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Title:Epidemiološki in mikrobiološki pristopi za spremljanje bolnišničnih okužb v UKC Maribor
Authors:ID Kotnik Kevorkijan, Božena (Author)
ID Rupnik, Maja (Mentor) More about this mentor... New window
ID Klavs, Irena (Comentor)
ID Lejko Zupanc, Tatjana (Comentor)
Files:.pdf DOK_Kotnik_Kevorkijan_Bozena_2019.pdf (2,01 MB)
MD5: 894B08C0EB35E91A1A9B6BC4E6DEE6C6
PID: 20.500.12556/dkum/a788d77c-ff98-41a3-8044-7f143aba8c6e
 
Language:Slovenian
Work type:Doctoral dissertation
Organization:MF - Faculty of Medicine
Abstract:Bolnišnične okužbe (BO) so okužbe, povezane z zdravstveno oskrbo (OPZ), ki nastanejo v bolnišnici in predstavljajo najpogostejši zaplet zdravljenja v bolnišnici. Spremljanje njihove pogostosti se lahko uporablja kot kazalnik kakovosti za bolnišnice. K spremljanju spreminjanja pogostosti BO lahko pristopimo tudi s ponavljajočimi se presečnimi raziskavami BO. Evropski center za preprečevanje in obvladovanje bolezni (angl. European Centre for Disease Prevention and Control, ECDC) vsakih pet let koordinira izvedbo evropske presečne raziskave BO. Leta 2011 smo v Sloveniji opravili drugo Slovensko nacionalno presečno raziskavo BO (SNPRBO II), prevalenčno presečno raziskavo na dan (angl. point prevalence survey - PPS) v okviru evropske prevalenčne presečne raziskave BO. V raziskavi je sodeloval tudi Univerzitetni klinični center (UKC) Maribor. Visoko usposobljena zdravnica za obvladovanje in preprečevanje BO (ZOBO) je v UKC Maribor opravila vzporedno validacijo metode zbiranja podatkov, ki so jih zbrali anketarji v skladu s standardizirano metodologijo zbiranja podatkov, ki jo priporoča ECDC. Preverila je pravilnost zabeleženih podatkov za vse bolnike, pri katerih so anketarji prepoznali BO, in za vsakega petega bolnika, pri katerem anketarji niso prepoznali BO. Ob spremljanju širjenja mikroorganizmov znotraj bolnišnice in prepoznavanju izbruhov je pomembna tipizacija mikroorganizmov, ki so povzročili BO. V UKC Maribor smo se odločili za tipizacijo proti meticilinu odpornih zlatih stafilokokov (angl. Methicillin resistant Staphylococcus aureus, MRSA), saj je spremljanje MRSA obvezni kazalnik kakovosti v slovenskih bolnišnicah. Tipizirali smo tudi bakterijo Clostridium difficile (CD), saj marsikje v zdravstveno razvitih državah CD predstavlja kazalnik kakovosti in povzroča klinično pomembne okužbe. Za MRSA smo uporabili spa tipizacijo, za CD pa ribotipizacijo. Cilji doktorske naloge so vključevali: razvoj modificirane, delovno intenzivnejše metode za validacijo uporabljene »običajne ECDC metode« za prepoznavanje BO v presečni raziskavi (»modificirana ECDC metoda«); ocenili smo prevalence BO ob uporabi »običajne ECDC metode« in »modificirane ECDC metode«, razvite v okviru doktorske naloge; občutljivost in specifičnost »običajne ECDC metode« za prepoznavanje BO v primerjavi z »modificirano ECDC metodo« ter potrebo po nadomestitvi »običajne ECDC metodo« z našo »modificirano ECDC metodo«. Opisali smo značilnosti bolnikov, vključenih v presečno raziskavo, izpostavljenost invazivnim postopkom, BO, izolirane mikroorganizme in odpornost nekaterih mikroorganizmov na izbrane antibiotike ali skupine antibiotikov, ter uporabo antibiotikov. Spremljali smo dva izbrana povzročitelja BO, MRSA in CD, v časovnem obdobju enega leta in ocenili pomen molekularnih tipizacij za prepoznavanje in nadzor BO. V PPS smo vključili 991 bolnikov, to je vse bolnike, ki so bili hospitalizirani v UKC Maribor na dan raziskave. O vsakem smo zabeležili številne podatke, tudi o dejavnikih tveganja za BO, zdravljenju s protimikrobnimi sredstvi in BO. Z obema metodama smo prepoznali 52 bolnikov, ki so na dan raziskave imeli vsaj eno BO oziroma so bili na dan raziskave še vedno zdravljeni zaradi BO. Ustrezna ocena prevalence BO je bila 5,2 % (s 95 % intervalom zaupanja 3,9 % - 6,8 %). Največ BO so imeli bolniki v enotah za intenzivno zdravljenje (EIZ) 25,0 %, na kirurških oddelkih je imelo BO 6,2 % bolnikov, na ginekološkem in porodnem oddelku 4,4 %, na internih oddelkih 3,1 % bolnikov. Z univariatnimi in multivariatnimi analizami smo opredelili neodvisne dejavnike tveganja za BO: prisotnost vsadka v zadnjem letu, prisotnost urinskega katetra, operacija v zadnjih 30 dneh in intubacija. Skupno smo prepoznali 66 BO. Najpogostejše so bile okužbe spodnjih dihal (25 %), okužbe kirurške rane in okužbe sečil. 9 % BO je bilo prisotnih že ob sprejemu bolnika v UKC Maribor, 91 % BO pa je bilo pridobljenih v času aktualne hospitalizacije, največ v obdobju 4.–7. dne po sprejemu. V
Keywords:bolnišnične okužbe, presečna raziskava, prevalenca, proti meticilinu odporen Staphylococcus aureus - MRSA, Clostridium difficile, spa tipizacija, ribotipizacija
Place of publishing:Maribor
Year of publishing:2019
PID:20.500.12556/DKUM-71021 New window
COBISS.SI-ID:303320576  New window
NUK URN:URN:SI:UM:DK:M44ROWR1
Publication date in DKUM:14.01.2020
Views:1926
Downloads:459
Metadata:XML DC-XML DC-RDF
Categories:MF
:
KOTNIK KEVORKIJAN, Božena, 2019, Epidemiološki in mikrobiološki pristopi za spremljanje bolnišničnih okužb v UKC Maribor [online]. Doctoral dissertation. Maribor. [Accessed 13 April 2025]. Retrieved from: https://dk.um.si/IzpisGradiva.php?lang=eng&id=71021
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License:CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Link:http://creativecommons.org/licenses/by-nc-nd/4.0/
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Licensing start date:02.07.2018

