Hastane Enfeksiyonu Etkenleri
Özet
Afetler, hastane altyapısının zarar görmesi, sağlık hizmetlerinin aksaması, yetersiz sanitasyon, kalabalık yaşam koşulları ve su kirliliği gibi faktörler nedeniyle enfeksiyon riskini ciddi oranda artırmaktadır. Sağlık bakımıyla ilişkili enfeksiyonlar olarak da bilinen hastane enfeksiyonları, hastaneye başvuru sırasında mevcut olmayıp, sağlık hizmeti alma sürecinde edinilen enfeksiyonlardır. Afet sonrası hastane kaynaklı enfeksiyonlar arasında yara enfeksiyonları öne çıkmakta, bunlara sıklıkla Escherichia coli, Staphylococcus aureus ve Pseudomonas aeruginosa gibi antibiyotik dirençli patojenler neden olmaktadır. Yara enfeksiyonlarının laboratuvar tanısında derin doku biyopsisi, sürüntü ve iğne aspirasyonu teknikleri kullanılmaktadır. Doku biyopsisi yara enfeksiyonunu belirlemede altın standart yöntem olsa da, sürüntü kültürü; pratik, invaziv olmayan, tekrarlanabilir ve ucuz olma özelliği nedeniyle klinikte en yaygın kullanılan tekniktir. Enfeksiyonun doğru tanısı ve etkili tedavisi için bu örneklerin uygun şekilde alınması ve mikrobiyolojik incelemesi hayati öneme sahiptir. Afet sonrasında sağlık hizmetlerinin yetersizliği, yaraların kontaminasyonu ve crush sendromu gibi faktörler enfeksiyon riskini artırır. Bu durum, yaralıların tedavisinde hijyen ve yara bakımı gibi önlemlerin önemini vurgular. Afet sonrası hastane enfeksiyonlarının önlenmesi için hijyen, izolasyon, yara temizliği ve cerrahi müdahale gibi tedbirler önemlidir. Antimikrobiyal direnç göz önünde bulundurularak uygun antibiyotik tedavisinin zamanında başlatılması gerekir. Etkili laboratuvar tanısı, enfeksiyonların erken tanısı ve yönetimi için şarttır, afet sonrası sağlık hizmetlerinin başarısında kilit rol oynar.
Disasters significantly increase the risk of infections due to damaged hospital infrastructure, disrupted healthcare services, poor sanitation, overcrowding, and water contamination. Hospital-acquired infections, also known as healthcare-associated infections, are infections not present during admission but acquired during healthcare delivery. Wound infections are particularly common after disasters and are frequently caused by antibiotic-resistant pathogens such as Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Diagnostic techniques for wound infections include deep tissue biopsy, swabbing, and needle aspiration. While tissue biopsy is the gold standard for identifying wound infections, swab cultures are most commonly used in clinical practice due to their practicality, non-invasiveness, repeatability, and cost-effectiveness. Proper collection and microbiological analysis of these samples are essential for accurate diagnosis and effective treatment. Post-disaster infection risks increase due to inadequate healthcare, wound contamination, and conditions like crush syndrome, highlighting the importance of hygiene and wound care in patient management. Preventing hospital-acquired infections after disasters requires hygiene, isolation, wound cleaning, and surgical intervention. Given the high levels of antimicrobial resistance, timely and appropriate antibiotic therapy is crucial. Effective laboratory diagnostics are essential for early infection detection and management, playing a critical role in the success of post-disaster healthcare.
Referanslar
Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infect Drug Resist. 2018(11):2321-33.
Ghashghaee A, Benis MR, Aryankhesal A, Tanha K, Hosseinifard H, Janani L, et al. The Prevalence of Hospital-Acquired Infections in the EMRO: A Systematic Review and Meta-Analysis from 2000 to 2018. 2019.
Raoofi S, Pashazadeh Kan F, Rafiei S, Hosseinipalangi Z, Noorani Mejareh Z, Khani S, et al. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One. 2023;18(1):e0274248.
Sax H, Schreiber PW, Clack L, Ratz D, Saint S, Greene MT, et al. Preventing healthcare-associated infection in Switzerland: Results of a national survey. Infect Control Hosp Epidemiol. 2020;41(5):597-600.
Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011;377(9761):228-41.
Munyeshyaka E, Cyuzuzo P, Yadufashije C, Karemera J. Contribution of medical wards contamination to wound infection among patients attending Ruhengeri Referral hospital. Int J Microbiol. 2021;2021.
Mavrouli M, Mavroulis S, Lekkas E, Tsakris A. The impact of earthquakes on public health: A narrative review of infectious diseases in the post-disaster period aiming to disaster risk reduction. Microorganisms. 2023;11(2):419.
Magill S, O’leary E, Janelle S, Thompson D, Dumyati G, Nadle J, et al. Emerging Infections Program Hospital Prevalence Survey Team. Changes in prevalence of health care-associated infections in US hospitals N Engl J Med. 2018;379(18):1732-44.
Ran Y-C, Ao X-X, Liu L, Fu Y-L, Tuo H, Xu F. Microbiological study of pathogenic bacteria isolated from paediatric wound infections following the 2008 Wenchuan earthquake. Scand J Infect Dis. 2010;42(5):347-50.
Wang T, Li D, Xie Y, Kang M, Chen Z, Chen H, et al. The microbiological characteristics of patients with crush syndrome after the Wenchuan earthquake. Scand J Infect Dis. 2010;42(6-7):479-83.
Liu J, Ma L, You C. Analysis of scalp wound infections among craniocerebral trauma patients following the 2008 Wenchuan earthquake. Turk Neurosurg. 2012;22(1):27-31.
Miskin IN, Nir-Paz R, Block C, Merin O, Burshtein Sa, Pirogovsky S, et al. Antimicrobial therapy for wound infections after catastrophic earthquakes. N Engl J Med. 2010;363(26):2571-3.
Kiani Q, Amir M, Ghazanfar M, Iqbal M. Microbiology of wound infections among hospitalised patients following the 2005 Pakistan earthquake. J Hosp Infect. 2009;73(1):71-8.
Lachish T, Halperin T, Snitser O, Kashat L, Merin O, Bader T, et al. The spectrum of bacteria and mechanisms of resistance identified from the casualties treated in the Israeli field hospital after the earthquake in Nepal, 2015: A retrospective analysis. Travel Med Infect Dis. 2020;37:101707.
Huang K-C, Lee T-S, Lin Y-M, Shu K-H. Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc. 2002;101(4):249-56.
Chen X, Zhong H, Fu P, Hu Z, Qin W, Tao Y. Infections in crush syndrome: a retrospective observational study after the Wenchuan earthquake. Emerg Med J. 2011;28(1):14-7.
Crisis Center of the Turkish Prime Ministry. Earthquakes 1999. Ankara: Press of Prime Ministry; 2000, p. 3–15.
Kotilainen H. Prevention and control of nosocomial infection in the intensive care unit. In: Rippe J, Irwin, RS, Alpert, JS, Fink, editor. Intensive care medicine. London: Little Brown and Co.; 1991. p. 827-38.
Keven K, Ates K, Sever MS, Yenicesu M, Canbakan B, Arinsoy T, et al. Infectious complications after mass disasters: the Marmara earthquake experience. Scand J Infect Dis. 2003;35(2):110-3.
Bekçibaşı M, Hoşoğlu S, Deveci Ö, Dayan S. Therapy for wound infections after earthquakes requires inclusion of drugs targeting Gram-negative bacteria. Infect Dis (Lond). 2017;49(11-12):862-4.
Öncül O, Keskin Ö, Acar H, Küçükardalı Y, Evrenkaya R, Atasoyu E, et al. Hospital-acquired infections following the 1999 Marmara earthquake. J Hosp Infect. 2002;51(1):47-51.
Eryilmaz-Eren E, Yalcin S, Ozan F, Saatci E, Suzuk-Yildiz S, Ture Z, et al. An outbreak analysis of wound infection due to Acinetobacter baumannii in earthquake-trauma patients. Am J Infect Control 2024;52(5):599-604.
Bowler P, Duerden B, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev 2001;14(2):244-69.
