RESUMEN
Healthcare-associated infections (HAIs) occurring in patients treated in an intensive care unit (ICU) are serious complications in the treatment process. Aetiological factors of these infections can have an impact on treatment effects, treatment duration and mortality. The aim of the study was to determine the prevalence and microbiological profile of HAIs in patients hospitalized in an ICU over a span of 10 years. The active surveillance method was used to detect HAIs in adult patients who spent over 48 h in a general ICU ward located in southern Poland between 2007 and 2016. The study was conducted in compliance with the methodology recommended by the Healthcare-associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC). During the 10 years of the study, 1849 patients hospitalized in an ICU for a total of 17,599 days acquired 510 with overall HAIs rates of 27.6% and 29.0% infections per 1000 ICU days. Intubation-associated pneumonia (IAP) posed the greatest risk (15.2 per 1000 ventilator days), followed by CLA-BSI (8.0 per 1000 catheter days) and CA-UTI (3.0 per 1000 catheter days). The most common isolated microorganism was Acinetobacter baumannii (25%) followed by Coagulaase-negativ staphylococci (15%), Escherichia coli (9%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (7%), Candida albicans (6%). Acinetobacter baumannii in 87% and were classified as extensive-drug resistant (XDR). In summary, in ICU patients pneumonia and bloodstream infections were the most frequently found. Acinetobacter baumannii strains were most often isolated from clinical materials taken from HAI patients and showed resistance to many groups of antibiotics. A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed.
Asunto(s)
Acinetobacter baumannii/aislamiento & purificación , Infecciones Relacionadas con Catéteres/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía Asociada al Ventilador/epidemiología , Infecciones Urinarias/epidemiología , Acinetobacter baumannii/fisiología , Infecciones Relacionadas con Catéteres/microbiología , Infección Hospitalaria , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Incidencia , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Persona de Mediana Edad , Neumonía Asociada al Ventilador/microbiología , Polonia/epidemiología , Pseudomonas aeruginosa/aislamiento & purificación , Factores de Riesgo , Infecciones Urinarias/microbiologíaRESUMEN
INTRODUCTION: Patients in the intensive care units (ICU) are exposed to many factors that may cause hospital acquired pneumonia (HAP), a particular type of which is ventilator-associated pneumonia (VAP). The specific risk factors for developing VAP affect patients already on the day of their admission to a unit and are associated with their underlying diseases and invasive medical procedures, which they undergo. The aim of this study was to evaluate the risk factors for VAP associated with a patient and the used invasive treatment. MATERIAL AND METHODS: 1227 patients were subject to the retrospective analysis. These patients were hospitalized between 2010 and 2014 in Intensive Care Unit (ICU) in the St. Luke District Hospital in Tarnów. Data about procedures used in ICU were obtained from the electronic hospital registration system and the decursus from each day when a patient stayed in the hospital, while information about hospital infections was obtained from the periodic department reports prepared by the Infection Control Team. In the diagnosis of VAP infections the definitions of nosocomial infections issued by CDC (Centers for Disease Control and Prevention) and ECDC (European Center for Disease Prevention and Control) were used. RESULTS: In the analyzed unit, 58 cases of VAP were detected in patents who underwent mechanical ventilation. Infections were more common among men (43 cases, that is 6%) than in women (15 cases, that is 3%). Mechanical ventilation longer than 20 days was a major determinant of VAP (p < 0.001). Patient's underlying diseases (which are the reason for patient's admission to a unit) had an impact on the incidence of VAP, and the most important of them are: multiple trauma (20 cases of VAP per 217 patients (9.2% incidence)), sepsis (3 cases of VAP per 31 patients (9.7% incidence)), central nervous system disease (10 cases of VAP per 124 patients (8.1% incidence)), endocrine system (1 case of VAP per 12 patients (8.3% incidence)), respiratory diseases (11 cases of VAP per 168 patients (6.5% incidence)). Invasive medical procedures performed in the patients' respiratory tract were significant risk factors (p < 0.001) for developing VAP: reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316). In the period from 2010 to 2014 VAP incidence was 4.7% and incidence density per 1000 ventilation-days was 10.5 and the mortality rate with VAP was 32.8%. The most common etiological factors of VAP were Acinetobacter Baumannie (21 isolates, that is 36.4%), Pseudomonas aeruginosa (8 isolates, that is 13.8%), Escherichia coli (7 isolates, that is 12%).
Asunto(s)
Infección Hospitalaria/epidemiología , Unidades de Cuidados Intensivos , Neumonía Asociada al Ventilador/epidemiología , Respiración Artificial/efectos adversos , Infección Hospitalaria/diagnóstico , Femenino , Humanos , Incidencia , Masculino , Neumonía Asociada al Ventilador/diagnóstico , Polonia/epidemiología , Prevención Primaria/organización & administración , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: This article aimed at evaluating the incidence and distribution of healthcare-associated (HAI) gastroenteritis (GE) in patients hospitalized on paediatric ward in St. Lukas Provincial Hospital in Tarnów. INTRODUCTION: Gastroenteritis remains a common manifestation of healthcare-associated infections on paediatric wards. In Poland, there are limited data on the proportion of healthcare-associated GE in the epidemiology of healthcare-associated infections. It was decided to present the incidence and etiology of these infections in a 7 year study period. METHODS: For the purpose of this study, standard definitions of healthcare-associated infections issued by the European Centre for Disease Prevention and Control (ECDC) were adopted. Cumulative incidence rates and incidence density rates were calculated. RESULTS: A total of 11,966 records of children hospitalized in 2007-2013 were subject to analysis. In this period, 251 healthcare-associated gastroenteritis cases of viral etiology were identified. For these infections, cumulative incidence rate (CIR) and incidence density rate (IDR) were 2.11% and 3.37/1,000 person-days, respectively. GE was most frequently reported in children aged less than 2 years (average - 1.6, SD - 2.1). Average hospitalization of a child who was not diagnosed with healthcare-associated GE was 6.2 days while for GE case it amounted to 11.2 days. GE was equally present in girls and boys, i.e. 2.1%. Rotavirus-induced GE was the most commonly diagnosed (GE-RV - Rotavirus Gastroenteritis). Such virus was identified in 189 children (CIR - 1.58%, IDR - 2.51/1,000 person-days). Rotavirus GE was followed by concomitant infections with rotaviruses and adenoviruses. A total of 12 patients were diagnosed with such co-infection (CIR - 0.10%, IDR - 0.16/1,000 person-days). Infections caused by adenoviruses (GE-AV - Adenovirus Gastroenteritis) occurred in 7 patients (CIR - 0.06%, IDR - 0.09/1,000 person-days). For 43 (17%) children, etiological agents of healthcare-associated GE were not determined. SUMMARY: Rotaviruses were the most commonly identified etiological agents of healthcare-associated gastroenteritis on paediatric ward. Children aged less than 2 years were those most frequently affected.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Enfermedades Gastrointestinales/epidemiología , Distribución por Edad , Niño , Preescolar , Infecciones por Clostridium/diagnóstico , Infecciones Comunitarias Adquiridas/epidemiología , Femenino , Enfermedades Gastrointestinales/microbiología , Unidades Hospitalarias/estadística & datos numéricos , Hospitales Generales/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Polonia/epidemiologíaRESUMEN
INTRODUCTION: In the ethology of inflammations within the head and neck area, odontogenic ethology still plays an important role. Early recognition, diagnosis and management of odontogenic infections are requisites for avoiding or minimizing the development of potential complications. THE AIM OF THE STUDY: The aim of this study was to retrospectively analyze the clinical presentation, surgical management and cost implications of patients treated for odontogenic inflammations of head and neck area at the Department of Otolaryngology in the Regional Hospital in Tarnów in last 5 years. MATERIALS AND METHODS: The study was based on medical documentations of 65 patients, 34 males and 31 females between the age of 16-83 years. RESULTS: Despite common accessibility of wholesome education and dental prevention, a lot of patients disregard their disorders. That's why treatment of odontogenic inflammations is often difficult and prolonged. The authors reveal a cost burden in a public health care as a result of odontogenic inflammations.
