Yıl: 2023 Cilt: 17 Sayı: 1 Sayfa Aralığı: 20 - 27 Metin Dili: İngilizce DOI: 10.5578/ced.20239904 İndeks Tarihi: 01-06-2023

Evaluation of Children with Ralstonia pickkettii Bacteraemia

Öz:
Objective: Ralstonia pickettii is an opportunistic pathogen that is often considered to be contaminant. It can cause infection due to colonisation in infusion solutions and disinfectants. Although rare, it can lead to nosocomial outbreaks, so this agent should not be ignored. In this study, it was aimed to evaluate the growth of R. pickettii in blood cultures taken in the pediatric wards of our hospital, to analyze the outbreaks by R. pickettii and to discuss the precautions to prevent the outbreaks. Material and Methods: Patients with Ralstonia picketti in blood cultures, who were admitted in the pediatric intensive care unit (PICU; n= 46, 81%), neonatal intensive care unit (n= 7, 12%) and other pediatric wards (n= 4, 7%) between February 2014 and December 2017 were included into the study. Patient’s data, the relation between the outbreaks and culture growths, and the sources and the prevention of potential outbreaks were evaluated. Recurrent growths were defined as a single episode. Results: Ralstonia pickettii detected in 57 different specimens in 38 different episodes in a total of 35 patients. Of the fifty-seven blood samples, 67% (n= 38) were peripheral blood cultures, 33% (n= 19) were catheter blood cultures and 74% of the samples lead to infection. Of the 38 episodes, 63% (n= 24) were considered as infection and 37% (n= 14) was contamination. Median age of the patients were seven (0-180) months, and the major underlying comorbidity was congenital heart disease. Of 57 specimens with Raltstonia pickettii growth, 16 (28%) had only R. pickettii growth, and the remaining 41 (71%) cultured growths were polymicrobial. Among these, the most common accompanying microorganisms were Stenotrophomonas maltophilia and Burkholderia species. Of 38 episodes, 58% (n= 22) had a central venous catheter (CVC), of which 64% (n= 14) developed catheter-related bloodstream infection due to R. pickettii. Eighty-one percent of the specimens were detected in the pediatric intensive care unit, and the outbreak situation was examined. Twenty-three (61%) of a total of 57 growths were associated with an outbreak of healthcare- associated infection in three separate periods. Ralstonia pickettii was not detected in environment scans. Antibiogram features of the growths were similar and they were thought to be of the same isolate, no molecular study was applied. Three patients died within the first 30 days after the growth. Conclusion: Our study has the largest case series reported in a pediatric population in Türkiye and the world. The mortality rate due to R. pickettii was low. Eighty-one percent of the specimens were in the pediatric intensive care unit and 61% was associated with the outbreak. The importance of hospital infection control measures in preventing R. pickettii and similar outbreaks were emphasized. A limited number of studies have been conducted on this subject in Türkiye, and we believe that our study will contribute to the literature.
Anahtar Kelime:

Ralstonia pickettii Bakteriyemili Çocuk Olguların Değerlendirilmesi

Öz:
Giriş: Ralstonia pickettii çoğunlukla kontaminan kabul edilen fırsatçı bir patojendir. İnfüzyon solüsyonlarında, dezenfektanlarda kolonize olarak enfeksiyona neden olabilir. Nadir de olsa nozokomiyal salgınlara yol açabileceği için göz ardı edilmemesi gereken bir etkendir. Bu çalışmada hastanemiz çocuk servislerinde alınan kan kültürlerindeki R. pickettii üremelerinin değerlendirilmesi, R. pickettii’nin neden olabileceği salgınların analizi ve engellemek için alınması gereken önlemlerden bahsetmek amaçlanmıştır. Gereç ve Yöntemler: Hastanemizin çocuk yoğun bakım ünitesi (ÇYBÜ; n= 46, %81), yenidoğan yoğun bakım ünitesi (n= 7, %12) ve diğer çocuk sağlığı ve hastalıkları kliniklerinde (n= 4, %7) Şubat 2014 ile Aralık 2017 tarihleri arasında yatmış olan hastalardan, kan kültürlerinde Ralstonia picketti üremesi olan olgular çalışmaya dahil edildi. Olguların verilerinin irdelenmesi, üremelerin salgınla ilişkisi, kaynağı ve potansiyel salgınların önlenmesi yaklaşımları değerlendirildi. Ardışık üremeler tek epizod olarak tanımlandı. Bulgular: Toplam 35 hastada, 38 farklı epizodda, 57 kan kültüründe R. pickettii üremesi tespit edildi. Elli yedi kan örneğinin %67 (n= 38)’si periferik kan kültürü, %33 (n= 19)’ü kateterden alınan kan kültürü olup örneklerin %74 (n= 42)’ü anlamlıydı. Otuz sekiz epizoddan %63 (n= 24)’ü anlamlı, %37 (n= 14)’si kontaminasyon olarak kabul edildi. Hastaların yaşları medyan yedi (0-180) ay olup, altta yatan major komorbidite konjenital kalp hastalığıydı. Raltstonia pickettii üremesi olan 57 örneğin 16’sında (%28) sadece R. pickettii üremesi olup kalan 41 (%71) kültür üremesi polimikrobiyaldi. Bunlar içerisinde en sık eşlik eden mikroorganizmalar Stenotrophomonas maltophilia ve Burkholderia spp. türleri idi. Otuz sekiz epizoddan %58 (n= 22)’inde santral venöz kateter (SVK) mevcut olup, bunların %64 (n= 14)’ünde R. pickettii’ye bağlı kateter ilişkili kan dolaşım enfeksiyonu gelişti. Üremelerin %81’i çocuk yoğun bakım ünitesinde tespit edilmiş olup salgın durumu incelendi. Toplam 57 üremenin 23 (%61)’ü üç ayrı dönemde sağlık bakımı ile ilişkili enfeksiyon salgını ile ilişkilendirildi. Ortam taramalarında R. pickettii saptanmadı. Üremelerin antibiyogram özellikleri birbirine benzer olup aynı izolat olduğu düşünüldü, moleküler çalışma uygulanmadı. Üç hasta üreme sonrası ilk 30 gün içerisinde kaybedildi. Sonuç: Çalışmamız Türkiye ve dünyada çocuk olgularda bildirilen en geniş seriydi. R. pickettii’ye bağlı mortalite oranı düşük bulundu. Üremelerin %81’i çocuk yoğun bakım ünitesinde olup %61’i salgınla ilişkiliydi. Hastane enfeksiyon kontrol önlemlerinin R. pickettii ve benzer salgınların önlemesindeki önemi vurgulandı. Türkiye’de bu konuda kısıtlı sayıda çalışma yapılmış olup, çalışmamızın literatüre katkı sağlayacağı kanaatindeyiz.
Anahtar Kelime:

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APA Yesil E, Hacimustafaoglu M, Celebi S, Ozer A, düzcan kilimci d, Eren H, Özakın C (2023). Evaluation of Children with Ralstonia pickkettii Bacteraemia. , 20 - 27. 10.5578/ced.20239904
Chicago Yesil Edanur,Hacimustafaoglu Mustafa,Celebi Solmaz,Ozer Arife,düzcan kilimci duygu,Eren Hale,Özakın Cüneyt Evaluation of Children with Ralstonia pickkettii Bacteraemia. (2023): 20 - 27. 10.5578/ced.20239904
MLA Yesil Edanur,Hacimustafaoglu Mustafa,Celebi Solmaz,Ozer Arife,düzcan kilimci duygu,Eren Hale,Özakın Cüneyt Evaluation of Children with Ralstonia pickkettii Bacteraemia. , 2023, ss.20 - 27. 10.5578/ced.20239904
AMA Yesil E,Hacimustafaoglu M,Celebi S,Ozer A,düzcan kilimci d,Eren H,Özakın C Evaluation of Children with Ralstonia pickkettii Bacteraemia. . 2023; 20 - 27. 10.5578/ced.20239904
Vancouver Yesil E,Hacimustafaoglu M,Celebi S,Ozer A,düzcan kilimci d,Eren H,Özakın C Evaluation of Children with Ralstonia pickkettii Bacteraemia. . 2023; 20 - 27. 10.5578/ced.20239904
IEEE Yesil E,Hacimustafaoglu M,Celebi S,Ozer A,düzcan kilimci d,Eren H,Özakın C "Evaluation of Children with Ralstonia pickkettii Bacteraemia." , ss.20 - 27, 2023. 10.5578/ced.20239904
ISNAD Yesil, Edanur vd. "Evaluation of Children with Ralstonia pickkettii Bacteraemia". (2023), 20-27. https://doi.org/10.5578/ced.20239904
APA Yesil E, Hacimustafaoglu M, Celebi S, Ozer A, düzcan kilimci d, Eren H, Özakın C (2023). Evaluation of Children with Ralstonia pickkettii Bacteraemia. Çocuk Enfeksiyon Dergisi, 17(1), 20 - 27. 10.5578/ced.20239904
Chicago Yesil Edanur,Hacimustafaoglu Mustafa,Celebi Solmaz,Ozer Arife,düzcan kilimci duygu,Eren Hale,Özakın Cüneyt Evaluation of Children with Ralstonia pickkettii Bacteraemia. Çocuk Enfeksiyon Dergisi 17, no.1 (2023): 20 - 27. 10.5578/ced.20239904
MLA Yesil Edanur,Hacimustafaoglu Mustafa,Celebi Solmaz,Ozer Arife,düzcan kilimci duygu,Eren Hale,Özakın Cüneyt Evaluation of Children with Ralstonia pickkettii Bacteraemia. Çocuk Enfeksiyon Dergisi, vol.17, no.1, 2023, ss.20 - 27. 10.5578/ced.20239904
AMA Yesil E,Hacimustafaoglu M,Celebi S,Ozer A,düzcan kilimci d,Eren H,Özakın C Evaluation of Children with Ralstonia pickkettii Bacteraemia. Çocuk Enfeksiyon Dergisi. 2023; 17(1): 20 - 27. 10.5578/ced.20239904
Vancouver Yesil E,Hacimustafaoglu M,Celebi S,Ozer A,düzcan kilimci d,Eren H,Özakın C Evaluation of Children with Ralstonia pickkettii Bacteraemia. Çocuk Enfeksiyon Dergisi. 2023; 17(1): 20 - 27. 10.5578/ced.20239904
IEEE Yesil E,Hacimustafaoglu M,Celebi S,Ozer A,düzcan kilimci d,Eren H,Özakın C "Evaluation of Children with Ralstonia pickkettii Bacteraemia." Çocuk Enfeksiyon Dergisi, 17, ss.20 - 27, 2023. 10.5578/ced.20239904
ISNAD Yesil, Edanur vd. "Evaluation of Children with Ralstonia pickkettii Bacteraemia". Çocuk Enfeksiyon Dergisi 17/1 (2023), 20-27. https://doi.org/10.5578/ced.20239904