Hiransuthikul N, Tantisiriwat W, Lertutsahakul K, Vibhagool A, Boonma P. Skin and soft-tissue infections among tsunami survivors in southern Thailand. Clin Infect Dis. 2005;41(10):e93-e6.
Buckle R, Dhukani A, Bridges RL, Garcia BC. Hurricane Harvey Aftermath: An Interdisciplinary Case Report on the Management of an Open Bimalleolar Fracture. J Am Podiatr Med Assoc. 2020;110(2).
Wuthisuthimethawee P, Lindquist SJ, Sandler N, Clavisi O, Korin S, Watters D, et al. Wound management in disaster settings. World J Surg. 2015;39:842-53.
Ladhani HA, Yowler CJ, Claridge JA. Burn wound colonization, infection, and sepsis. Surg Infect (Larchmt). 2021;22(1):44-8.
Zhang B, Liu Z, Lin Z, Zhang X, Fu W. Microbiologic characteristics of pathogenic bacteria from hospitalized trauma patients who survived Wenchuan earthquake. Eur J Clin Microbiol Infect Dis. 2012;31:2529-35.
Spear M. When and how to culture a chronic wound: A culture is a valuable tool in wound care if used correctly. Wound Care Advisor. 2014;3(1):23-6.
Spear M. Best technique for obtaining wound cultures. Plast Surg Nurs. 2012;32(1):34-6.
Kallstrom G. Are quantitative bacterial wound cultures useful? J Clin Microbiol. 2014;52(8):2753-6.
Li S, Renick P, Senkowsky J, Nair A, Tang L. Diagnostics for wound infections. Adv Wound Care (New Rochelle). 2021;10(6):317-27.
Baron EJ. Specimen collection, transport, and processing: bacteriology. Pp: 270-315. In: Jorgensen JH, Pfaller MA. Manual of Clinical Microbiology. 2015, 11th ed. Volume 1. ASM Press, Washington, DC.
Özakın C, Akçalı A, Dalyan Cilo B, Öğünç D, Öz Y, Ülger N et al. Sürüntü örnekleri, Apse ve aspirat örnekleri, Doku ve biyopsi örnekleri. Sf: 5-17. KLİMUD Deri, Deri Ekleri, Yumuşak Doku ve Göz Örneklerinin Laboratuvar İncelemesi Rehberi, 2024, 2. Baskı, Kaynak No: 8, Ankara.
Swanson T, Ousey K, Haesler E, Bjarnsholt T, Carville K, Idensohn P, et al. IWII Wound Infection in Clinical Practice consensus document: 2022 update. J Wound Care. 2022;31(Sup12):S10-S21.
Burnet M, Metcalf DG, Milo S, Gamerith C, Heinzle A, Sigl E, et al. A host-directed approach to the detection of infection in hard-to-heal wounds. Diagnostics (Basel). 2022;12(10):2408.
Loaiza WM, Ruiz AKR, Patiño CCO, Vivas MC. Bacterial Resistance in Hospital-Acquired Infections Acquired in the Intensive Care Unit: A Systematic Review. Acta medica (Hradec Kralove). 2023;66(1):1-10.
Doung‐ngern P, Vatanaprasan T, Chungpaibulpatana J, Sitamanoch W, Netwong T, Sukhumkumpee S, et al. Infections and treatment of wounds in survivors of the 2004 tsunami in Thailand. Int Wound J. 2009;6(5):347-54.
Ubbink DT, Vermeulen H, Goossens A, Kelner RB, Schreuder SM, Lubbers MJ. Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial. Arch Surg. 2008;143(10):950-5.
Strich JR, Palmore TN. Preventing transmission of multidrug-resistant pathogens in the intensive care unit. Infect Dis Clin North Am. 2017;31(3):535-50.
Bartels SA, VanRooyen MJ. Medical complications associated with earthquakes. Lancet. 2012;379(9817):748-57.
Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol. 2010;31(10):1025-9.
Referanslar
Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infect Drug Resist. 2018(11):2321-33.
Ghashghaee A, Benis MR, Aryankhesal A, Tanha K, Hosseinifard H, Janani L, et al. The Prevalence of Hospital-Acquired Infections in the EMRO: A Systematic Review and Meta-Analysis from 2000 to 2018. 2019.
Raoofi S, Pashazadeh Kan F, Rafiei S, Hosseinipalangi Z, Noorani Mejareh Z, Khani S, et al. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One. 2023;18(1):e0274248.
Sax H, Schreiber PW, Clack L, Ratz D, Saint S, Greene MT, et al. Preventing healthcare-associated infection in Switzerland: Results of a national survey. Infect Control Hosp Epidemiol. 2020;41(5):597-600.
Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011;377(9761):228-41.
Munyeshyaka E, Cyuzuzo P, Yadufashije C, Karemera J. Contribution of medical wards contamination to wound infection among patients attending Ruhengeri Referral hospital. Int J Microbiol. 2021;2021.
Mavrouli M, Mavroulis S, Lekkas E, Tsakris A. The impact of earthquakes on public health: A narrative review of infectious diseases in the post-disaster period aiming to disaster risk reduction. Microorganisms. 2023;11(2):419.
Magill S, O’leary E, Janelle S, Thompson D, Dumyati G, Nadle J, et al. Emerging Infections Program Hospital Prevalence Survey Team. Changes in prevalence of health care-associated infections in US hospitals N Engl J Med. 2018;379(18):1732-44.
Ran Y-C, Ao X-X, Liu L, Fu Y-L, Tuo H, Xu F. Microbiological study of pathogenic bacteria isolated from paediatric wound infections following the 2008 Wenchuan earthquake. Scand J Infect Dis. 2010;42(5):347-50.
Wang T, Li D, Xie Y, Kang M, Chen Z, Chen H, et al. The microbiological characteristics of patients with crush syndrome after the Wenchuan earthquake. Scand J Infect Dis. 2010;42(6-7):479-83.
Liu J, Ma L, You C. Analysis of scalp wound infections among craniocerebral trauma patients following the 2008 Wenchuan earthquake. Turk Neurosurg. 2012;22(1):27-31.
Miskin IN, Nir-Paz R, Block C, Merin O, Burshtein Sa, Pirogovsky S, et al. Antimicrobial therapy for wound infections after catastrophic earthquakes. N Engl J Med. 2010;363(26):2571-3.
Kiani Q, Amir M, Ghazanfar M, Iqbal M. Microbiology of wound infections among hospitalised patients following the 2005 Pakistan earthquake. J Hosp Infect. 2009;73(1):71-8.
Lachish T, Halperin T, Snitser O, Kashat L, Merin O, Bader T, et al. The spectrum of bacteria and mechanisms of resistance identified from the casualties treated in the Israeli field hospital after the earthquake in Nepal, 2015: A retrospective analysis. Travel Med Infect Dis. 2020;37:101707.
Huang K-C, Lee T-S, Lin Y-M, Shu K-H. Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc. 2002;101(4):249-56.
Chen X, Zhong H, Fu P, Hu Z, Qin W, Tao Y. Infections in crush syndrome: a retrospective observational study after the Wenchuan earthquake. Emerg Med J. 2011;28(1):14-7.
Crisis Center of the Turkish Prime Ministry. Earthquakes 1999. Ankara: Press of Prime Ministry; 2000, p. 3–15.
Kotilainen H. Prevention and control of nosocomial infection in the intensive care unit. In: Rippe J, Irwin, RS, Alpert, JS, Fink, editor. Intensive care medicine. London: Little Brown and Co.; 1991. p. 827-38.
Keven K, Ates K, Sever MS, Yenicesu M, Canbakan B, Arinsoy T, et al. Infectious complications after mass disasters: the Marmara earthquake experience. Scand J Infect Dis. 2003;35(2):110-3.
Bekçibaşı M, Hoşoğlu S, Deveci Ö, Dayan S. Therapy for wound infections after earthquakes requires inclusion of drugs targeting Gram-negative bacteria. Infect Dis (Lond). 2017;49(11-12):862-4.
Öncül O, Keskin Ö, Acar H, Küçükardalı Y, Evrenkaya R, Atasoyu E, et al. Hospital-acquired infections following the 1999 Marmara earthquake. J Hosp Infect. 2002;51(1):47-51.
