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The Epidemiology of Post-traumatic Osteitis and Some Methods of Its Control


Author: Snejana Stoleicov
Degree:doctor of medicine
Speciality: 14.00.30 - Epidemiology
Year:2007
Scientific adviser: Viorel Prisăcari
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Filip Gornea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 25 April, 2007
Approved by NCAA on the 14 June, 2007

Abstract

Adobe PDF document0.27 Mb / in romanian

Thesis

CZU 616.71-002-001-036.22

Adobe PDF document 1.56 Mb / in romanian
119 pages


Keywords

Post-traumatic osteitis, morbidity, risk factors, antibiotics resistance, preventive measures and treatment

Summary

The work represents a study of epidemiology, etiology, prevention and treatment of the post-traumatic osteitis. In the study there were involved 591 patients with post-traumatic osteitis. The etiological structure of post-traumatic osteitis and the antibiotics resistance of the detailed culture of microorganisms were studied on the basis of the conducted standard bacteriological researches with 138 patients.

The epidemiological peculiarities in post-traumatic osteitis are characterized by: affecting able-bodied people aged between 21 – 55 (78, 20 %), infection prevalence in lower extremities traumas (83, 55 %), as well as in closed traumas (74, 15 %), men prevalence in general morbidity (80, 50 %), infection becomes chronic (69, 5%).

In the paper there are reflected the risk factors, which contribute to the growth of post-traumatic osteitis conditional on the type of trauma, the presence of concomitant diseases, the time of patient’s address for medical assistance and the period of carrying out of the primary surgical treatment.

There was ascertained that in 43, 18 % cases, the contamination of the injured area has occurred as a result of a trauma, in 20, 55 % - as a result of surgical interference with an use of metallic structures, in 15, 03 % - during the hospital stay, in 20, 89 % - in routine conditions of life and in 0, 38 % - in an outpatients clinic. The main contamination of the traumatized area in open fractures has occurred mostly in routine conditions of life (85, 86 %), while in closed fractures – within hospital conditions (59, 58 %). The influence of metallic structures usage on the progress of pyo-inflammatory processes was also noticed, especially in closed fractures. More frequently post-traumatic osteitis occurs as a result of Ilizarov equipment usage (25, 86 %) and in osteo-synthesis with stitches (22,22 %), in cento-medullar osteo-synthesis – 19, 19 %, in osteo-synthesis with metallic board - 17, 78 % and in osteo-synthesis with screw - 14, 95 % out of the whole number of patients.

There was determined the etiological structure of post-traumatic osteitis: in 62, 6 % of cases prevails the gram-positive flora, inclusive 75, 0 % of cases – in patients with closed fractures. The gram-negative flora prevails in open fractures – 46, 7 %. Out of detailed microorganisms prevails S.aureus – 36,64%, S.epidermidis – 20,61%, P.aeruginosa – 10,69%, E.coli – 8,40%, P.mirabilis – 7,63%.

There was studied the resistance to 34 antibiotics of the detailed culture of microorganisms. There was ascertained that the greatest resistance is displayed by gram-negative microorganisms (73, 4 %), especially P.vulgaris (90, 3%) and P.aeruginsa (77, 5%). The detailed microorganisms 76, 9 % cases are poly-resistant to antibiotics.

There was proposed a new antibacterial medication “Izohidrafural”, a 0, 05% solution, for the treatment and prevention of post-traumatic osteitis, which is twice or four times more active and nine times less toxic in comparison with its structural analogue – furacillin