Research Article
Todorova-Christova M, Vatch
Abstract
This second part presents the results of the survey of the microbial isolates frequency distribution by infection sites (principal NI classification groups) in the country throughout the period 1999-2011. The results refer to the overall percentage distribution of the isolates in major NI classification groups (VAP, LRTIs, SSIs, sepsis, UTIs) on the basis of the official registration data of the Computerized Information System-Nosocomial Infections (CIS-NI). The objective was to emphasize the tendencies in the isolation rate of the most frequent nosocomial pathogens for the period studied attempting to propose links for binding the surveillance of NI microbiological diagnostic with the special surveillance of patients undergoing risk procedures as well as a link for monitoring of the drug-resistance. The generalized CIS-NI database for the total country is extrapolated. The predominance of the ten most frequently isolated microbial species is presented in the form of percent from the total number of isolates in the microbiologically confirmed cases for the corresponding infections group (infection site), and for the corresponding year of the period indicated. The microbial characteristics presented mark out in broad outlines the involvement of the most common microbial agents in important for the clinical practice nosocomial infections. The isolates assigned as NI causative agents refer predominantly to strains of S. aureus and E. coli (of substantial importance in SSIs), S. aureus (sepsis), E. coli (UTIs), a number of opportunistic bacteria as Pseudomonas spp., Acinetobacter spp., Klebsiella spp., enterococci, other Enterobacteriaceae as Enterobacter spp. and Serratia spp., Proteus spp. (VAP, LRTIs, sepsis). These species in comparatively constant or in separate years in an increasing percentage are invariably present in the visualized by years microbiological spectrum of the discussed infections groups. The presented microbiologic characteristics emphasizes the necessity of strict implementation of the NI prevention and control measures endorsed, updated guidelines including, in the risk clinical practices as operative/resuscitation procedures and manipulations, installation of vascular devices, urinary catheters, etc., and the care respectively for the patients, undergoing such procedures as preoperative, postoperative care, or attendance in the course of other clinical treatment. Schemes for assessment of the antibacterial resistance based on NHSN pattern are proposed for approbation as well as adapted from external sources e-files intended for supervision of the observance of the correct hospital practices for care of the patients on mechanical ventilation and/or vascular catheter.