Niektoré aspekty infekčných komplikácií u pacientov s chirurgickými chorobami. Multicentrická štúdia

SUMMARY
Background: At present postoperative infectious complications are reported worldwide to be the commonest in inpatients at surgical and intensive care units. Based on statistics on the infection control prevention, WHO has raised concerns over a high risk of infectious complications, which may occur following the delivery of health care at any medical settings. According to WHO reports the incidence of infectious complications among patients in high-income countries reaches 7 – 10 %, while in low-income countries, this figure reaches up to 20 %. In recent decades, the etiological structure of postsurgical infectious complications has been remaining almost unchanged. The aim of this study is to identify the leading causative agents of infectious complications in patients with surgical diseases.


Patients and methods: The study involved 137 middle-aged inpatients (mean age – 56 ± 3 years) with post-surgical infectious complications of various localization who underwent the surgeries at the Surgical Department of M. Pirogov Vinnitsa Regional Clinical Hospital for 2007 – 2019. To investigate aerobic and opportunistic anaerobic microflora, samples were collected using sterile cotton swabs from each patient suspected to have infected areas prior the beginning of antibiotic therapy. Statistical analysis of the results obtained was performed by standard software packages “Microsoft Excel 2010” and “IBM SPSS Statistics 22”.
Results: Gram-positive cocci have been found out as the commonest causative agents for postoperative infectious complications in the patients with surgical diseases as evidenced by the isolation rate over 60 % in the samples studied. It should be noted that the overwhelming majority of isolates are constituted by opportunistic microorganisms, representatives of the genus Staphylococcus (n = 45) with the prevalence of coagulase-negative species. Enterococcus spp. cause about 16 % of complications in the patients at the surgical wards. Gram-negative microorganisms have been found out as significantly rarer (35.3 %) compared with gram-positive microorganisms in the patients studied. Non-fermenting gram-negative bacteria were isolated in 34 patients out of 137 patients, and A. baumannii was found as the dominant causative agent of postoperative complications in 27 patients that is 10 times more common than Staphylococcus aureus. P. aeruginosa bacteria and Candida yeast-like fungi were detected to cause infectious complications in the patients with surgical pathology in only 3 % of cases.
Conclusion: Etiological structure of postoperative infectious complications differs depending on the type of complication itself. In cases of abscess, mediastinitis, infectious complications in oesophageal perforations, gram-positive cocci have been found out as a leading etiological factor, while gram-negative microorganisms are the commonest causative agents for phlegmons. Despite the almost unchanged spectrum of the primary causative agents of infectious complications in patients at surgical wards, recently there have been observed some deviations from the conventional etiological structure. Therefore, it is of great clinical importance to monitor and detect even slight changes occurring in the spectrum of microorganisms that cause complications, depending on the types of surgical intervention, its location and some others.
Key words: antibiotics, complications, mediastinitis, phlegmons, post-surgical infection, resistance.
Lek Obz, 2020, 69 (7 – 8): 257-260


Volodymyr SHAPRYNSKYI 1, Oleksandr NAZARCHUK 1, Mariia FAUSTOVA 2, Bohdan MITIUK 1, Dmytro DMYTRIIEV 1, Oleksandr DOBROVANOV 3,4, Karol KRALINSKY 5,6, Yuliana BABINA 1

1 National Pirogov Memorial Medical University, Vinnitsia, Ukraine
2 Ukrainian Medical Stomatological Academy, Poltava, Ukraine
3 A. Getlik Clinic for Children and Adolescents: Slovak Medical University and University Hospital, Bratislava, Slovakia, head doc. MD. K. Furkova, CSc., assoc. prof.
4 St. Elizabeth University of Health and Social sciences, Bratislava, Slovakia, head prof. MD. K. Kralinsky, PhD.
5 2nd Children‘s Clinic of Slovak Medical University, Children Faculty Hospital with Policlinic, Banska Bystrica, Slovakia
6 Faculty of Health Care of Slovak Medical University in Bratislava, based in Banska Bystrica, Slovakia