[Risk of increase in nosocomial infections incidence in a surgical clinic. A case-control study].
The complex activities of epidemiological surveillance of nosocomial infections (NI) have, among the main objectives, the identification of the causes and the assessment of risk factors. In 2002, the Clinic Hospital of Pneumology Iasi had 220 beds and was divided into the following units: Pneumophtisiology Unit (PPU), Thoracic Surgery Unit (TSU) and Intensive Care Unit (ICU). The global incidence of NI was of 0.85%. The incidence of cases with NI in the TSU and ICU increased to 5.39% in the interval April-June 2002 so that urgent epidemiological measures were applied to limit the phenomenon. After that, a case-control study was proposed in order to identify and assess the risk levels. The retrospective study met the methodological conditions such as case definitions for NI and post-surgical NI, for extrinsic and intrinsic risk factors, the selection of cases according to inclusion and exclusion criteria, the formation of the representative sample. The study included 16 patients with pleural NI and 55 controls with the pleurotomy performed between April-June in the TCU, as a common feature. The factors that increased the probability of a post-surgical NI development were: the external pleural drainage maintained more than 30 days (OR = 185.5; p < 0.0001 for CI = 95%), tuberculosis as the most important associated disease among the patients' pathological history records (OR = 28.0; p < 0.0001; CI = 95%); the antibiotherapy with multiple associations (OR = 3.30; p < 0.04; CI = 95%). The conclusions underlined that the patients suffered from tuberculosis since the very admission, which need pleurotomy have an increased risk to develop a NI. This fact should require an appropriate epidemiological, clinical and microbiological surveillance and the empirical antibiotic strategy or that conducted by the antibiogram results has to be performed adequately, according to the operative recommendations.
Azoicăi
Doina
D
Catedra de Epidemiologie, Facultatea de Medicină, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi.
Corcaci
Doina Carmen
DC
Mitrofan
C
C
Ivan
A
A
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology*; D004654:Empyema, Tuberculous / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D005260:Female; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery