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Background/Aim. Hospital-acquired pneumonia (HAP) in a surgical population significantly increases morbidity and mortality, prolongs hospitalization and increases total treatment costs. In the present study, we aimed to determine incidence, in-hospital mortality and risk factors (RFs) of HAP in patients with intra-abdominal surgical procedures hospitalized in a tertiary hospital in Belgrade (Serbia). Methods. Through regular hospital surveillance of patients who underwent intra-abdominal surgical procedures, we prospectively identified postoperative HAP during five years. In the matched case-control study, every surgical patient with HAP was compared with four control patients without HAP. In the group of patients with HAP, those who died were compared with those who survived. Results. Overall 1.4% of all intra-abdominal surgical patients developed HAP in the postoperative period. The incidence of HAP (per 1,000 operative procedures) was greatest in patients undergoing exploratory laparotomy (102.6), followed by small bowel surgery (36.6), and gastric surgery (22.7). Multivariate logistic regression analysis (MLRA) identified three independent risk factors (RF) associated with HAP: multiple transfusion [p = 0.011; odds ratio (OR): 4.26; 95% confidence interval (CI): 1.59–11.33], length of hospital stay (p = 0.024; OR: 1.02; 95%CI: 1.00–1.03) and hospitalization in the Intensive care unit (ICU) (p = 0.043; OR: 2.83; 95%CI: 1.03–7.71). MLRA identified only surgical site infection as an independent RF associated with the poor outcome of HAP (p = 0.017; OR: 5.929; CI95%: 1.37–25.67). Conclusion. The results of the present study are valuable in documenting the relations between RFs and HAP in patients undergoing intra- abdominal surgical procedures.

Introduction/Aim. Intravascular device placement (IVD) is a part of everyday medical practice, however, its application is associated with a high risk of onset of nosocomial infections (NI) and increased mortality and morbidity. Nosocomial blood infections (NBIs) account for 10% of all the registered NI. NBIs are more frequent in patients with a placed IVD and it present an important risk factor for the onset of NBI, i.e. catheter-associated NBIs (CANBIs). Pathogenesis of CANBIs is complex and conditioned by the presence of different characteristics related to a catheter, patient and a specific causative organism. The most common CRBSI causes include coagulase-negative staphylococcus, S. aureus, Enterobacter spp, Candida spp, Klebsiella spp, Pseudomonas spp. and Enterococcus spp. Methods. All the patients hospitalized at the Intensive Care Department of the Clinic of Digestive Diseases over the period January 1, 2004-September 1, 2004 were retrospectively analyzed. The study included 107 patients in whom central venous catheter (CVC) was placed for more than 48 h. All the causes isolated from a CVC segment were recorded. Culture, isolation and identification of the causative organisms were performed using standard microbiological methods in the Bacteriological Laboratory within the Emergency Center, Clinical Center of Serbia. Catheter segment samples (tip of the CVC 3-5 cm long) were analyzed. Based on the insight into medical documentation, patients’ examination and medical staff interview, catheter and patient-related characteristics were recorded. Results. A total of 107 CVCs were analyzed, out of which 56 (52%) were sterile while 51 (48%) were colonized. The results of our study evidenced that total parenteral nutrition (TPN) (p < 0.05), number of catheterization days (p < 0.05), and central venous pressure measurement (p < 0.05) were significantly associated with CVC colonization. In this study, no statistically significant difference in catheter colonization was found with respect to sex, age, anatomical insertion site and CVC placement site. Conclusion. According to the results of our study, TPN, the number of catheterization days and measurement of central venous pressure play major roles in colonization of CVC. Understanding risk factors associated with CVC colonization and onset of CANBIs is a prerequisite for quality preventive work of health professionals.

