| Abstract | UVOD: Bolničke infekcije važan su pokazatelj zdravstvene skrbi te predstavljaju važan problem moderne zdravstvene zaštite. Važnost bolničkih infekcija očituje se u tome što pogoršavaju zdravstveni status bolesnika, produljuju vrijeme boravka u bolnici, povećavaju smrtnost bolesnika te troškove liječenja zbog potrebe za upotrebom velikog broja antibiotika. Bolesnici su u jedinicama intenzivnog liječenja (JIL) posebno osjetljivi na bolničke infekcije, između ostaloga zbog česte potrebe za invazivnim potpornim mjerama te su zbog toga infekcije u JIL-u u porastu. Rizik za nastanak bolničke infekcije povezan je s trajanjem hospitalizacije, vrstom osnovne bolesti te intenzitetom skrbi.
CILJ ISTRAŢIVANJA: Utvrditi pojavnost i karakteristike abnormalnih mikrobioloških nalaza s obzirom na duţinu liječenja bolesnika u JIL-u kod kojih su utvrđeni i znakovi infekcije.
MATERIJALI I METODE: Retrospektivno istraživanje je po odobrenju Etičkoga povjerenstva bolnice provedeno u 135 bolesnika liječenih u JIL-u (od 1. siječnja do 31. prosinca 2019). Podaci su prikupljani iz arhive medicinske dokumentacije i informatičkog bolničkog sustava (BIS-a).
REZULTATI: Prosječna životna dob ispitanika bila je 68,7±14,7 godina. Najmlađi ispitanik imao je 33 godine, a najstariji 91 godinu. Kirurški bolesnici (66,6%) su dominirali nasuprot nekirurških (33,4%) koji su također liječeni u JIL-u (p<0,001). Najveći broj ispitanika je proveo u JIL-u do 5 dana (49,6%; 6-15 dana 39,2% i više od 16 dana 11,2%) (p<0,001). U 44,4% bolesnika koji su liječeni u JIL-u su u mikrobiološkom materijalu izolirani patogeni uzročnici. Među njima su bile učestalije žene, starije životne dobi (72,3±11,7 godina) u usporedbi sa muškarcima (61,1±15,5 godina)(p=0,003). U liječenju 93,4% ispitanika s pozitivnim mikrobiološkim nalazom je primijenjen respirator (p<0,001). U najvećem broju ispitanika su uz kvasce (35%) izolirani Pseudomonas aeruginosa (15,9%) i Klebsiella pneumoniae (14,6%). Patogeni mikroorganizmi su najčešće izolirani iz endotrahealnog aspirata (54,8%) (urinokultura 29,2%, hemokultura 4,9% i bris kirurške rane 3.4%)(p<0,001). U 4,6% bolesnika je iz nadzornih kultura (bris nosa i ţdrijela) izolirana patogena bakterija koja je bila i uzrokom bolničke infekcije.
ZAKLJUČAK: U istraživanju ove skupine ispitanika je utvrđena statistički značajna povezanost između primjene strojne ventilacije i učestalosti abnormalnog mikrobiološkog nalaza bolesnika. Aspirat endotrahealnog tubusa je bio signifikantno najučestaliji uzorak u kojem su izolirani patogeni uzročnici. Kvasci su uz Pseudomonas aeruginosa i Klebsiella-u pneumoniae bili najučestaliji izolati. Dužina liječenja ove skupine bolesnika u JIL-u je bila povezana s značajno većom učestalosti pojave patogenih uzročnika u bolesnika. |
| Abstract (english) | INTRODUCTION: Hospital infections are important indicators of healthcare and they represent an important issue of contemporary health protection. The importance of hospital infections is manifested in the deterioration of the patient status, extension of hospital stay, increase in the mortality rate as well as medical expenses due to the use of a large number of antibiotics. Patients in intensive care units (ICU) are particularly vulnerable to hospital infections, inter alia, due to frequent need for invasive aid, for which reason infections in ICU are increasing. The risk of a hospital infection occurrence is associated with the length of hospital stay, the type of primary disease and the intensity of care.
RESEARCH GOALS: To determine the occurrence and features of abnormal microbiological findings in intensive care units patients given the length of treatment and in the presence of signs of infection.
MATERIALS AND METHODS: A retrospective study was conducted with the approval of the Hospital Ethics Committee in 135 patients treated at the ICU (from 1 January to 31 December 2019). Data were collected from the archives of medical records and the hospital information system (BIS).
RESULTS: The average age of patients was 68,7±14,7. The youngest patient was 33 and the oldest one was 91 years old. The most common reason for the ICU admission was surgical indication (p<0,001). The largest number of patients spent one to 5 days in ICU (p<0,001). Pathogenic agents were isolated in 44,4% of cases. The average age of men with microbiological findings was 61,1±15,5 years, whereas it was 72,3±11,7 (p=0,003) for women. In the treatment of 93,4% patients with positive microbiological findings a mechanical ventilation was applied (p<0,001). The most often isolated pathogenic microorganisms were fungi (35%), Pseudomonas aeruginosa (15,9%) and Klebsiella pneumoniae (14,6%). In most cases pathogenic agents were found in tube aspiration (p<0,001).
CONCLUSION: A statistically significant correlation was found between the appliance of mechanical ventilation and the appearance of positive microbiological findings. The endotracheal tube swab was the most common and statistically significant sample with pathogenic isolated agents. Fungi were the most common isolates in patients in association with Pseudomonas aeruginosa and Klebsiella pneumoniae. Finally, the length of health treatment in ICU was connected to higher prevalence of pathogenic agents in patients. |
