ارتباط میان مصرف پروفیلاکسی آنتی بیوتیکی قبل از جراحی و عفونت‌های بیمارستانی در بخش مراقبتهای ویژه (ICU)

نوع مقاله : مقاله پژوهشی

نویسندگان

1 گروه فیزیولوژی و فارماکولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی کردستان

2 دانشگاه شیراز، دانشکده دامپزشکی، بخش علوم پایه، شیراز، ایران

3 گروه ایمنی شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی شهرکرد

4 گروه عفونی، دانشکده پزشکی، دانشگاه تهران، تهران، ایران

چکیده

زمینه و هدف: عفونت‌های بیمارستانی (Nosocomial infections یا NIs) در زمان بستری در بخش مراقبتهای ویژه ممکن است باعث ایجاد عوارض، مرگ و میر و بستری شدن مجدد در بیمارستان شود. هدف از انجام این مطالعه تعیین فاکتورهای خطر در عفونت‌های بیمارستانی در بخش مراقبتهای ویژه با تأکید بر مصرف پروفیلاکسی آنتی بیوتیک قبل از اعمال جراحی است.
مواد و روش ها: یک مطالعه گذشته نگر درمورد NIs در بخش مراقبتهای ویژه در فاصله زمانی اکتبر 2019 تا می 2020 در یک بیمارستان دولتی در تهران انجام شد. میزان کلی عفونت، محل ایجاد عفونت، پاتوژن بیماری زا، مدت زمان بستری در ICU و فاکتورهای خطر برای عفونت‌های بیمارستانی مورد ارزیابی قرار گرفتند.
یافته ها: میزان NIs در بیمارانی که از یک آنتی بیوتیک قبل از جراحی استفاده کرده بودند در مقایسه با بیمارانی که بیش از یک آنتی بیوتیک دریافت کرده بودند؛ به طور معنی داری کمتر بود (p <0.001). استفاده طولانی مدت از آنتی‌بیوتیک‌ها به‌منظور پروفیلاکسی قبل از جراحی و یا استفاده از آنتی‌ بیوتیک های وسیع الطیف ریسک عفونت‌های بیمارستانی در ICU را افزایش داد.
نتیجه گیری: نتایج نشان داد که استفاده بیش از یک آنتی بیوتیک به‌عنوان پروفیلاکسی قبل از جراحی با ریسک بالای عفونت‌های بیمارستانی مرتبط است. علاوه بر این، تجویز آنتی‌بیوتیک‌های وسیع الطیف به‌عنوان پروفیلاکسی قبل از جراحی و همچنین استفاده طولانی مدت از تجهیزات پزشکی، با خطر ابتلا به NIs را در بیماران بدحال ارتباط دارد.

کلیدواژه‌ها

عنوان مقاله [English]

Relationship between surgical antibiotic prophylaxis and nosocomial infection in intensive care units

نویسندگان [English]

  • Ehsan Motaghi 1
  • Razieh Gerami 2
  • Masumeh Ghasemi 3
  • Shahin Jafarpour 4
  • Mohammad Javad Hosseini 4
1 Department of Physiology and Pharmacology, School of Medicine, Kurdistan University of Medical Sciences.
2 Shiraz University, Collage of veterinary, Basic Science Section
3 Immunology Department,, School of Medicine, Shahrekord University of Medical Science
4 Department of Infectious disease, School of Medicine, Tehran University, Tehran, Iran
چکیده [English]

Background and aim: Nosocomial infections (NIs) during ICU admission may cause morbidity, mortality and hospital readmissions. The aim of this study was to determine risk factors of nosocomial infections in ICUs with an emphasis on preoperative antibiotic prophylaxis.
Method: A retrospective study of NIs was conducted in ICUs of a public hospital in Iran between October 2019 and May 2020. The overall rate of NI, distribution of the infection sites and responsible pathogen and the length of ICU stay as well as the risk factors of NIs were investigated.
Results: The rate of NIs in patients receiving one preoperative antibiotic was much lower than that in patients receiving more than one antibiotics (p<0.001). Long-term pre-operative antibiotic prophylaxis or use of broad spectrum surgical prophylaxis increased the risk of NIs in ICUs.
Conclusions: The results indicated that using of more than one antibiotic as preoperative prophylaxis is associated with higher risk of NIs. Moreover, administration of broad spectrum antibiotics as preoperative prophylaxis increase the risk of NIs in critically ill patients.