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Background/Aim. Postoperative urinary tract infection (UTI) is one of the most common infective complications of ureteroscopic lithotripsy. Preoperative asymptomatic bacteriuria is not a contraindication for performing ureteroscopic lithotripsy but it can be a significant risk factor for occurrence of severe forms of postoperative urinary infection. Methods. From January 2010 until December 2014 at the Urology Clinic of the Military Medical Academy in Belgrade, 389 patients undergoing ureteroscopic lithotripsy were analyzed, and their postoperative infective complications were monitored. From the group, the incidence of posteoperative urinary infection was analysed in 52 patients with preoperative asymptomatic bacteriuria. Results. Infective complications occured in 18.7% of patients, and postoperative UTI in 10% of patients. Out of 52 patients with preoperative asymptomatic bacteriuria, 36.5% had postoperative urinary tract infection (χ2 = 46.773; p < 0.001). In these patients, we registered higher frequency of severe forms of postoperative UTI, systemic inflammatory response syndrome (SIRS) and sepsis. Conclusion. Preoperative asymptomatic bacteriuria represents a significant risk factor for developing postoperative UTI following ureteroscopic lithotripsy and is associated with increased risk for occurence of severe forms of SIRS and sepsis. It is desirable that every patient with indicated ureteroscopic lithotripsy has sterile urine culture, and if this is impossible to achieve, a special caution and an adequate antibiotic therapy and prophylaxis are needed before and during the surgical procedure

Background/Aim. Patients in a neurologic intensive care unit (ICU) are especially susceptible to healthcare-associated infections (HAIs). HAIs are cause of significant morbidity and mortality. Aim of this study was to assess the incidence of HAIs, to identify significant risk factors (RFs) and causative microorganisms for HAIs and to identify RFs for inhospital mortality in a neurological ICU. Methods. A prospective cohort study was conducted in the six-bed ICU of the Clinic for Neurology, Military Medical Academy in Belgrade from January 1, 2014 to December 31, 2016. Active surveillance on HAIs was performed by the hospital infection control team, using methodologies of the European Centre for Disease Prevention and Control and the National Healthcare Safety Network/Centres for Disease Prevention and Control. Results. One hundred forty eight patients with a total of 2,708 patient-days were enrolled. There were 49 HAIs in 39 patients during the study period. The incidence and incidence density of HAIs were 26.3% and 18.1 per 1000 patient-days, respectively. The most frequent HAIs were urinary tract infections (15.5%), pneumonia (10.1%) and bloodstream infections (4%). RFs independently associated with HAIs in the neurological ICU were: urinary catheter [risk ratio (RR): 5.6; 95% confidence interval (CI): 1.153–27.632], urinary catheter-days (RR: 1.1; 95% CI: 1.057–1.188), central-line days (RR: 1.1; 95% CI: 1.010– 1.150), and mechanical ventilation (RR: 0.3; 95% CI: 0.079– 0.859). The most common microorganism was Klebsiella spp. RFs independently associated with in-hospital mortality in the neurological ICU were: mechanical ventilation (RR: 6.5; 95% CI: 2.868–14.116), Glasgow Coma Score (RR: 2.7; 95% CI: 1.135–6,396), and age (RR: 1.03; 95% CI: 1.005– 1.055). Conclusion. Usage of invasive procedures during ICU hospitalization carries significant risk for development of HAIs. HAIs in ICU setting are most often caused by Gram-negative bacteria with substantial antimicrobial resistance. These results stress the importance of infection prevention.

Background/Aim. Ureteroscopic lithotripsy is today a safe method of endoscopic destruction of stone in the kidney and ureter with a small number of complications of which the most common is postoperative urinary tract infection. Risk factors for the occurrence of urinary tract infection after the ureteroscopic destruction of stones in the ureter and kidney are not clearly defined in the previous studies. Methods. The study included 389 patients with ureteroscopic lithotripsy and possible risk factors were analyzed: age of the patients, sex, diabetes presence, degree of hydronephrosis, stone size, stone localization, wear of ureteral JJ stent and percutaneous nephrostomy catheter, type of surgical procedure and duration of the operation. The frequency of postoperative urinary tract infection was statistically analyzed in relation to the possible risk factors. Results. Ten percent of the patients had postoperative urinary tract infection. The higher incidence of postoperative urinary tract infection was found in patients with diabetes (χ2 = 22.918; p < 0.001), those who before surgery carried a ureteral JJ stent (χ2 = 4.620; p = 0.040) and percutaneous nephrostomy catheter (χ2 = 8.240; p = 0.004), who had a larger stone (χ2 = -3.301; p = 0.001), and whose surgery lasted longer (t = 4.261; p < 0.001). Conclusion. The frequency of postoperative urinary infection and risk factors for its emergence in our study are in line with the results of studies by other authors. Patients with diabetes, who preoperatively carried JJ stent or a percutaneous nephrostomy catheter, who had large stones and in which the operating time is longer have a greater risk of developing postoperative urinary tract infection. Accordingly, the importance of identifying these patients in the preparation for ureteroscopic lithotripsy contributes to the appropriate preoperative preparation and decreases the frequency of postoperative urinary tract infection to a minimum.

Background/Aim. Chlamydia trachomatis infection (CTI) is an increasing public health problem worldwide and is the most frequent sexually transmitted infection. Studies conducted in many armed forces worldwide showed that CTI is common within military population and generate significant healthcare costs. The aim of this study was to estimate the prevalence of CTI among members of the Serbian Armed Forces (SAF) and to determine risk factors for this infection. Methods. The study was designed as a cross-sectional survey and consisted of completing a questionnaire and chlamydial testing. The questionnaire was divided into two question groups: one was about demographic/service related characteristics and the other was about behavioral patterns/ habits. Chlamydia trachomatis real time polymerase chain reaction (Real-TM PCR) was used for detection of pathogen genome specific sequence in the male urethral swabs and in the female endocervical swabs. All data collected were used to compare military personnel with and without CTI. Risk factors independently associated with CTI were identified by the stepwise multivariate logistic regression analysis (MLRA) of variables selected by the univariate logistic regression analysis (ULRA), with a limit for entering and removing variables from the model at 0.05. Results. The overall prevalence of CTI was 55 of 356 respondents (15.4%; 95% CI 0.5–2.7%). The ULRA identified that CTI was significantly associated with several characteristics: number of sexual partners during previous year (p = 0.008), knowledge about symptoms of CTI (p = 0.035), tattooing (p = 0.035) and married or in stable relationship (p = 0.022). The MLRA revealed that number of different sexual partners during last year was independent risk factor of CTI (p = 0.026; OR : 0.344; 95% CI: 0.13–0.88). Conclusion. CTI is significant problem in male and female military personnel in the SAF. The number of different sexual partners during previous year was independently associated with CTI. These finding indicates that screening for CTI should be undertaken in the SAF, to reduce rates of CTI in the SAF and to prevent morbidity due to this infection.

Background/Aim. Hip fracture remains the leading cause of death in trauma among elderly population and is a great burden to national health services. In-patient death analysis is important to evaluate risk factors, make appropriate selection and perform adequate treatment of infections for patients to be operated. The aim of this study was to analyze in-hospital mortality in proximal femoral fracture patients operatively treated with hip arthroplasty procedure. Methods. We followed 622 consecutive patients, and collected data about age, gender, the presence of infection preoperatively and postoperatively, American Society of Anesthesiologists (ASA) score, diabetes mellitus and the type of surgical procedure. Postoperative infections included pneumonia, urinary tract infections, surgical site infections and sepsis. Results. We found a statistically significant influence of preoperative and postoperative infection presence for in-patient mortality with relative risk for lethal outcome of 4.53 (95% CI: 1.44-14.22) for patients with preoperative infection and 7.5 (95% CI: 1.90-29.48) for patients with postoperative infection. We did not confirm a statistically significant influence of age, gender, ASA score, diabetes mellitus or the type of surgical procedure for increased mortality rate. Conclusion. Adequate preoperative selection, risk evaluation and adequate treatment of infections are of the key importance for lowering the risk of death in patients operated due to proximal femoral fracture and treated by hip arthroplasty procedures. Special attention is to be paid for the presence of preoperative and postoperative infections in patients operatively treated due to the risk for increased in-hospital mortality.

Background/Aim. Melanoma is the most aggresive malignant tumor of the skin. Contradictory data was published on vascular endothelial growth factor (VGEF) in tumor samples and its role in skin melanoma progression and prognosis. The aim of this study was to investigate the significance of VEGF expression as a prognostic parameter in melanoma. Methods. The experimental group included 81 patients with primary skin melanomas treated from 2009 to 2013 at the Military Medical Academy, Belgrade. The control group included 20 patients with dysplastic and 20 with benign naevi. Stratification was done according to gender, age, clinical and patological stage, localization, histologic type, Clark’s, Breslow, mitotic count, regression and ulceration, tumor infiltrating lymphocytes and metastatic spread. Immunohistochemical staining was performed on skin biopsies using DAKO anti-VEGF antibodies (Ab), LSABTM +HRP, Dand microvawe antigen (Ag) retrieval in DAKO pH 9.0 solution. For statistical data analysis was done with ANOVA, Bonferroni, Mann Whitney and Wilcoxon test. Results. The mean intensity of VEGF staining was statistically significantly higher in melanomas than in benign or dysplastic naevi. Furthermore, the highest recorded values were in Ia and IV clinical stages. The majority of melanomas with high intensity of VEGF staining were in pT1a pathological stage. Melanomas with the highest mitotic count (> 6) had a significantly higher intensity of VEGF staining than those with < 2 mitoses. The higest intensity of staining was in melanomas without significant lymphocytic infiltrate and the lowest was in those with brisk lymphocytic infiltrate, thus a statistical difference was siginifant. The mean intensity of VEGF staining was highest in melanomas with lymphovascular invasion. There was no statistically significant difference between VEGF and any other parameter. Conclusion. VEGF in primary skin melanomas plays an important role in tumor progression and is linked to the absence if tumor infiltrating lymphocytes and the presence of lymphovascular invasion. More detailed studies have to be done on VEGF prognostic value in melanoma on a larger number of patients.

Background/Aim. Because patients in intensive care units usually have an urinary catheter, the risk of urinary tract infection for these patients is higher than in other patients. The aim of this study was to identify risk factors and causative microrganisms in patients with catheter-associated urinary tract infection (CAUTI) in the Surgical Intensive Care Unit (SICU) during a 6-year period. Methods. All data were collected during prospective surveillance conducted from 2006 to 2011 in the SICU, Military Medical Academy, Belgrade, Serbia. This case control study was performed in patients with nosocomial infections recorded during surveillance. The cases with CAUTIs were identified using the definition of the Center for Disease Control and Prevention. The control group consisted of patients with other nosocomial infections who did not fulfill criteria for CAUTIs according to case definition. Results. We surveyed 1,369 patients representing 13,761 patient days. There were a total of 226 patients with nosocomial infections in the SICU. Of these patients, 64 had CAUTIs as defined in this study, and 162 met the criteria for the control group. Multivariate logistic regression analysis identified two risk factors independently associated to CAUTIs: the duration of having an indwelling catheter (OR = 1.014; 95% CI 1.005-1.024; p = 0.003) and female gender (OR = 2.377; 95%CI 1.278-4.421; p = 0.006). Overall 71 pathogens were isolated from the urine culture of 64 patients with CAUTIs. Candida spp. (28.2%), Pseudomonas aeruginosa (18.3%) and Klebsiella spp. (15.5%) were the most frequently isolated microorganisms. Conclusions. The risk factors and causative microrganisms considering CAUTIs in the SICU must be considered in of planning CAUTIs prevention in this setting.

Background/Aim. Active surveillance is an important component of surgical site infection (SSI) reduction strategy. The aim of this study was to analyze and compare SSI surveillance data in orthopedic patients in the Military Medical Academy (MMA), Belgrade. Methods. A 4-year prospective cohort study was performed to identify the incidence rate and risk factors for SSI in orthopedic patients in the MMA, Belgrade. We collected data regarding patients characteristics, health care and microorganisms isolated in SSI. The National Nosocomial Infection Surveillance (NNIS) risk index was subsequently calculated for each patient. The Centers for Disease Control and Prevention criteria were used for the diagnosis of SSI. Results. Assessment of 3,867 patients after different orthopedic operations revealed SSI in 109 patients. The overall incidence rate of SSI was 2.8% with the decrease from 4.6% in 2007 to 1.6% in 2010. Using NNIS risk index for surgical procedures there were: 53.7% (2,077) patients with risk 0 - the incidence rate of 1.4%; 38.9% (1,506) patients with risk 1 - the incidence rate of 3.1%; 7.3% (281) patients with risk 2 - the incidence rate of 11.7%; 0.1% (3) patients with risk 3 - without infection within the risk. Multivariate logistic regression analysis identified 6 independent risk factors associated with SSI: contaminated or dirty wounds, smoking, preoperative infection, NNIS risk index, body mass index and the length of hospital stay. Conclusion. The results of our study are valuable confirmation of relations between risk factors and SSI in orthopedic patients. A decreasing incidence rate of SSI (from 4.6% to 1.6%) during a 4-year active surveillance approved its implementation as an important component of SSI reduction strategy.

