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Epidemiology of septic-purulent nosocomial infections at the modern phase ( on the model of Chisinau city)


Author: Angela Paraschiv
Degree:doctor of medicine
Speciality: 14.00.30 - Epidemiology
Year:2006
Scientific adviser: Viorel Prisăcari
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 15 February, 2006
Approved by NCAA on the 27 April, 2006

Abstract

Adobe PDF document0.26 Mb / in romanian

Thesis

CZU 616.981.48-03.2+614

Adobe PDF document 0.82 Mb / in romanian
131 pages


Keywords

septic-purulent nosocomial infections, disease, risk factors, surveillance

Summary

In order to optimize the system of epidemiological surveillance of SPNI was determined the evolution and epidemiological peculiarities of the morbidity through these infections, was estimated the real morbidity, risk factors that contribute to the development of septic-purulent complications and was elaborated the method of prognostication of the appearance of septic-purulent nosocomial complications at the precocious stage.

Real incidence of the SPNI morbidity was determined, on the basis of two hospitalization profiles and represents: in the departments of abdominal surgery 83,16 per 1000 surgical interventions; in the department of multiple and associated traumas – 74,2 per 1000 surgical interventions. On the basis of retrospective survey it was established that more frequently septic-purulent complications are registered among patients with surgical profile, representing 66,3% of the general morbidity.

SPNI structure is determined by the infections of surgery wounds, including the superficial (45,81%) and profound ones (19,90%), followed by the infections of skin and soft tissues (13,29%), reproductive system (12,06%), osteoarticular system (2,53%), inferior respiratory tract (3,9%), cardiovascular system (0,92%), central nervous system (0,76%), eye and ear infections (0,76%).

It was determined a specification of the etiological factor in SPNI depending on the profile of hospitalization. Thus, in the surgical departments prevail gram-negative microorganisms and in trauma departments – gram-positive. Isolated stems manifest resistance to 54,87% of the 33 tested antibiotics, especially to the penicillin group medicines (92,3%).

On the basis of the performed study were determined the risk factors that contribute to the development of septic-purulent complications. For the departments with surgical profile these are the following: old age of the patients, basic diagnosis, presence of concurrent pathologies, way of hospitalization, time of the surgery (8 am- 6 pm), the type and duration of surgical intervention, duration of patients’ stay in the hospital, frequency of dressings, and immunodeficiency of the body.

In the trauma departments the following factors were outlined: patient’s age, way of hospitalization, anatomical-topographical localization of the trauma, type of trauma, presence of concurrent pathologies to the basic diagnosis, duration of post-surgical period, time and duration of the surgical intervention, curative-surgical manipulations carried out during the surgery, duration of stay in the hospital, frequency of dressings in the post-surgical period.

On the basis of the examined factors the most informative factors were established to be the predictive ones in the appearance of septic-purulent nosocomial complications. Thus, in the abdominal surgery departments septic-purulent complications could be prognosticated in 71,95% and in the department of multiple and associated traumas in 76,09 % cases.

On the basis of the obtained results were outlined some optimization directions of the epidemiological surveillance system in septic-purulent nosocomial infections (SPNI) depending on the profile of the department.