کلیدواژه‌ها [English]

  • Acinetobacter
  • Nosocomial infections
  • infection inhibition

مراجع

  1. Bocicor MI, Molnar A-J, Taslitchi C. Preventing hospital acquired infections through a workflow-based
    cyber-physical system. arXiv preprint arXiv:170208010. 2017.
    2. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: Incidence,
    risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. J Crit Care
    Med. 2015;19(1):14.
    3. Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and
    surveillance. Asian Pacific Journal of Tropical Biomedicine. 2017;7(5):478-82.
    4. Krause G. Changing Infection Patterns: New Evidence on the Prevalence of Nosocomial Infections and
    Antibiotic Resistance in Hospitals in Germany. Deutsches Ärzteblatt International. 2017;114(50):849.
    5. Stiller A, Schröder C, Gropmann A, Schwab F, Behnke M, Geffers C, et al. ICU ward design and
    nosocomial infection rates: a cross-sectional study in Germany. Journal of Hospital Infection. 2017;95(1):71-5.
  2. 6. Edwardson S, Cairns C. Nosocomial infections in the ICU. Anaesthesia & Intensive Care Medicine.
    2018;20(1):14-8.
    7. Ierano C, Nankervis J-AM, James R, Rajkhowa A, Peel T, Thursky K. Surgical antimicrobial
    prophylaxis. Australian prescriber. 2017;40(6):225.
    8. Strymish J, Branch-Elliman W, Itani K, Gupta K, editors. National Trends in Vancomycin use for PeriOperative Prophylaxis Over 5 Years. Open Forum Infectious Diseases; 2015: Infectious Diseases Society of
    America.
    9. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease
    Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery.
    2017;152(8):784-91.
    10. Tita AT, Rouse DJ, Blackwell S, Saade GR, Spong CY, Andrews WW. Evolving concepts in antibiotic
    prophylaxis for cesarean delivery: A systematic review. Obstetrics and gynecology. 2009;113(3):675.
    11. Tita AT, Szychowski JM, Boggess K, Saade G, Longo S, Clark E, et al. Adjunctive azithromycin
    prophylaxis for cesarean delivery. New England journal of medicine. 2016;375(13):1231-41.
    12. Das S, Adler AL, Miles-Jay A, Kronman MP, Qin X, Weissman SJ, et al. Antibiotic prophylaxis is
    associated with subsequent resistant infections in children with an initial extended-spectrum-cephalosporinresistant Enterobacteriaceae infection. Antimicrobial agents and chemotherapy. 2017;61(5):e02656-16.
    13. Adrie C, Garrouste-Orgeas M, Essaied WI, Schwebel C, Darmon M, Mourvillier B, et al. Attributable
    mortality of ICU-acquired bloodstream infections: impact of the source, causative micro-organism, resistance
    profile and antimicrobial therapy. J Infect. 2017;74(2):131-41.
    14. Lee HJ, Jeong JS, Ki HK, Lee SI. Comparison between the Surveillance Definitions for Nosocomial
    Pneumonia Published by the CDC in 1996 and 2002. Korean Journal of Nosocomial Infection Control.
    2009;14(1):51-9.
    15. Olgac G, Aydogmus U, Mulazimoglu L, Kutlu CA. Antibiotics are not needed during tube thoracostomy
    for spontaneous pneumothorax: an observational case study. J Cardiothorac Surg. 2006;1(1):43.
    16. Ravikumar V, Ho AL, Pendharkar AV, Sussman ES, Kwong-hon Chow K, Li G. The use of vancomycin
    powder for surgical prophylaxis following craniotomy. Neurosurgery. 2017;80(5):754-8.
    17. Scheverin N, Steverlynck A, Castelli R, Sobrero D, Kopp NV, Dinelli D, et al. Prophylaxis of surgical
    site infection with vancomycin in 513 patients that underwent to lumbar fusion. Coluna/Columna.
    2015;14(3):177-80.
    18. Cohen-Rosenblum A, Crutcher M, Gui J, Novicoff W, Nelson S, Browne J. Dual Antibiotic Therapy
    with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty. Reconstructive Review.
    2018;8(2).
    19. Hagel S, Scheuerlein H. Perioperative antibiotic prophylaxis and antimicrobial therapy of intraabdominal infections. Visceral Medicine. 2014;30(5):310-6.
    20. Sepehr A, Santos BJG, Chou C, Karimi K, Devcic Z, Oels S, et al. Antibiotics in head and neck surgery
    in the setting of malnutrition, tracheotomy, and diabetes. The Laryngoscope. 2009;119(3):549-53.
    21. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after
    cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation.
    2000;101(25):2916-21.