Background/Aim. Millions of soldiers around the world represent one of the most vulnerable populations regarding exposure to human immunodeficiency virus (HIV) infection. The programs for HIV prevention remain the most viable approach to reducing the spread of HIV infection. Very few studies have tested the effectiveness of HIV preventive interventions undertaken in military population. The aim of this study was to determine the effectiveness of educational film to transfer knowledge about HIV infection to soldiers. Methods. We performed a quasi-experimental study among 102 soldiers of the Serbian Armed Forces. The experimental intervention consisted of the HIV knowledge pre-questionnaire, watching a film on HIV knowledge, then the post-HIV knowledge questionnaire. The results of pre-and post-HIV knowledge questionnaires were compared. Results. There were 23 questions in the test. The average total score on the questionnaire before watching the film was 18.23 and after watching it was 20.14, which was statistically significant difference (p < 0.001). Conclusions. The results of the study show that viewing a film on HIV infection is an effective method of transferring knowledge about HIV to the Serbian military population.

Introduction. Among the most important causes of diarrhea in modern hospitals is Clostridium difficile (C. difficile). A wide spectrum of diseases caused by this bacterium is now known as C. difficile associated disease (CDAD). The development of CDAD is usually preceded by the administration of antimicrobial therapy and fecal-oral infections with C. difficile. Over the last years epidemiology of CDAD has significantly changed. Recently, a hypervirulent BI/NAP1/027 strain, the cause of severe epidemics in North America and Western Europe, has been identified. Objective. The aim of this study was to identify risk factors for CDAD in patients operated on at the Military Medical Academy (MMA). Methods. The study included all patients who underwent surgery at the MMA during 2010. Nested case-control study design was used. The subjects were divided into groups of operated patients with and without CDAD. The patients were under prospective follow-up, while their data were collected using a questionnaire during a routine epidemiological control. Results. During 2010 the incidence rate of CDAD was 3.3 per 10,000 hospital days. Univariate regression analysis showed that the length of administration of one or two antibiotics, as well as concurrent administration of two antibiotics, were far more frequently observed in the patients with than in the patients without CDAD. Independent risk factor for the development of CDAD was the length of the administration of one antibiotic. Conclusion Reduction in the incidence rate of CDAD can be achieved by using reliable measures of prevention and control; the rational use of antibiotics, early diagnosis and therapy of infected patients, contact isolation of infected persons, proper disinfection, and continued education of medical and non-medical personnel.

Background/Aim. Military personnel is a population group at special risk of exposure to sexually transmitted diseases (STD). In peacetime, STD infection rates among service members are generally 2 to 5 times higher than among civilian population. In time of conflict, the differences can be 50 or more times greater. This study describes sexual behavior as a risk factor for STD in the Armed Forces of Serbia. Methods. The sample of 5 617 voluntary blood donors from the Armed Forces of Serbia gave blood and filled World Health Organization Questionnaire about sexual behavior within January 2007 - December 2008 period. The mandatory testing of voluntary blood donors was performed in the Institute of Transfusiology Military Medical Academy in Belgrade, by the specific immunoenzyme tests and polymerasa chain reaction tests for HIV, hepatitis B, C and syphilis. Statistical analysis of data was done using State for Windows 93, USA, 1996. Results. We identified 36 soldiers with some form of STDs. This study showed that 1 668 (29.7%) tested soldiers reported always using condoms, 1 725 (30.72%) almost always, 1 238 (20.04%) sometimes, 495 (8.81%) almost never and 490 (8.73%) never. Among the sample, 449 (7.99%) soldiers reported sexual contacts with partners with high risk of sexual behavior, whilst 22 (0.37%) of them reported homosexual and bisexual contacts. Conclusion. This study reported STDs found in voluntary blood donors among the service members of the Armed Forces of Serbia, but none of them was identified to be HIV positive. Soldiers with the most frequent risk behavior were reported to be those with inconsistent condom use. In the future, the STD Control and Prevention Program should be more intensively conducted among the members of the Armed Forces of Serbia.

