvās terapijas nodaļā var būt nopietns potenciāls riska faktors nozokomiālās pneimonijas attīstībai.
References.
[1] ECDC. Surveillance Report. Annual Epidemiological Report for 2015 Healthcare-associated infections acquired in intensive care units.
https://www.ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-healthcare-associated-infections.pdf
Introduction. At the present time one of the most actual problem of health care system are nosocomial infections, especially high risk of them is observed in an intensive care unit (ICU). According to the European Centre for Disease Prevention and Control (ECDC) 2015 data collected from 15 European countries, 6.4% among patients staying in an ICU for more than two days were affected by at least one episode of pneumonia, 97.4% of them were associated with intubation. Aim. The aim of this study is to identify microorganisms on intubation tubes from intensive care unit. Materials and methods. The distal parts of intubation tubes from intensive care unit were sonicated for one minute at 44 kHz frequency and then were mixed for one minute by Vortex 1. The obtained bacterial suspension was cultured at the temperature at 37oC on five types of culture medium – blood agar, mannitol salt agar, egg yolk salt agar, eosin methylene blue (Levine) agar and Sabouraud agar. The pure cultures were identified by VITEK 2 system and Latex agglutination test. Bacterial susceptibility to antibiotics was determined by Kirby-Bauer disc diffusion method. Results. 58 intubation tubes were analyzed (37 male and 21 female), 53 (91.4%) of them were contaminated. The average patient age was 63.2 years, the average intubation time was 6.5 days. The most frequent pathogen was A. baumanii et lwofii (36.2%), then S. aureus (29.3%) and K. pneumoniae (27.6%). Other pathogens included Pseudomonas spp. (13.8%), Ent. faecais et faecium (10.3%), E. coli (8.6%), Sphmon. paucimobilis (8.6%), Ent. cloacae (8.6%), B. cepacia (8.6%) and S. haemolyticus (6.9%). Candida spp. were detected in 27.6% of cases. According to determined antibacterial susceptibility, in 8 of 58 cases antimicrobial therapy given in the intensive care unit was inadequate. 100% of identified S. aureus were sensitive to all applied antibiotics, at the same time 100% of K.pneumoniae were resistant to ampicillin but 65% of A. baumanii et lwofii were resistant to gentamycin and 95% - to ciprofloxacin. Conclusion. The most frequent pathogens of this study were A. baumanii et lwofii (65% resistance to gentamycin and 95% - to ciprofloxacin), MSSA (100% sensitivity to all applied antibiotics) and K. pneumoniae (100% resistance to ampicillin) that are considered one of the main cause of nosocomial pneumonia. The results demonstrate that intubation tube usage in the intensive care unit can be an important potential risk factor for developing nosocomial pneumonia. References. [1] ECDC. Surveillance Report. Annual Epidemiological Report for 2015 Healthcare-associated infections acquired in intensive care units. https://www.ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-healthcare-associated-infections.pdf
Introduction. At the present time one of the most actual problem of health care system are nosocomial infections, especially high risk of them is observed in an intensive care unit (ICU). According to the European Centre for Disease Prevention and Control (ECDC) 2015 data collected from 15 European countries, 6.4% among patients staying in an ICU for more than two days were affected by at least one episode of pneumonia, 97.4% of them were associated with intubation. Aim. The aim of this study is to identify microorganisms on intubation tubes from intensive care unit. Materials and methods. The distal parts of intubation tubes from intensive care unit were sonicated for one minute at 44 kHz frequency and then were mixed for one minute by Vortex 1. The obtained bacterial suspension was cultured at the temperature at 37oC on five types of culture medium – blood agar, mannitol salt agar, egg yolk salt agar, eosin methylene blue (Levine) agar and Sabouraud agar. The pure cultures were identified by VITEK 2 system and Latex agglutination test. Bacterial susceptibility to antibiotics was determined by Kirby-Bauer disc diffusion method. Results. 58 intubation tubes were analyzed (37 male and 21 female), 53 (91.4%) of them were contaminated. The average patient age was 63.2 years, the average intubation time was 6.5 days. The most frequent pathogen was A. baumanii et lwofii (36.2%), then S. aureus (29.3%) and K. pneumoniae (27.6%). Other pathogens included Pseudomonas spp. (13.8%), Ent. faecais et faecium (10.3%), E. coli (8.6%), Sphmon. paucimobilis (8.6%), Ent. cloacae (8.6%), B. cepacia (8.6%) and S. haemolyticus (6.9%). Candida spp. were detected in 27.6% of cases. According to determined antibacterial susceptibility, in 8 of 58 cases antimicrobial therapy given in the intensive care unit was inadequate. 100% of identified S. aureus were sensitive to all applied antibiotics, at the same time 100% of K.pneumoniae were resistant to ampicillin but 65% of A. baumanii et lwofii were resistant to gentamycin and 95% - to ciprofloxacin. Conclusion. The most frequent pathogens of this study were A. baumanii et lwofii (65% resistance to gentamycin and 95% - to ciprofloxacin), MSSA (100% sensitivity to all applied antibiotics) and K. pneumoniae (100% resistance to ampicillin) that are considered one of the main cause of nosocomial pneumonia. The results demonstrate that intubation tube usage in the intensive care unit can be an important potential risk factor for developing nosocomial pneumonia. References. [1] ECDC. Surveillance Report. Annual Epidemiological Report for 2015 Healthcare-associated infections acquired in intensive care units. https://www.ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-healthcare-associated-infections.pdf
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Nozokomiālā infekcija, bakteriālā kolonizācija, intubācijas caurules, intensīvās terapijas nodaļa., Nosocomial infection, bacteriological colonisation, intubation tubes, intensive care unit.