RESUMEN
Introduction: Clostridioides difficile (C. difficile) infection (CDI) is one of the most common healthcare-associated (HA) infections in contemporary medicine. The risk factors (RFs) for HA CDI in medical and surgical patients are poorly investigated in countries with a limited resource healthcare system. Therefore, the aim of the study was to investigate differences in patients' characteristics, factors related to healthcare and outcomes associated with HA CDI in surgical and medical patients in tertiary healthcare centre in Serbia.Materials and Methods: A prospective cohort study was conducted including adult patients diagnosed with initial episode of HA CDI, first recurrence of disease, readmission to hospital, while deaths within 30 days of CDI diagnosis and in-hospital mortality were also recorded. Patients hospitalized for any non-surgical illness, who developed initial HA CDI were assigned to medical group, whereas those who developed initial HA CDI after surgical procedures were in surgical group. The data on patients' characteristics and factors related to healthcare were collected, too.Results: During 7-year period, from 553 patients undergoing in-hospital treatment and diagnosed with CDI, 268 (48.5%) and 285 (51.5%) were surgical and medical patients, respectively. Age ≥ 65 years, use of proton pump inhibitors, chemotherapy and fluoroquinolones were positively associated with being in medical group, whereas admission to intensive care unit and use of second- and third-generation cephalosporins were positively associated with being in surgical group.Conclusions: Based on obtained results, including significant differences in 30-day mortality and in-hospital mortality, it can be concluded that medical patient were more endangered with HA CDI than surgical ones.
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Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/microbiología , Infección Hospitalaria/diagnóstico , Hospitalización/tendencias , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Cefalosporinas/efectos adversos , Cefalosporinas/uso terapéutico , Clostridioides difficile/efectos de los fármacos , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/mortalidad , Atención a la Salud/economía , Quimioterapia/métodos , Quimioterapia/estadística & datos numéricos , Femenino , Fluoroquinolonas/efectos adversos , Fluoroquinolonas/uso terapéutico , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inhibidores de la Bomba de Protones/efectos adversos , Inhibidores de la Bomba de Protones/uso terapéutico , Factores de Riesgo , Serbia/epidemiología , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
BACKGROUND: The objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA) Clostridium difficile infection (CDI) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital. METHODS: Risk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI. RESULTS: The overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P = 0.007, OR: 10.62, 95% CI: 1.93-58.4), the admission to intensive care unit (P = 0.004, OR:3.00, 95% CI:1.41-6.40), and the administration of 3rd generation cephalosporins (P = 0.014, OR:2.27, 95% CI:1.18-4.39). Patients with HA CDI had significantly higher in-hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84-43.43). CONCLUSIONS: CDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.
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AIM: To review ten-years experience in diagnostics and operative treatment of osteoid osteoma. METHODS: A total of 15 patients were retrospectively analyzed in this study. Clinical diagnosis was based on medical check-up, aspirin test, and conventional laboratory and radiographic examinations. CAT scan radionuclide bone scan, and magnetic resonance were performed in certain cases. All the patients were operatively treated by local resection of the tumor-infested bone. The resected part of the bone was intraoperatively checked by X-ray. The aim of this examination was to verify nidus in the resected bone. Afterwards, the resected bone with nidus was histologically analyzed. RESULTS: Osteoid osteoma was histologically verified in 86.6% of cases. Other forms of bone tumors were verified in 13.3%. In the early postoperative period patients were without previous discomforts. Future treatment consisted of regular medical check-up of all the patients. In order to verify the final results, in February 2002 another medical check-up was performed for 11 patients, upon their consent. All of the patients with verified osteoid osteoma were without discomforts. Medical findings were regular in each case. Conventional radiography showed a solid bone remodelling in place of resected bone. CONCLUSION: Osteoid osteoma is a benign bone tumor with typical clinical and radiographic findings. Operative treatment represents a method of choice and demands accurate preoperative localization of the lesion, with the help of computer-assisted tomography.
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Neoplasias Óseas/diagnóstico , Neoplasias Óseas/terapia , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/cirugía , Adolescente , Adulto , Neoplasias Óseas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoma Osteoide/patologíaRESUMEN
Massive deficiency of acetabular bone stock is a challenging problem in the increasing number of patients who need a revision of the failed hip arthroplasty. Oblong acetabular cup has been presented as an alternative reconstruction technique for hips with extensive acetabular bone loss. The aim of this study was to present our results with the use of a bilobed acetabular component inserted during revisional surgery, to define indications, and to introduce this method into our orthopaedic practice. Seven patients underwent revisional hip arthroplasty with a cementless oblong acetabular component between September 2000 and June 2002. Six patients underwent revisional hip arthroplasty, and in one primary hip arthroplasty by oblong acetabular component was performed because of bone defect of acetabulum after gunshot fracture. The average follow up was thirteen months. Radiographic analysis in all patients demonstrated stable, bone incorporated acetabular component with the restored hip. All the patients walked with full weight bearing and were without pain. On the basis of our experience we find this method satisfactory in certain types of bone defects of acetabulum, and that it provides stable reconstruction of acetabulum with the correction of hip joint.