Background/Aim. Acinetobacter spp. has emerged as nosocomial pathogen during the past few decades in hospitals all over the world, but it has increasingly been implicated as a serious nosocomial pathogen in military hospitals. The aim of this study was to analyze and compare the surveillance data on Acinetobacter nosocomial colonization/infection (NCI) collected during the wartime with the data collected in peacetime. Methods. We conducted a prospective study of incidence of Acinetobacter spp. colonization/ infection. Also, the two nested case-control studies were conducted. The patients with nosocomial infection (cases) were compared with those with nosocomial colonization (controls) during the two different periods, wartime and peacetime. The patients with NCI by Acinetobacter spp. were identified by the case-based surveillance. The surveillance covered all the patients in 6 surgical clinics. Results. During the study periods a total of 166 patients had cultures that grew Acinetobacter spp. and the pooled rates of Acinetobacter spp. colonization and infection were significantly higher in wartime. When patients with NCI in wartime were compared with those with NCI in peacetime significant differences were observed. In the war year, the patients were more significantly males (p < 0.000). In a period of peace, most of the colonization/infections were reported from patients with certain chronic diseases (p = 0.020) and the survival of patients was more significant (p = 0.049). During the peacetime, proportions of Acinetobacter isolates resistent to ciprofloksacin, imipenem and meropenem were significantly higher (p < 0.001). Conclusion. This study provides additional important information about the risk factors of nosocomial Acinetobacter spp. infections in a large cohort of surgical patients. This is also the first study that directly examines epidemiological differences between NCI caused by Acinetobacter spp. during the war and peace period.

Background/Aim. Nosocomial bloodstream infections (BSI) contribute to grater morbidity and mortality rates, as well as to increasing length of hospital stay and health care costs. All patients with nosocomial BSI identified during the one-year period were studied to identify microbiological factors associated with these infections. Methods. A one-year prospective cohort study was performed in patients in intensive care units (ICU), and non- ICU patients. The patients were identified by active surveillance and positive blood cultures during the study period. The definitions of nosocomial BSI of the Center for Diseases Control and Prevention, Atlanta were used. Hospital laboratory detected growth in blood cultures, identified organisms, and performed susceptibility testing were in according with the American National Committee for Clinical Laboratory Standards. Results. The incidence of nosocomial BSI was 2.2 per 1 000 admission in non-ICU and 17.4 per 1 000 admission in ICU patients. The 28- day crude mortality rate was 44.9%. There were 60.3% primary nosocomial BSI. Gram-negative organisms accounted for 50%, gram-positive organisms accounted for 44.9%, and 4.1% were caused by fungi. The most common pathogens were coagulasenegative staphylococci (21.4%), Staphylococcus aureus (14.3%), Klebsiella spp. (13.3%), Pseudomonas aeruginosa (8.2%), Acinetobacter spp. (7.1%). Methicillin resistance was detected in 64.3% of S.aureus and 100% of coagulasa-negative staphylococci. Vancomycin resistance in enterococci and staphylococci was not deteced. The proportion of ceftazidim resistance among K.pneumoniae isolates was 92%. Conclusion. This study might help to better understanding not only the characteristics of BSI, but also the featares of their causes, primarily the resistance of coagulase-negative staphylococci and S. aureus to methicillin, and of K. pneumoniae to ceftazidime.

Surveillance based on laboratory findings of bacteria isolated from hospitalized patients is an important activity in epidemiologic surveillance of nosocomial infections. It provides the insight into the circulation and management of some causative agents of nosocomial infections in hospitals which facilitates defining of proper measures for the prevention and suppression of nosocomial infections caused by these agents. The aim of this study was to analyze and compare surveillance data collected in Military Medical Academy (MMA) during June 1999 (the period of war) and June 2000 (the period of peace). Isolation frequency of bacteria that were the most common agents of nosocomial: Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Acinetobacter spp. and Enterococcus spp., was monitored in patients from 5 various surgical wards of MMA. In the war period, the increase of number of isolates of all these bacteria was registered, but the increase of isolated Acinetobacter spp. was the most significant. The total number of isolates was greater in June 1999 in comparison to June 2000. Most isolates were recovered from wound cultures when the increased number of Enterococcus spp. Methicillin-resistant Staphylococcus aureus isolated from the blood was registered. In the period of peace isolates of Pseudomonas aeruginosa manifested reduced resistance to quinolones, imipenem and 3rd generation cephalosporins. Barrier infection control measures are necessary in preventing nosocomial transmission particularly in the wartime. Thus, preventive medicine is important for performing efficient surveillance, and suggesting the adequate measures for prevention and repression of nosocomial infections, particularly in the period of war.

