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Etiological, clinical-epidemiological and management peculiarities of nosocomial pneumonia at the level of the republican medical institution


Author: Toma Cristina
Degree:doctor of medicine
Speciality: 14.00.26 - Phtisiopneumology
Year:2022
Scientific adviser: Victor Botnaru
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Ion Balica
doctor habilitat, associate professor (docent)
Institution: Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc"

Status

The thesis was presented on the 1 December, 2021
Approved by NCAA on the 1 March, 2022

Abstract

Adobe PDF document – 0.51 Mb / in romanian

Thesis

CZU 616.24-002-02-036.22-08:614.21(043.2)

Adobe PDF document 3.36 Mb / in romanian
179 pages

Keywords

nosocomial pneumonia, antibiotical resistance, multidrugresistant bacteria, prognostic scores, prognostic factors, healthcare-associated pneumonia

Summary

Thesis structure: the thesis is written on 136 pages of main text, which includes introduction, five chapters and conclusions. The manuscript cites 330 bibliographic references, and is illustrated by 61 tables, 11 figures and 2 annexes. The thesis results are published in 22 scientific papers. Domain of study: 321-07 - Phthisiopneumology.

Goal of the research: evaluation of the etiology, clinical manifestations and evolution of nosocomial pneumonia at the level of a tertiary republican medical institution.

Objectives of research: To investigate clinical manifestations and evolution of nosocomial pneumonia at the level of the republican tertiary medical institution; To elucidate etiological structure, antibiotical resistance and to asess the efficiency of the predictive scores for MDR infection in nosocomial pneumonia; To investigate etiological features and antibiotical resistance in secondary in-hospital bacterial infections of the lower respiratory tract in patients with SARS-CoV-2 viral pneumonia; To highlight etiology, clinical manifestations and evolution peculiarities of healthcare-associated pneumonia; To identify prognostic factors for the unfavorable evolution of nosocomial pneumonias and to asess the efficiency of the predictive scores in nosocomial pneumonia.

Novelty and originality of the research: for the first time for the Republic of Moldova, was done an analysis of etiology and antibiotical resistance in NP at the level of the third medical institution; were assesed some prognostic tools of the unfavorable evolution in NP and were assesed some recently developed scores for predicting MDR infection; the etiology and antibiotical resistance in secondary in-hospital bacterial infections of the lower respiratory tract in patients with SARS-CoV-2 viral pneumonia were evaluated.

Scientific problem addressed: the results of the research led to elaboration of a set of practical principles, which allow to focus on subjects at high risk for the unfavorable evolution of the disease and at risk for the multidrug-resistant infection.

Theoretical importance of the research and applied value: the assessment of clinical features and evolution of nosocomial pneumonia allowed to recommend some criteria for selecting cases with high risk of unfavorable evolution of the disease, in order to modify the antibiotical treatment and to ensure the necessary volume of care. The obtained data regarding the etiological structure and antibiotical resistance in this pneumonia, argue the necessity of an control system over the prescription of broad spectrum antibiotics.