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ETIOLOGY AND NOSOLOGICAL FORMS OF NOSOCOMIAL INFECTIONS IN
SURGICAL DEPARTMENTS OF HOSPITALS IN FERGANA REGION
Ro‘zaliyev Komiljon Nosirovich
Fergana Medical Institute of Public Health
Fergana, Uzbekistan
Abstract
: In different regions of the Republic of Uzbekistan, indicators of surgical field
infections (SSI) are unevenly distributed. The main part of the etiological factors in the origin of
SSIs is
Staphylococcus aureus, , Eschericha coli, Enterobacter spp., Klepsiella spp., Proteus spp.,
Pseudomonas spp.,
and
Candida, Polymicrobials
. As a result of research conducted in Fergana
region, as of 2023-2024, Staphylococcus aureus, coronavirus infection, and viral hepatitis B and C
were the main factors in the origin of SSIs in surgical departments of regional hospitals. 95.65%
of SSIs are abscesses and 4.35% are nosological forms of suture rupture.
Keywords:
Nosocomial infection, surgical field infection, etiology, nosological forms, antibiotic-
resistant infections, Staphylococcus aureus.
INTRODUCTION
The human skin is a natural barrier against infection. Although there are many precautions and
measures to prevent infections, any operation that disrupts the integrity of the skin can lead to
infection. Doctors call these infections Surgical Site Infections (SSIs) because they occur in the
part of the div where the surgery was performed. If you undergo surgery, the likelihood of
developing an SSI is approximately between 1% and 3% (Surgical Site Infections, Johns Hopkins
Medicine).
According to international data, among adult patients, surgical site infections account for 15-25%
of registered infections, while in the pediatric population, this figure ranges from 2.5% to 20%.
Staphylococci are the main bacteria responsible for surgical site infections (SSIs) after surgery.
Cases caused by
S. aureus
account for 40-60%. Coagulase-negative staphylococci are responsible
in 20-30% of cases. Other etiological agents include
Escherichia coli
,
Enterobacter
spp.,
Klebsiella
spp.,
Proteus
spp.,
Pseudomonas
spp.,
Candida
, and polymicrobial infections (10-40%).
In the etiological structure of SSIs,
S. aureus
predominates (46.5%), followed by
E. coli
(22.2%)
and
S. epidermidis
(16.7%), occupying the second and third places, respectively. Perioperative
antibiotic prophylaxis is considered an effective method for preventing SSIs in pediatric surgery.
Nosocomial infections are a major problem in hospitals worldwide. Understanding the bacterial
etiology and antibiotic susceptibility is a crucial factor in combating nosocomial infections.
According to research conducted by Indonesian scientists, pathogens responsible for infections in
children with nosocomial infections, both antibiotic-sensitive and multidrug-resistant, were
identified. In pediatric wards, nosocomial infections were isolated as follows:
Pseudomonas
aeruginosa
(55%),
Klebsiella
spp. (6%),
Enterobacteriaceae
(4%),
Acinetobacter baumannii
(1%), and
Escherichia coli
(<1%).
The antibiotic susceptibility of nosocomial pathogens to imipenem, amikacin, ciprofloxacin, and
ceftazidime was 86%, 84%, 84%, and 75%, respectively. Significant mortality was observed
among children infected with antibiotic-resistant pathogens.
According to epidemiological studies in Mexico, among children admitted to the neonatal
intensive care unit, the infection rate was the highest, while it was lowest among school-age
children and those admitted to the infectious diseases ward. The most commonly isolated
organisms were
Klebsiella pneumoniae
,
Candida
species, and coagulase-negative staphylococci.
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The mortality rate was higher in children with Gram-negative bacterial infections (45.2%) and
lower in those with Gram-positive bacterial infections (19.2%).
Complications of surgical wound infections can be local or systemic. Local complications include
delayed and untreated wounds, cellulitis, abscess formation, osteomyelitis, and subsequent wound
breakdown. Systemic complications include prolonged hematogenous spread and bacteremia with
the potential for sepsis.
MЕTHОDS
Reports and Statistical Data of the Sanitary-Epidemiological Welfare and Public Health Service
of the Republic of Uzbekistan and Fergana Region (2023-2024). Epidemiological and Statistical
Methods.
RESULTS
According to data from the Fergana Region, in 2023, out of 11 cases of surgical site infections
(SSIs), 8 were confirmed clinically and 3 by laboratory tests. For the year 2023 overall, out of 41
cases of infections, 26 were clinically confirmed and 15 were confirmed by laboratory testing.
The etiological indicators of laboratory-confirmed nosocomial infections for 2023–2024 are
presented below.
In 2023, the highest number of cases were caused by
Staphylococcus aureus
(3 cases). In 2024,
among 15 laboratory-confirmed cases, 8 were caused by
Staphylococcus aureus
, 5 by coronavirus
infection, and 1 case each by viral hepatitis B and C.
This indicates that
Staphylococcus aureus
is the leading etiological agent of nosocomial infections.
It has been confirmed that
S. aureus
is the most common causative agent of nosocomial infections
not only in Fergana region but worldwide. The presence of hospital strains of
S. aureus
resistant
to disinfectants and antibiotics is one of the global challenges faced by healthcare systems.
In Fergana region in 2023, the causative factors of nosocomial infections were as follows:
S.
aureus
accounted for 53.3%, coronavirus infection for 33.3%, and viral hepatitis B and C
infections accounted for 0.067% each.
Absolute numbers of nosological forms of surgical infections in Fergana region for 2023: 23
postoperative infections were recorded, mainly local forms. The most common was abscess with
22 cases, followed by 1 case of wound dehiscence.
According to official statistics, in 2023 in Fergana region, abscesses accounted for 95.65% of
postoperative nosocomial infections, while wound dehiscence accounted for 4.35%. No other
forms were reported.
In recent years, cases of abscess have become more frequent. Improving preventive measures
against surgical site infections (SSIs) in hospitals remains the key solution to this problem.
The complexity of combating hospital infections is determined by their severity, structure, and
dynamics, which result from the influence and interaction of many factors. This necessitates a
comprehensive approach to prevention. Experience accumulated both in our country and abroad
shows that the success of hospital infection prevention largely depends on the effectiveness of
organizational efforts.
DISCUSSION
Surgical site infections cause significant resource damage and lead to morbidity and mortality.
Therefore, numerous general rules and guidelines exist primarily to prevent them. These include
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preoperative skin preparation, maintaining surgical sterility, postoperative and perioperative
prophylactic antibiotics, and wound dressing. Additionally, enhancing the patient’s natural
defense mechanisms, such as early mobilization and improving nutritional status, is important.
For prophylaxis, a safe, narrow-spectrum antibiotic targeting the expected microorganisms should
be used and administered for the shortest effective duration. Antibiotics should be given 30–60
minutes before surgery to ensure therapeutic tissue concentration during the operation. For clean
procedures, antibiotics should cover staphylococci, typically 2 g of cefazolin (adjusted by weight)
or vancomycin 15 mg/kg plus metronidazole, cefoxitin, or ertapenem. Prophylaxis is generally not
recommended for contaminated and dirty procedures, as therapeutic antibiotic management is
required.
Considering the multifactorial nature of hospital-acquired infections, especially surgical site
infections (SSIs), a continuous monitoring system must be established that accounts for all causes
contributing to the intensification of epidemic processes. Such monitoring ensures an
epidemiological surveillance system, which encompasses the dynamics of the epidemic process in
nosocomial infections (incidence, mortality, structure of hospital infections, etc.), disease etiology,
and influencing factors. The spread of nosocomial infections and the results of epidemiological
surveillance form the basis for developing rational control and preventive measures.
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