Purpose: To investigate the incidence and risk factors associated with the development of surgical site infections (SSIs) using the National Nosocomial Infection Surveillance (NNIS)., Methods: A prospective cohort study was conducted at a tertiary health care center. Infection control personnel collected general and health care related data about patients. The NNIS risk index was calculated on the basis of data relating to the operation: wound contamination class, duration of surgery, and the American Society of Anesthesiologists (ASA) score., Results: A total of 5109 surgical procedures were included in the study. The overall cumulative incidence rate was 6.3%. The incidence of SSIs was 2.3% (63.5% of operative procedures), 8.3% (29.7%), 34.6% (6.2%), and 43.3% (0.6%), in patients with 0, 1, 2, and 3 risk index, respectively. The length of hospital stay (OR: 1.0; 95% CI: 1.053-1.075), preoperative length of stay (odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.953-1.981), antibiotic prophylaxis (OR: 2.5; 95% CI: 1.421-4.628), drainage (OR: 1.7; 95% CI: 1.360-2.353), ASA score (OR: 1.5; 95% CI: 1.235-1.946), class of wound contamination (OR: 2.0; 95% CI: 1.745-2.003), and NNIS risk index (OR: 1.3; 95% CI: 1.063-1.7) were independently associated with an increased risk for SSIs. Staphylococcus aureus was the most frequently isolated microorganism, 64% of them being methicillin-resistant., Conclusion: The aim of this study was to investigate the most important risk factors associated with the development of surgical site infections (SSIs). Therefore, greater attention has been given to adherence to recommendations for the prevention and control of SSIs as well as to antibiotic prophylaxis protocols.

Background: Nosocomial bloodstream infections (BSI) create a serious health problem in hospitals all over the world. The objectives of our study were to explore putative disease markers and potential risk factors with nosocomial BSI in patients in intensive care units (ICU) and non-ICU patients and to determine risk factors associated with increased 28-day mortality rate in patients with nosocomial BSI acquired in combined medical-surgical ICU. However, the major purposes of this report were to identify epidemiologic differences between nosocomial BSI acquired in ICU and non-ICU, as well as analyses outcomes for patients with nosocomial BSI acquired in ICU., Methods: A 1-year prospective cohort study was performed to determine the incidence of nosocomial BSI in hospitalized patients. Patient characteristics, risk factors related to health care, and source of infection of patients with BSI acquired in non-ICU were compared with those patient with BSI acquired in ICU. Also, nested case-control study of patients to nosocomial BSI acquired in ICU was performed to evaluate outcome. Patients were identified by active surveillance and positive blood culture during the study period., Results: The incidence of nosocomial BSI was 2.2 per 1000 admission in non-ICU patients and 17.4 per 1000 admission in ICU patients. The 28-day crude mortality rate was 69% in ICU patients. A multivariate model showed that nasogastric tube (RR, 25.1; 95% CI: 3.845-163.85; P=.001), mechanical ventilation (RR, 13.04; 95% CI: 1.974-96.136; P=.008), and H2 blockers (RR, 12.16; 95% CI: 1.748-84.623; P=.012) were more prevalent among patients with BSI acquired in ICU, and aggressive procedures (RR, 8.65; 95% CI: 1.70-44.00; P=.009) were more prevalent among patients with BSI acquired in non-ICU patients. Risk factors independently associated with increased 28-day mortality rate in ICU patients were mechanical ventilation (OR, 8.63; 95% CI: 1.5-49.8; P=.016) and SAPS II >40 (OR, 6.0; 95% CI: 1.0-35.7; P=.049). The most common isolated nosocomial BSI pathogens (in both groups of patients) were coagulase-negative staphylococci (21%), Staphylococcus aureus (14%), and Klebsiella species (13%). Klebsiella species was the only organism independently influencing the poor outcome of nosocomial BSI in ICU patients (OR, 4.3; 95% CI: 1.2-15.3; P=.022)., Conclusions: Our results show epidemiologic differences between non-ICU and ICU BSI. Also, this study suggests that severity of underlying host conditions, mechanical ventilation, and microbial agents (Klebsiella species) affect the outcome of NBI in patients in ICU.