Secondary language

Language:English
Title:EPIDEMIOLOGICAL AND MICROBIOLOGICAL APPROACHES FOR HAI SURVEILLANCE AT THE UNIVERSITY MEDICAL CENTER MARIBOR
Abstract:Hospital-acquired infections (HAI) are infections occurring in hospital environment. They are associated with medical care and high complications rates. Monitoring their frequency can be used as a quality indicator for hospitals. Repeated cross-sectional HAI surveys can be applied to monitor the changes in the frequency of HAI. Every 5 years the implementation of a cross-sectional HAI survey is coordinated by the European Centre for Disease Prevention and Control (ECDC). In 2011, the second Slovenian National Cross-Sectional point prevalence survey (SNPRBO II) was conducted as part of a European Point Prevalence HAI study. The University Medical Centre Maribor was taking part in this study, where a high-qualified clinician for the management and control of HAI carried out a parallel validation of data, collected by interviewers in line with a standardized methodology for the collection of data as recommended by ECDC. The accuracy of the recorded data for all HAI patients and for every fifth patient without HAI were checked by qualified clinician. Next to surveillance of micro-organisms spreading in the hospital environment and recognizing outbreaks, characterization of microorganisms (typing) causing HAI also plays a crucial role. At the University Medical Centre Maribor (UKC Maribor), methicillin resistant Staphylococcus aureus (MRSA) typing was used because the surveillance of MRSA is a mandatory quality indicator in Slovene hospitals. Clostridium difficile (CD) was chosen for typing because it is a quality indicator in numerous countries and is currently one of the most important health care associated infections. Spa typing was used for MRSA and ribotyping was used for CD. The objectives of the thesis were the following: to develop a modified, work-intensive method of HAI recognition ("modified ECDC method") in order to validate the applied "usual ECDC method" for recognizing HAI in a cross-sectional HAI survey; to evaluate the HAI prevalence by using the "usual" and the "modified ECDC method" developed in the doctoral thesis; to assess the sensitivity and specificity of the "usual ECDC method" for identifying HAI compared to the "modified ECDC method" and assess the need to replace the "normal ECDC method" with our "modified ECDC method". We described the characteristics of patients involved in the survey, invasive procedures, HAI, exposure to commonly known risk factors for hospital infections, isolated microorganisms, and the resistance of certain microorganisms to selected antibiotics or groups of antibiotics, as well as the use of antibiotics. MRSA and CD were monitored over a period of at least one year and the importance of molecular typing for the recognition and control of HAI was evaluated. The point prevalence study (PPS) included 991 patients, i.e. every patient that was hospitalized at the UKC Maribor on the day of survey. In addition to general data, HAI risk factors, treatment with antimicrobials, and hospital-acquired infections were also recorded. Using both methods, 52 patients with at least one HAI on the day of study were identified or still receiving treatment for HAI on the day of the study. HAIs prevalence was 5.2% (with a 95% CI 3.9%–6.8%). The prevalence of HAIs in ICUs was the highest (25.0%), followed by patients in surgical wards (6.2%), obstetrics/gynecology (4.4%), and departments of internal medicine (3.1%). By using univariate and multivariate analyses, independent risk factors for HAI were defined: implant surgery in the last year, a urinary catheter, patients undergone surgery in the last 30 days and intubation. 66 HAIs were identified in total. The most common were lower respiratory tract infections (25%), surgical wound infections, and urinary tract infections. 9% of HAIs were already present at hospital admission, 91% were acquired during the current hospital stay and the majority was acquired in the period from day 4 to 7 following admittance. Except of one, all HAIs were acquired at
Keywords:hospital-acquired infections, cross-sectional survey, prevalence, methicillin-resistant Staphylococcus aureus – MRSA, Clostridium difficile, spa-typing, ribotyping


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