    22. Torres A, Ewig S, Lode H, Carlet J, Group EHW. Defining, treating and preventing hospital acquired
    pneumonia: European perspective. Intensive care medicine. 2009;35(1):9-29.
    23. Alverdy JC, Laughlin RS, Wu L. Influence of the critically ill state on host-pathogen interactions within
    the intestine: gut-derived sepsis redefined. Critical care medicine. 2003;31(2):598-607.
    24. Forestier C, Guelon D, Cluytens V, Gillart T, Sirot J, De Champs C. Oral probiotic and prevention of
    Pseudomonas aeruginosa infections: a randomized, double-blind, placebo-controlled pilot study in intensive care
    unit patients. Critical Care. 2008;12(3):R69.
    25. Oudhuis GJ, Stobberingh EE, Kessels A, Bergmans DC, Dormans T, Verbon A. Infection prevention in
    Intensive Care patients using the probiotic Lactobacillus plantarum 299/299v. Infection prevention in Intensive
    Care patients: probiotics compared to antibiotics. 2012:87.
    26. Liu K-x, Qu J-m, Zhang J, Lin Q-c. Probiotic Prophylaxis of Nosocomial Pneumonia in Critically Ill
    Patients. Diet and Nutrition in Critical Care. 2014:1-17.
    27. Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for
    hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Canadian Journal of Infectious
    Diseases and Medical Microbiology. 2008;19(1):19-53.
    28. Haas JP, Evans AM, Preston KE, Larson EL. Risk factors for surgical site infection after cardiac surgery:
    the role of endogenous flora. Heart & Lung. 2005;34(2):108-14.
  3. 29. Branch-Elliman W, Ripollone JE, O’Brien WJ, Itani KM, Schweizer ML, Perencevich E, et al. Risk of
    surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis
    with vancomycin plus a beta-lactam versus either drug alone: a national propensity-score-adjusted retrospective
    cohort study. PLoS medicine. 2017;14(7):e1002340.
    30. Mireya UA, Marti PO, Xavier KV, Cristina LO, Miguel MM, Magda CM. Nosocomial infections in
    paediatric and neonatal intensive care units. J Infect. 2007;54(3):212-20.
    31. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during
    hospitalization. Jama. 2003;290(14):1868-74.
    32. Feldman C. An overview of nosocomial pneumonia. Southern African Journal of Epidemiology and
    Infection. 2005;20(2):49-57.
    33. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units
    in Argentina: attributable mortality and length of stay. Am J Infect Control. 2003;31(5):291-5.
    34. Wang J, Gao P, Guo S, Liu Y, Shao L, Kang H, et al. Analysis of death risk factors for nosocomial
    infection patients in an ICU: a retrospective review of 864 patients from 2009 to 2015. Zhongguo Wei Zhong
    Bing Ji Jiu Yi Xue. 2016;28(8):704-8.
    35. Gastmeier P, Sohr D, Geffers C, Behnke M, Daschner F, Rüden H. Mortality risk factors with nosocomial
    Staphylococcus aureus infections in intensive care units: results from the German Nosocomial Infection
    Surveillance System (KISS). Infection. 2005;33(2):50-5.
    36. Cevik M, Yilmaz G, Erdinc F, Ucler S, Tulek N. Relationship between nosocomial infection and
    mortality in a neurology intensive care unit in Turkey. Journal of Hospital Infection. 2005;59(4):324-30.
    37. Custovic A, Smajlovic J, Hadzic S, Ahmetagic S, Tihic N, Hadzagic H. Epidemiological surveillance of
    bacterial nosocomial infections in the surgical intensive care unit. Materia socio-medica. 2014;26(1):7-11.
    38. Geffers C, Gastmeier P. Nosocomial infections and multidrug-resistant organisms in Germany:
    epidemiological data from KISS (the Hospital Infection Surveillance System). Deutsches Ärzteblatt International.
    2011;108(6):87-93.
    39. Jahani-Sherafat S, Razaghi M, Rosenthal VD, Tajeddin E, Seyedjavadi S, Rashidan M, et al. Deviceassociated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the
    International Nocosomial Infection Control Consortium (INICC). J Infect Public Health. 2015;8(6):553-61.
    40. Urban C, Segal-Maurer S, Rahal JJ. Considerations in control and treatment of nosocomial infections
    due to multidrug-resistant Acinetobacter baumannii. Clin Infect Dis. 2003;36(10):1268-74.
مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
دوره 65، شماره 3
مرداد-شهریور1401
مرداد و شهریور 1401
صفحه 1105-1112

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