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Çocuk cerrahisi yenidoğan yoğun bakım ünitesinde sağlık bakımı ilişkili enfeksiyonlar ve risk faktörleri

Year 2019, Volume: 44 Issue: Supplement 1, 455 - 468, 29.12.2019

Abstract

Amaç: Bu çalışmanın amacı Çocuk Cerrahisi yenidoğan yoğun bakım ünitesinde tedavi edilmiş hastalarda sağlık bakımı ilişkili enfeksiyon (SBİE) sıklığını, enfeksiyon etkenlerini ve risk faktörlerini araştırmaktır.

Gereç ve Yöntem: Hastalar cinsiyet, doğum şekli, doğum kilosu, gestasyonel yaş, başvuru anındaki yaş, hastanede kalış süresi, ameliyat yapılıp yapılmaması, sepsis gelişimi, TPN (Total parenteral nutrisyon) alımı, toraks tüpü uygulaması, endotrakeal entübasyon, idrar sondası kullanımı, nazal veya oral sonda kullanımı, karın dreni uygulaması, santral kateter uygulaması, oral beslenmeme süresi, laboratuar parametreleri, cerrahi stres dereceleri, yara niteliği yönünden incelendi. 

Bulgular: Düşük doğum ağırlığı, yüksek cerrahi stres derecesi, TPN kullanımı ve süresi, toraks tüpü takılması ve süresi, endotrakeal entübasyon ve süresi, idrar sondası ve süresi, santral kateter, ameliyatlarda karın dreni konulması, nazal-oral sonda süresi ve enteral beslenmesiz geçen sürenin uzaması SBİE için risk faktörü olarak bulundu. SBİE olan hastaların 57’sinde sepsis saptandı, bunların 35’i öldü. 

Sonuç: İnvaziv işlemler ve süresinin azaltılması, hastanede kalış süresinin kısaltılması, salgın şeklindeki mikroorganizmalara özel önlemler alınması SBİE ve buna bağlı ölüm oranlarını düşürebilir.


References

  • 1. Sumathı N, Nalını S. Change in epidemiology of health care-associated infections in a neonatal intensive care unit. The pediatric infectious disease 2002; 21(9):839-842.
  • 2. Srivastava S, Shetty N. Healthcare-associated infections in neonatal units: lessons from contrasting worlds. Journal of Hospital Infection 2007; 65:292-306.
  • 3. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36:309-32.
  • 4. Stoll BJ. Infections of the neonatal infant. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics (18th ed). Philadelphia: W.B. Saunders Company, 2007; 109:794-811.
  • 5. Palazzi DL, Marcy SM, Baker CJ. Bacterial sepsis and menengitis. In: Remington JS, Klein JO, eds. Infectious diseases of the fetus and newborn infant (6th ed), Philadelphia: WB Saunders, 2006; 248-95.
  • 6. Gray JW. A 7-year study of bloodstream infections in an English children’s hospital. Eur J Pediatr 2004; 163:530-5.
  • 7. Aggarwal R, Sarkar N, Deorari AK, Paul AK. Sepsis in the newborn. Indian J Pediatr 2001; 68(12):1143-7.
  • 8. Goldstein B, Giroir B. İnternational pediatric sepsis consensus conference: Definitions for sepsis and organ disfunction in pediatrics. Pediatr Crit Care Med 2005; 6(1):2-8.
  • 9. American Academy of pediarics. Antimicrobial prophylaxis in pediatric surgical patients. Pediatrics 1984; 74:437-9.
  • 10. Madden NP, Agrawal M, Brereton RJ. An audit of postoperative sepsis in a neonatal surgical unit. Pediatr Surg Int 1991; 6:185-9.
  • 11. Tuğtepe H, Uygun İ, Özel K, İskit SH, Dağlı TE. Cerrahi YYBÜ sepsis ve risk faktörleri. Ped Cerrahi dergisi 2002; 16:22-6.
  • 12. Anand KJS, Ansley-Greeen A. Measuring the severity of surgical stress in newborn infants. J Pediatr Surg 1988; 23:297-305.
  • 13. Stoll BJ, Hansen N, Fanaroff AA. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110:285-91.
  • 14. Ovalı F. Bakteryel infeksiyonlar. Dağoğlu T, Ovalı F. Neonatoloji. İstanbul: Nobel Tıp Kitapevleri Ltd, 2007:765-810.
  • 15. Cordero L, Ayers LW, Davis K. Neonatal airway colonization with gram-negative bacilli, Infect Dis J 1997; 16:18-23.
  • 16. Perinatal and neonatal mortality 2006. Global, regional and country estimates. Geneva, World Health Organization, 2004.
  • 17. Korpela JK, Campbell J, Singh N. Healthcare-Associated Infections. In: MacDonald MG, Seshia MMK, Mullett MD. Avery's Neonatology. 6th Edition, Philadelphia Elselvier Saunders, 2005: 1357-83.
  • 18. Jeong IS, Jeong JS, Choi EO. Nosocomial infection in a newborn intensive care unit, South Korea. BMC Infectious Diseases 2006; 6:103.
  • 19. Yapicioglu H, Satar M, Ozcan K, Narli N, Ozlu F, Sertdemir Y, Tasova Y. 6 years prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey. J Paediatr Child Health 2010; 46:337-42.
  • 20. Orsi GB, d’Ettorre G, Panero A, Chiarini F, Vullo V, Venditti M. Hospital-acquired infection survaeillance in a neonatal intensive care unit. Am J Infect Control 2009; 37:201-3.
  • 21. Shankar KR, Brown D, Hughes J, Lamont GL, Losty PD, Lloyd DA, van Saene HKF. Classification and Risk-Factor Analysis of Infections in a Surgical Neonatal Unit. J Pediatr Surg 2001;36:276-81.
  • 22. Wu J, Chen C, Tsao P, Hsieh W, Chou H. Neonatal Sepsis: A 6-Year Analysis in a Neonatal Care Unit in Taiwan. Pediatr Neonatol 2009; 50(3):88-95.
  • 23. Al Jarousha AMK, El Jadba AHN, Al Afifi AS, El Qouqa IA. Nososcomial multidrug-resistant A.baumannii in the neonatal intensive care unit in Gaza City, Palestine. International Journal of Infection Diseases 2009; doi:10.1016/j.ijid.2008.08.029:1-8.
  • 24. Van der Zweet WC, Kaiser AM, van Elburg RM. Nasocmial infections in a Dutch neonatal intensive care unit:surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005; 61:300-11.
  • 25. Tekerekoglu MS, Durmaz R, Ay S, Çiçek A, Kutlu O. Epidemiyologic and clinical features of a sepsis caused by methicillin-resistant Staphylococcus epidermidis (MRSE) in a pediatric intensive care unit. Am J Infect Control 2004; 32:362-364.
  • 26. Ay S, Tekerekoğlu MS, Bayraktar M, Abut L, Duman B. Klinik örneklerden izole edilen Koagülaz negatif stafilokok türlerinde “slime” oluşumu ve antibakteriyallere duyarlılığı. Ankem derg 2002; 16:40-143.
  • 27. Polin RA, Saiman L. Nosocomial infections in the Neonatal Intensive Care Unit. Neo Revievs 2003; 4:81-89.
  • 28. Todd JK. Staphylococcus. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics (18th ed). Philadelphia: W.B. Saunders Company, 2007; 180:1123-1130.
  • 29. Oliver NC, Blake RK, Steed LL, Salgado CD. Risk of vancomycin-resistant Enterococcus (VRE) bloodstream infection among patients colonized with VRE. Infect Control Hosp Epidemiol 2008; 29(5):404-409.
  • 30. Huang Y, Zhuang S, Du M. Risk factors of nosocomial ınfection with Extended-Spectrum Beta-Lactamase-Producing bacteria in a neonatal ıntensive care unit in China. Infection 2007; 35(5):339-345.
  • 31. Marija T, Barisic IG, Punda-Polic V. Prevalence and antimicrobial resistance of extended-spectrum β-lactamases-producing Escherichia coli and Klebsiella pneumoniae strains isolated in a university hospital in Split, Croatia. Int Microbiol 2005; 8(2):119-124.
  • 32. Park KY, Jung S, Park KH et all. Independent emergence of colistin-resistant Acinetobacter spp. İsolates from Korea. Diagnostic Microbiyology and Infectious Disease 2009; 64:43-51.
  • 33. Li J, Rayner CR, Nation RL, Owen RJ, Spelman D, Tan KE. Heteroresistance to Colistin in Multidrug-Resistant Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy 2006; 50:2946-2950.
  • 34. Fanaroff AA, Korones SB, Wright LL Verter J, Poland RL, Bauer CR, Tyson JE, Edward W. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network. Pediatr Infect Dis J 1998; 17:593-8.
  • 35. Perlman SE, Saiman L, Larson EL. Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 2007; 35(3):177-182.
  • 36. Mussi-Pinhata MM, Nascimento SD. Neonatal nosocomial infection. Jornal de Pediatria 2001; 77:81-96.
  • Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, Fanaroff AA, Lemons JA, Donovan EF, Oh W, Stevenson DK, Ehrenkranz RA, Papile LA, Verter J, Wright LL. Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network. Journal of Pediatrics 1996; 129(1):72-80.
  • 38. Stoll BJ, Hansen N, Fanaroff AA, Wrihgt LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh W, Bauer CR. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002; 110:285-91.
  • 39. Brodie SB, Sands KE, Gray JE, Parker RA, Goldmann DA, Davis RB, Richardson DK. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J 2000; 19:56-65.
  • Yeung CY, Lee HC, Huang FY, Wangs CS.. Sepsis during total parenteral nutrition: exploration of risk factors and determination of the effectiveness of peripherally inserted central venous catheters. Pediatr Infect Dis J 1998; 17:135-42.
  • 41. Geffers C,Baerwolff S, Schwab F, Gastmeier P. Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. Journal of Hospital Infection 2008; 68(3):214-221.
  • 42. Oldfield MM, El-Masri MM, Fox-Wasylyshyn SM. Examining the association between chest tube-related factors and the risk of developing healthcare-associated infections in the ICU of a community hospital: A retrospective case-control study. Intensive and Critical Care Nursing 2009; 25:38-44.
  • 43. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-analysis. Clinical Infectious Diseases 2004; 39:206-217.
  • 44. Pinhata MMM, Nascimento SD. Neonatal nosocomial infections. Journal of pediatr (Rio J) 2001; 1:81-96.
  • 45. Auriti C. Maccallini A, Di Liso G, Di Ciommo V, Ronchetti MP, Orzalesi M. Risk factors for nosocomial infections in a neonatal intensive-care unit. Journal of Hospital Infection 2003; 53:25-30.
  • 46. Stoll BJ, Gordon T, Korones SB, Shankaran, J. Tyson, C. Bauer, A. Fanaroff, J. Lemons, E. Donovan, W. Oh. Late onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development neonatal Research network. J Pediatr 1996; 129:63-71.