Eryilmaz-Eren E, Yalcin S, Ozan F, Saatci E, Suzuk-Yildiz S, Ture Z, et al. An outbreak analysis of wound infection due to Acinetobacter baumannii in earthquake-trauma patients. Am J Infect Control 2024;52(5):599-604.
Bowler P, Duerden B, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev 2001;14(2):244-69.
Hiransuthikul N, Tantisiriwat W, Lertutsahakul K, Vibhagool A, Boonma P. Skin and soft-tissue infections among tsunami survivors in southern Thailand. Clin Infect Dis. 2005;41(10):e93-e6.
Buckle R, Dhukani A, Bridges RL, Garcia BC. Hurricane Harvey Aftermath: An Interdisciplinary Case Report on the Management of an Open Bimalleolar Fracture. J Am Podiatr Med Assoc. 2020;110(2).
Wuthisuthimethawee P, Lindquist SJ, Sandler N, Clavisi O, Korin S, Watters D, et al. Wound management in disaster settings. World J Surg. 2015;39:842-53.
Ladhani HA, Yowler CJ, Claridge JA. Burn wound colonization, infection, and sepsis. Surg Infect (Larchmt). 2021;22(1):44-8.
Zhang B, Liu Z, Lin Z, Zhang X, Fu W. Microbiologic characteristics of pathogenic bacteria from hospitalized trauma patients who survived Wenchuan earthquake. Eur J Clin Microbiol Infect Dis. 2012;31:2529-35.
Spear M. When and how to culture a chronic wound: A culture is a valuable tool in wound care if used correctly. Wound Care Advisor. 2014;3(1):23-6.
Spear M. Best technique for obtaining wound cultures. Plast Surg Nurs. 2012;32(1):34-6.
Kallstrom G. Are quantitative bacterial wound cultures useful? J Clin Microbiol. 2014;52(8):2753-6.
Li S, Renick P, Senkowsky J, Nair A, Tang L. Diagnostics for wound infections. Adv Wound Care (New Rochelle). 2021;10(6):317-27.
Baron EJ. Specimen collection, transport, and processing: bacteriology. Pp: 270-315. In: Jorgensen JH, Pfaller MA. Manual of Clinical Microbiology. 2015, 11th ed. Volume 1. ASM Press, Washington, DC.
Özakın C, Akçalı A, Dalyan Cilo B, Öğünç D, Öz Y, Ülger N et al. Sürüntü örnekleri, Apse ve aspirat örnekleri, Doku ve biyopsi örnekleri. Sf: 5-17. KLİMUD Deri, Deri Ekleri, Yumuşak Doku ve Göz Örneklerinin Laboratuvar İncelemesi Rehberi, 2024, 2. Baskı, Kaynak No: 8, Ankara.
Swanson T, Ousey K, Haesler E, Bjarnsholt T, Carville K, Idensohn P, et al. IWII Wound Infection in Clinical Practice consensus document: 2022 update. J Wound Care. 2022;31(Sup12):S10-S21.
Burnet M, Metcalf DG, Milo S, Gamerith C, Heinzle A, Sigl E, et al. A host-directed approach to the detection of infection in hard-to-heal wounds. Diagnostics (Basel). 2022;12(10):2408.
Loaiza WM, Ruiz AKR, Patiño CCO, Vivas MC. Bacterial Resistance in Hospital-Acquired Infections Acquired in the Intensive Care Unit: A Systematic Review. Acta medica (Hradec Kralove). 2023;66(1):1-10.
Doung‐ngern P, Vatanaprasan T, Chungpaibulpatana J, Sitamanoch W, Netwong T, Sukhumkumpee S, et al. Infections and treatment of wounds in survivors of the 2004 tsunami in Thailand. Int Wound J. 2009;6(5):347-54.
Ubbink DT, Vermeulen H, Goossens A, Kelner RB, Schreuder SM, Lubbers MJ. Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial. Arch Surg. 2008;143(10):950-5.
Strich JR, Palmore TN. Preventing transmission of multidrug-resistant pathogens in the intensive care unit. Infect Dis Clin North Am. 2017;31(3):535-50.
Bartels SA, VanRooyen MJ. Medical complications associated with earthquakes. Lancet. 2012;379(9817):748-57.
Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol. 2010;31(10):1025-9.
