[A study of the incidence and the specific risk factors for surgical site nosocomial infections]. / Studiu asupra incidentei reale a infectiilor nosocomiale de sediu chirurgical si a factorilor de risc specific.

UNLABELLED: The aim of our study is to estimate the incidence of surgical site nosocomial infections in a general surgery department and also to present the importance of the risk factors associated with these infections using the latest diagnostic protocols. MATERIAL AND METHOD: a retrospective analysis of 3038 surgical procedures performed between 2000-2002. We identified all the patients with surgical site nosocomial infection (SSI) mentioned in the observation sheet using NNISS/HELICS protocols to appreciate the risk for surgical site nosocomial infections. The results were compared to those published in the literature. RESULTS: we selected 198 cases (6,55%) with surgical site nosocomial infections of 3024 surgical patients (we excluded 14 cases): 41.4% of them were superficial infections, 49% profound infections, 7.1% organ-space infections and 2.5% with mixed nosocomial infections. We analysed the incidence depending on the risk factors and the type of surgical procedure, the agents involved in the development of the postoperative nosocomial infections, the germs concerned and their antibiotics resistance. CONCLUSIONS: the rates of different NNISS values after surgical procedures with nosocomial infections are analysed relative to the rates published by HELICS study for Romania and other European countries and it shows larger rates than the european average, maybe because our country has not started yet the HELICS protocol for SSI.

[Septic complications in acute appendicitis. Problems of diagnosis and treatment]. / Complicatiile septice perioperatorii în apendicita acuta. Probleme de diagnostic si tratament.

AIM: diagnostic improvement in complicated acute appendicitis (AA) by implementing the new sepsis concepts and modern imaging procedures; optimization of treatment with decreasing postoperation morbidity and mortality and improving the cost-efficiency indicator. 1495 cases of AA admitted between 2000 and 2004 have been assessed retrospectively and among them 306 (20.46%) had complications. On admission 80.43% patients were diagnosed with AA, 17.50% with acute abdominal syndrome and 2.07% with chronic appendicitis. On discharge there were 1158 (77.45%) cases of inflammatory AA and 306 (20.46%) cases of complicated AA (perforation, gangrene, peritonitis, plastron abscess). TREATMENT: 98.26% of patients under-went operation and 1.73% did not. SURGICAL PROCEDURES: standard appendicectomy in 1407 (95.77%) cases; laparoscopic appendicectomy in 30 (2.04%) cases; extraperitoneal approach in 15 (1.02%) cases; associated with surgical interventions on other organs in 75 (5.10%) cases. POST-OPERATORY MORBIDITY:128 (41.08%) cases out of 306; septic parietal complications in 102 (33.33%) cases; intraperitoneal complications in 26 (8.49%) cases. POST-OPERATORY MORTALITY: 6 deaths in patients aged over 68. AVERAGE LENGTH OF STAY IN HOSPITAL: 4 days for uncomplicated AA and 14.6 days for complicated ones. Perioperative septic complications are the result of evolution of late diagnosed disease, unjustified postponing of operation, surgical technique, patient health condition.