Health care related infections and risk factors in neonatal intensive care unit of pediatric surgery

Year 2019, Volume: 44 Issue: Supplement 1, 455 - 468, 29.12.2019

Abstract

Purpose: The purpose of this study is to investigate the infectious agents, risk factors and prevalance of the healthcare-associated infections (HAIs) in patients treated at surgical neonatal intensive care unit. 

Materials and Methods: Patients were examined for application date, sex, mode of delivery, birth weight, gestation age, age at admission, hospital stay, hospitalization at another center, the provinces they come, surgery, developement of sepsis, use of TPN (Total parenteral nutrition), application of chest tube, endotracheal intubation, urinary catheter use, nasal or oral catheter use, application of abdominal drains, central catheter application, oral feeding time, laboratory parameters, degree of surgical stress and the nature of wounds. 

Results: Low birth weight, prior hospitalisation at another center, high degree of surgical stres, TPN use and duration, chest tube application and duration, endotracheal intubation and duration, urinary catheterisation and duration, central cathetery, application of abdominal drains at surgery, duration of nasal-oral catheterisation and the duration of nonenteral feding were found as risk factors of HAIs. Sepsis was detected at 57 of HAIs patients and 35 of them died.

Conclusion: Decreasing the number and duration of invasive procedures, shorten the duration of hospital stay, special measures for the epidemic microorganisms can reduce the HAIs and the related deaths.


