Hospital-acquired pneumonia in patients receiving immunosuppressive therapy

Ebru Çakır EDİS,OSMAN NURİ HATİPOĞLU,İlker YILMAN,Alper EKER,Özlem TANSEL,NECDET SÜT,Emre TEKGÜNDÜZ,AHMET MUZAFFER DEMİR

Özet

Amaç: ÇalIşmamIzda immunsupresif tedavi alIrken hastane kökenli pnömoni (HKP) gelişen hastalarda klinik başarI oranlarInI, nötropeninin tedavi başarIsIna olan etkilerini, mortalite ile ilişkili risk faktörlerini ve survi oranlarInI saptamayI amaçladIk. Yöntem ve Gereçler: ûmmunsupresif tedavi alIrken HKP gelişen 45 erişkin hasta prospektif olarak çalIşmaya alIndI. Transplant hastalarI ve human immunodeficiency virus (HIV)-pozitif olan hastalar çalIşmaya alInmadI.Antibiyotik tedavisi multidisipliner olarak yönetildi. Survi analizlerinde Kaplan Meier, mortaliteyle ilişkili bağImsIz risk faktörlerini saptamak için Cox regresyon uygulandI. Nötropeninin klinik başarI oranlarI ile ilişkisi Chi Square yöntemiyle karşIlaştIrIldI. Bulgular: Ampirik tedavi olarak 43 hastanIn 40’da (%93) antipseudomonal tedavi başlanmasIna rağmen en sIk izole edilen etkenler Acinetobacter spp ve Escherichia coli idi. Tedavi sonu klinik başarI oranI %65.1 idi. Sürvi oranlarI 3.,14., 42. ve 365. gün sIrasIyla % 97, 86, 58 ve 19 olarak bulundu. Üre yüksekliği [Hazard Ratio=1.01 (%95 GA: 1.00-1.02)] ve kan şekeri yüksekliği [HR=1.01 (%95 GA: 1.00-1.02)] surviyi olumsuz etkileyen bağImsIz risk faktörleri olarak bulundu. Nötropenik olmayan (n=23) hastalarda klinik başarI oranlarI nötropenik (n=20) olanlara göre daha yüksek bulundu (p=0.05). Sonuç: ûmmunsupresif tedavi alan hastalarda gelişen HKP’lerde tedavi başarI oranlarI düşüktür.

Abstract

Objective: The aims of this study were to determine the clinical success rates, effect of neutropenia on treatment success rates, risk factors related to mortality, and survival in patients who developed hospital-acquired pneumonia (HAP) while receiving immunosuppressive therapy. Materials and Methods: Forty-three adult patients receiving immunosuppressive therapy who developed HAP were included in this prospective study. Transplantation patients and human immunodeficiency virus (HIV)-positive patients were not included. Antibiotic treatment was managed by a multidisciplinary team. The Kaplan Meier method was used for the survival analysis and Cox regression was used for the identification of mortality-related independent risk factors. The relationship between neutropenia and the clinical success rate was determined using the chi-square test. Results: Although anti-pseudomonal antibiotics were started empirically in 40 of the 43 patients (93%) at the beginning of the treatment, the most frequently isolated pathogens were Acinetobacter spp. and Escherichia coli. The success rate at the end of the treatment was 65.1%. The survival rates for the 3rd, 14th, 42nd, and 365th days were 97%, 86%, 58%, and 19%, respectively. Elevated levels of urea [Hazard Ratio=1.01 (95% CI: 1.00–1.02)] and blood glucose [HR=1.01 (95% CI: 1.00–1.02)] were found to be independent risk factors affecting survival. The treatment success rate was higher in patients without neutropenia (n=23) than in those with neutropenia (n=20) (p=0.05). Conclusion: The treatment success rate was low in patients who developed HAP while receiving immunosuppressive therapy.