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Infección Focal Dental/complicaciones , Cabeza/fisiopatología , Inflamación/diagnóstico , Inflamación/etiología , Cuello/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inflamación/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Gastrointestinal system infection (GI) is an infection which is frequently acquired in health- care settings. In Poland, there are limited data on the distribution of gastrointestinal system infections in the epidemiology of healthcare-associated infections (HAIs). Therefore, a study was initiated with the objective to assess the prevalence and distribution of healthcare-associated gastrointestinal system infections in patients hospitalized in St. Lukas Provincial Hospital in Tarnów. MATERIALAND METHODS: Data of 297,545 patients hospitalized in 2004-2013 were subject to analysis. Standard epidemiological methods and unified definitions of healthcare-associated infections issued by the European Centre for Disease Prevention and Control (ECDC) were employed in the analysis. RESULTS: A total of 944 healthcare-associated gastrointestinal system infections were indentified in the material analyzed. In a 10-year observation of HAI prevalence, GIs predominated over other HAIs registered in St. Lukas Provincial Hospital in Tarnów. Cumulative incidence rate (CIR) and incidence density rate (IDR) for GIs were 0.35% and 0.57/1,000 person-days, respectively. Infections with Clostridium difficile (GI-CDI), also referred to as C. difficile-associated diarrhoea (CDAD) were diagnosed in 301 patients. For GI-CDI, CIR and IDR were 0.11% and 0.18/1,000 person-days, respectively. Gastroenteritis excluding CDI (GI-GE) was identified in 643 patients with CIR and IDR amounting to 0.24% and 0.39/1,000 person-days, respectively. Gastroenteritis of rotavirus (CIR - 0.11% and IDR - 0.18/1,000), adenovirus (CIR - 0.01% and IDR - 0.02/1,000) and norovirus (CIR - 0.01% and IDR - 0.01/1,000) etiology was identified in 292, 32 and 17 patients, respectively. The highest number of infections was reported in paediatric ward, i.e. 307 persons (32.5%) (CIR - 1.84% and IDR - 2.79/1,000) and internal medicine and nephrology ward - 202 infections (21.4%) (CIR - 1.47% and IDR - 1.66/1,000). CONCLUSIONS: A 10-year observation of healthcare-associated infections showed a change in the distribution of HAIs. In recent years, GIs predominated over all infections acquired in healthcare settings. The most prevalent etiological agent identified was Clostridium difficile.
Asunto(s)
Infecciones por Clostridium/epidemiología , Infecciones Comunitarias Adquiridas/epidemiología , Infección Hospitalaria/epidemiología , Enfermedades Gastrointestinales/epidemiología , Adulto , Causalidad , Niño , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/diagnóstico , Infecciones Comunitarias Adquiridas/diagnóstico , Comorbilidad , Infección Hospitalaria/diagnóstico , Femenino , Enfermedades Gastrointestinales/microbiología , Humanos , Incidencia , Masculino , Polonia/epidemiología , PrevalenciaRESUMEN
THE PURPOSE OF THE STUDY: The purpose of this study was to evaluate the prevalence and structure of surgical site infections in the Department of Orthopaedis - Trauma Unit in Regional Hospital. St. Luke in Tarnow in 2008-2012. MATERIALS AND METHODS: Data analysis included 7189 patients operated in 2008-2012. The data collection and analysis used standard statistical tools and definitions for nosocomial infections issued by the U.S. Centers for Disease Control and Prevention (CDC). RESULTS: In the study group it was 91 cases of SSI (surgical site infection), including 35 patients (38%) with post-operative open reduction of long bone fracture (FX), 16 (18%) with reduction of closed fractures (CR), 15 patients (16%) undergoing hip endoprosthesis (HPRO), 13 (14%) with open reduction surgery of small bones (OR-OTHER), 4 (4%) after knee endoprosthesis surgery (KPRO), and 8 (9%), after treatments of other infections (OTHER). The latter have not been taken into account in the further analysis due to the small number and variety of surgical procedures. The incidence of SSI was for: FX from 2.6 (2008) to 4.1 (2011); CR from 1.2 (2012) 4.8 (2008), HPRO from 0.7 (2012) to 1.3 (2009 r.), OR-OTHER from 0 (2009) to 4.5 (2010); KPRO from 0 (2010-2012) to 2.1 (2009). Among the etiological factors isolated from clinical materials derived from patients diagnosed with infections dominated Gram-positive bacteria, especially Staphylococcus-aureus: HPRO-40%, KPRO-75% FX-46%, OR-OTHER-62%, CR-63%, OTHER -38%. Strains resistant to methicillin (MRSA) were not reported. CONCLUSION: Prevention measures implemented in many areas of the potential impact on risk factors for SSI, has helped to achieve in 2012, the lowest rate of infection for all the analyzed procedures in the last 5 years. Conducting targeted surveillance of surgical site infection keeps morbidity associated with SSI at an acceptably low level and allows for precise planning of the preventive measures in this area.