References

  • 1. Sumathı N, Nalını S. Change in epidemiology of health care-associated infections in a neonatal intensive care unit. The pediatric infectious disease 2002; 21(9):839-842.
  • 2. Srivastava S, Shetty N. Healthcare-associated infections in neonatal units: lessons from contrasting worlds. Journal of Hospital Infection 2007; 65:292-306.
  • 3. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36:309-32.
  • 4. Stoll BJ. Infections of the neonatal infant. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics (18th ed). Philadelphia: W.B. Saunders Company, 2007; 109:794-811.
  • 5. Palazzi DL, Marcy SM, Baker CJ. Bacterial sepsis and menengitis. In: Remington JS, Klein JO, eds. Infectious diseases of the fetus and newborn infant (6th ed), Philadelphia: WB Saunders, 2006; 248-95.
  • 6. Gray JW. A 7-year study of bloodstream infections in an English children’s hospital. Eur J Pediatr 2004; 163:530-5.
  • 7. Aggarwal R, Sarkar N, Deorari AK, Paul AK. Sepsis in the newborn. Indian J Pediatr 2001; 68(12):1143-7.
  • 8. Goldstein B, Giroir B. İnternational pediatric sepsis consensus conference: Definitions for sepsis and organ disfunction in pediatrics. Pediatr Crit Care Med 2005; 6(1):2-8.
  • 9. American Academy of pediarics. Antimicrobial prophylaxis in pediatric surgical patients. Pediatrics 1984; 74:437-9.
  • 10. Madden NP, Agrawal M, Brereton RJ. An audit of postoperative sepsis in a neonatal surgical unit. Pediatr Surg Int 1991; 6:185-9.
  • 11. Tuğtepe H, Uygun İ, Özel K, İskit SH, Dağlı TE. Cerrahi YYBÜ sepsis ve risk faktörleri. Ped Cerrahi dergisi 2002; 16:22-6.
  • 12. Anand KJS, Ansley-Greeen A. Measuring the severity of surgical stress in newborn infants. J Pediatr Surg 1988; 23:297-305.
  • 13. Stoll BJ, Hansen N, Fanaroff AA. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110:285-91.
  • 14. Ovalı F. Bakteryel infeksiyonlar. Dağoğlu T, Ovalı F. Neonatoloji. İstanbul: Nobel Tıp Kitapevleri Ltd, 2007:765-810.
  • 15. Cordero L, Ayers LW, Davis K. Neonatal airway colonization with gram-negative bacilli, Infect Dis J 1997; 16:18-23.
  • 16. Perinatal and neonatal mortality 2006. Global, regional and country estimates. Geneva, World Health Organization, 2004.
  • 17. Korpela JK, Campbell J, Singh N. Healthcare-Associated Infections. In: MacDonald MG, Seshia MMK, Mullett MD. Avery's Neonatology. 6th Edition, Philadelphia Elselvier Saunders, 2005: 1357-83.
  • 18. Jeong IS, Jeong JS, Choi EO. Nosocomial infection in a newborn intensive care unit, South Korea. BMC Infectious Diseases 2006; 6:103.
  • 19. Yapicioglu H, Satar M, Ozcan K, Narli N, Ozlu F, Sertdemir Y, Tasova Y. 6 years prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey. J Paediatr Child Health 2010; 46:337-42.
  • 20. Orsi GB, d’Ettorre G, Panero A, Chiarini F, Vullo V, Venditti M. Hospital-acquired infection survaeillance in a neonatal intensive care unit. Am J Infect Control 2009; 37:201-3.
  • 21. Shankar KR, Brown D, Hughes J, Lamont GL, Losty PD, Lloyd DA, van Saene HKF. Classification and Risk-Factor Analysis of Infections in a Surgical Neonatal Unit. J Pediatr Surg 2001;36:276-81.
  • 22. Wu J, Chen C, Tsao P, Hsieh W, Chou H. Neonatal Sepsis: A 6-Year Analysis in a Neonatal Care Unit in Taiwan. Pediatr Neonatol 2009; 50(3):88-95.
  • 23. Al Jarousha AMK, El Jadba AHN, Al Afifi AS, El Qouqa IA. Nososcomial multidrug-resistant A.baumannii in the neonatal intensive care unit in Gaza City, Palestine. International Journal of Infection Diseases 2009; doi:10.1016/j.ijid.2008.08.029:1-8.
  • 24. Van der Zweet WC, Kaiser AM, van Elburg RM. Nasocmial infections in a Dutch neonatal intensive care unit:surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005; 61:300-11.
  • 25. Tekerekoglu MS, Durmaz R, Ay S, Çiçek A, Kutlu O. Epidemiyologic and clinical features of a sepsis caused by methicillin-resistant Staphylococcus epidermidis (MRSE) in a pediatric intensive care unit. Am J Infect Control 2004; 32:362-364.
  • 26. Ay S, Tekerekoğlu MS, Bayraktar M, Abut L, Duman B. Klinik örneklerden izole edilen Koagülaz negatif stafilokok türlerinde “slime” oluşumu ve antibakteriyallere duyarlılığı. Ankem derg 2002; 16:40-143.
  • 27. Polin RA, Saiman L. Nosocomial infections in the Neonatal Intensive Care Unit. Neo Revievs 2003; 4:81-89.
  • 28. Todd JK. Staphylococcus. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics (18th ed). Philadelphia: W.B. Saunders Company, 2007; 180:1123-1130.
  • 29. Oliver NC, Blake RK, Steed LL, Salgado CD. Risk of vancomycin-resistant Enterococcus (VRE) bloodstream infection among patients colonized with VRE. Infect Control Hosp Epidemiol 2008; 29(5):404-409.
  • 30. Huang Y, Zhuang S, Du M. Risk factors of nosocomial ınfection with Extended-Spectrum Beta-Lactamase-Producing bacteria in a neonatal ıntensive care unit in China. Infection 2007; 35(5):339-345.
  • 31. Marija T, Barisic IG, Punda-Polic V. Prevalence and antimicrobial resistance of extended-spectrum β-lactamases-producing Escherichia coli and Klebsiella pneumoniae strains isolated in a university hospital in Split, Croatia. Int Microbiol 2005; 8(2):119-124.
  • 32. Park KY, Jung S, Park KH et all. Independent emergence of colistin-resistant Acinetobacter spp. İsolates from Korea. Diagnostic Microbiyology and Infectious Disease 2009; 64:43-51.
  • 33. Li J, Rayner CR, Nation RL, Owen RJ, Spelman D, Tan KE. Heteroresistance to Colistin in Multidrug-Resistant Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy 2006; 50:2946-2950.
  • 34. Fanaroff AA, Korones SB, Wright LL Verter J, Poland RL, Bauer CR, Tyson JE, Edward W. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network. Pediatr Infect Dis J 1998; 17:593-8.
  • 35. Perlman SE, Saiman L, Larson EL. Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 2007; 35(3):177-182.
  • 36. Mussi-Pinhata MM, Nascimento SD. Neonatal nosocomial infection. Jornal de Pediatria 2001; 77:81-96.
  • Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, Fanaroff AA, Lemons JA, Donovan EF, Oh W, Stevenson DK, Ehrenkranz RA, Papile LA, Verter J, Wright LL. Early-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network. Journal of Pediatrics 1996; 129(1):72-80.
  • 38. Stoll BJ, Hansen N, Fanaroff AA, Wrihgt LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh W, Bauer CR. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002; 110:285-91.
  • 39. Brodie SB, Sands KE, Gray JE, Parker RA, Goldmann DA, Davis RB, Richardson DK. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J 2000; 19:56-65.
  • Yeung CY, Lee HC, Huang FY, Wangs CS.. Sepsis during total parenteral nutrition: exploration of risk factors and determination of the effectiveness of peripherally inserted central venous catheters. Pediatr Infect Dis J 1998; 17:135-42.
  • 41. Geffers C,Baerwolff S, Schwab F, Gastmeier P. Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. Journal of Hospital Infection 2008; 68(3):214-221.
  • 42. Oldfield MM, El-Masri MM, Fox-Wasylyshyn SM. Examining the association between chest tube-related factors and the risk of developing healthcare-associated infections in the ICU of a community hospital: A retrospective case-control study. Intensive and Critical Care Nursing 2009; 25:38-44.
  • 43. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-analysis. Clinical Infectious Diseases 2004; 39:206-217.
  • 44. Pinhata MMM, Nascimento SD. Neonatal nosocomial infections. Journal of pediatr (Rio J) 2001; 1:81-96.
  • 45. Auriti C. Maccallini A, Di Liso G, Di Ciommo V, Ronchetti MP, Orzalesi M. Risk factors for nosocomial infections in a neonatal intensive-care unit. Journal of Hospital Infection 2003; 53:25-30.
  • 46. Stoll BJ, Gordon T, Korones SB, Shankaran, J. Tyson, C. Bauer, A. Fanaroff, J. Lemons, E. Donovan, W. Oh. Late onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development neonatal Research network. J Pediatr 1996; 129:63-71.
There are 46 citations in total.

Details

Primary Language Turkish
Subjects Surgery
Journal Section Research
Authors

Ahmet Gökhan Güler 0000-0003-4740-3512

Recep Tuncer This is me 0000-0003-4670-8461

Hilmi Serdar İskit This is me 0000-0002-6576-2618

Murat Alkan This is me 0000-0001-5558-9404

Ünal Zorludemir This is me 0000-0002-0113-3396

Cemal Parlakgümüş This is me 0000-0002-3691-5929

Zerrin Özçelik This is me 0000-0003-3728-0846

Publication Date December 29, 2019
Acceptance Date August 9, 2019
Published in Issue Year 2019 Volume: 44 Issue: Supplement 1

Cite

MLA Güler, Ahmet Gökhan et al. “Çocuk Cerrahisi yenidoğan yoğun bakım ünitesinde sağlık bakımı ilişkili Enfeksiyonlar Ve Risk faktörleri”. Cukurova Medical Journal, vol. 44, 2019, pp. 455-68.