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Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Ortopedia/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Centros Traumatológicos/estadística & datos numéricos , Adulto , Anciano , Causalidad , Femenino , Hospitales de Distrito , Humanos , Masculino , Persona de Mediana Edad , Polonia/epidemiología , PrevalenciaRESUMEN
OBJECTIVES: The evaluation of effectiveness of implemented actions to limit intravascular catheter-related bloodstream infection rates. INTRODUCTION: We have analyzed actions taken in nineteen wards in the St. Lukas District Hospital in Tarnów. During seven-year study period, from 2005 to 2011, 207 673 hospitalized patients were supervised. A study was done among all patients with peripheral intravenous catheters and central venous catheters. MATERIAL AND METHODS: Standard statistic tools and definitions of nosocominal infections used by US Centers for Disease Control and Prevention were used. Intravascular catheter-related bloodstream infection rates has been calculated by a formula: (number of catheter-related bloodstream infections/number of person-days with catheters) x1000. RESULTS: During the period study, decrease in frequency of occurrence was obtained: venous catheter-related bloodstream infections decreased from 2.8 to 0.4 per 1000 person-days, central venous catheter-related bloodstream infections decreased from 8.9 to 3.0 per 1000 person-days, peripheral intravenous catheter-related bloodstream infections decreased from 0.6 to 0.3 per 1000 person-days. The most common causative agent of venous catheter-related bloodstream infections was in 44% of cases Staphylococcus CNS and in 19% of cases Staphylococcus aureus. CONCLUSIONS: It is possible to significantly decrease intravascular catheter-related bloodstream infection rates by taking preventive actions combined with intensive education of medical personnel.
Asunto(s)
Bacteriemia/epidemiología , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/estadística & datos numéricos , Infección Hospitalaria/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/estadística & datos numéricos , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Hospitales de Distrito/estadística & datos numéricos , Humanos , Incidencia , Polonia/epidemiología , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/prevención & controlRESUMEN
The mechanism driving accumulation of large numbers of apoptotic and necrotic neutrophils in inflamed lateral neck cysts (LNC), in the absence of infection, remains obscure. The cellular content of cysts obtained from 17 patients was co-cultured with human macrophages. Phagocytosis levels of cyst-derived neutrophils were determined and compared to the uptake of spontaneously apoptotic neutrophils. Simultaneously, the expression of cytokines in macrophages exposed to cyst contents was measured. In comparison to spontaneously apoptotic neutrophils, the phagocytosis of LNC-derived neutrophils by macrophages was inefficient. An inverse correlation between neutrophil content in LNC and their uptake was observed. Macrophages co-cultured with cyst contents responded with variable expression of IL-6, TNF-α and IL-10. The hindered clearance of apoptotic neutrophils in LNC may lead to secondary necrosis of these cells and stimulation of the inflammatory reaction. Together with local production of anti-inflammatory cytokines, this may fuel chronic inflammation in the cysts.
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Apoptosis , Quistes/patología , Inflamación/patología , Neutrófilos/patología , Biopsia con Aguja , Células Cultivadas , Enfermedad Crónica , Quistes/genética , Quistes/metabolismo , Citocinas/biosíntesis , Citocinas/genética , Regulación de la Expresión Génica , Humanos , Inflamación/genética , Inflamación/metabolismo , Macrófagos/metabolismo , Macrófagos/patología , Cuello/patología , Neutrófilos/metabolismo , Fagocitosis , ARN Mensajero/biosíntesis , ARN Mensajero/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the occurrence and the structure of nosocomial infections in hospitalized patients, and also to indicate the possibility of lowering the infection rates in the St. Lukas District Hospital in Tarnow. MATERIAL AND METHODS: Data from 207 673 patients hospitalized in the years 2005-2011 have been collected and analyzed using standard statistical tools and definitions of nosocomial infections, issued by the U.S. Centers for Disease Control and Prevention (CDC). RESULTS: The surgical side infections (SSI) were proved to be the most commonly found, with 20% of all infections. There were also frequent bloodstream infections (BSI) 19%, as well as urinary tract (UTI) and gastrointestinal infections (IPP) 18%, while pneumonia (PNEU) appeared to be slightly less common, with 13% of all infections. The other types of infections represented 11%. The infection rates for clean surgical sites per 100 clean procedures were on average 0.7. Subsequently, average amounts per 1000 person-days were as follows: 16.7 for pneumonia (VAP, ventilator-associated pneumonia), 2.4 for catheter-related urinary tract infections (UTI), and 6.2 for bloodstream infections (CLA-BSI, central line-associated). CONCLUSIONS: Knowing the structure of infections is crucial for planning precise and cautious actions aimed at reducing the frequency of nosocomial infections.
Asunto(s)
Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Hospitales de Distrito/estadística & datos numéricos , Humanos , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía/epidemiología , Polonia/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Infecciones Urinarias/epidemiologíaRESUMEN
Standard adenoid swabs were taken from 33 children subjected to adenotomy. The bacterial growth was determined in swabs samples and in homogenates of surgically removed lymphatic tissue. Homogenates were also used for isolation of bacterial DNA. A standard bacteriological examination revealed the presence of Staphylococcus aureus only in 11 children (33%). In stark contrast S. aureus was detected in 20 samples (60%) of homogenized tissue, including all 11 positive swabs specimens. Results of plating were confirmed by molecular test (PCR- polymerase chain reaction). Inconsistent results between swabs and homogenate plating may indicate intracellular localization of S. aureus the tissue of hypertrophic adenoids.
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Tonsila Faríngea/microbiología , Tonsila Faríngea/patología , Enfermedades Nasofaríngeas/microbiología , Staphylococcus aureus/aislamiento & purificación , Tonsila Faríngea/cirugía , Técnicas Bacteriológicas/métodos , Niño , Preescolar , Femenino , Humanos , Hipertrofia/microbiología , Masculino , Manejo de Especímenes/métodosRESUMEN
During the 2001-2003 time period 17 patients with neck lateral cysts were subjected to surgery at the Department of Otolaryngology, Regional Hospital in Tarnów. Collected cysts contents were analyzed with respect to bacterial infection and neutrophil presence as a measure of ongoing local inflammation. All samples were shown being sterile and half of them contained large numbers of neutrophils in advanced apoptosis. The apparent lack of efficient clearance of apoptotic neutrophils may lead to maintenance of the local inflammatory reaction in the neck cysts.
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Apoptosis , Quistes/patología , Cuello/patología , Neutrófilos/patología , Quistes/microbiología , Quistes/cirugía , Humanos , Cuello/microbiología , Cuello/cirugíaRESUMEN
The authors describe a clinical case of extensive olfactory neuroblastoma, comprehensive the nasal cavity, paranasal sinuses and orbit who was treated in Otolaryngology Department of the Regional Hospital in Tarnów. The patient was treated with surgery and radiotherapy without orbit exenteration and the 2--year local progression--free survival was observed. Staging system, diagnostics and therapeutic methods were analyzed. Diagnostic difficulties in olfactory neuroblastoma recognition and value of the immunohistochemical examinations were emphasized.
Asunto(s)
Neuroblastoma/diagnóstico , Neoplasias Nasales/diagnóstico , Neoplasias Orbitales/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Neuroblastoma/patología , Neuroblastoma/radioterapia , Neuroblastoma/cirugía , Neoplasias Nasales/radioterapia , Neoplasias Nasales/cirugía , Neoplasias Orbitales/radioterapia , Neoplasias Orbitales/cirugía , Neoplasias de los Senos Paranasales/radioterapia , Neoplasias de los Senos Paranasales/cirugía , Radioterapia AdyuvanteRESUMEN
51 patients with laryngeal cancer were surgically treated on the ENT Departament of the St Lukas District Hospital in Tarnow between the years 1997-2000. The local advancement was stated as T3 and T4 according to the TNM system. The high grade of tumour differentiation (G1) was established in 13 patients (25.5%), mediam (G2) in 22 (43.1%), and low grade (G3) in 16 patients (31.4%). According to USG examination lymph nodes were estimated as NO in 20 patients (39.2%), as N1 in 21 (41.2%), and as N2 in 10 patients (19.6%). 76 radical and modified radical neck dissections were performed. The presence of lymph node metastases was found in 27 patients (52.9%), in 4 cases there were occult metastases (20% of NO lymph nodes). High rate of metastases was correlated with low (75%) and mediam (54.5%) tumour differentiation grade, and with supraglottic tumour localisation in the larynx (58.6%). 3-year disease-free survival rate was estimated as 58.8%. Poor results of treatment were observed in patients with low grade of tumour differentiation (G3).