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spisanie Detski i infektsiosni

Editor:
Central Medical Library ®,
MU - Sofia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Journal "Detski i infectsiosni bolesti" (Pediatric and Infectious Diseases)

ORIGINAL PAPERS

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Vol. 6, 2014

Vol. 6, 2014, № 2

INFECTIOUS DISEASES
ORIGINAL ARTICLES

R. Vatcheva, M. Todorova, R. Filipova, T. Kamenova and I. Ivanov. Nosocomial infections in bulgaria, 1999-2011 – part one - Detski i infectsiosni bolesti, V. 6, 2014, No2, 8-26. (Abstract)

R. Vatcheva, M. Todorova, R. Filipova, T. Kamenova and I. Ivanov. Nosocomial infections in bulgaria, 1999-2011 – part two – etiological characteristics - Detski i infectsiosni bolesti, V. 6, 2014, No2, 27-39. (Abstract)

V. Doycheva, Y. Mitova, S. Angelova and Ts. Mincheva. Epidemiological surveillance of HIV/AIDS in mеn who have sex with mеn and in injecting drug users in Europe and in Bulgaria - Detski i infectsiosni bolesti, V. 6, 2014, No2, 40-48. (Abstract)

 

INFECTIOUS DISEASES
ORIGINAL PAPERS

Nosocomial infections in Bulgaria, 1999-2011 – part one - Detski i infectsiosni bolesti, V. 6, 2014, No2, 8-26.
R. Vatcheva(1), M. Todorova(2), R. Filipova(2), T. Kamenova(2) and I. Ivanov(2)
(1)National Center of infectious and Parasitic Disease,
(2)Ministry of Health
Summary.
Nosocomial infections (NI) represent a serious public health problem because they are characterized by a prolonged hospital stay, difficult treatment due to the multidrug resistance of etiological agents, high mortality, and increased costs for hospital, patients and their families. Usually they affect critically ill patients, with impaired immunity, whose treatment may require invasive procedures or operation. The study presents an analysis in two parts of the officially registered NI in the country by the computerized information system (CIS-NI) in the course of a 13-year period (1999-2011). The system employs two types of indices – incidence rate (morbidity, recalculated in the study per 1000 discharged patients) and percentage distribution (frequency distribution, relative frequency distribution), i.e. the structure by the types of infections and microbial agents. The last actualization that started in 2011 registering ventilator-associated pneumonia (VAP) and the inclusion of additional specialized surgery wards has been reflected. Part One discusses NI total structure in the country and the incidence rate by hospital and wards categories, with accent on pediatric and reanimation wards. The average incidence rate is 10‰ at the following structure of infections: VAP  – 5%, surgical site infections (SSI) and pulmonary infections (the latter including bronchitis, bronchiolitis, pneumonia, non-associated with procedure of endotracheal intubation) of 16-18% each; urinary tract infections (UTI) – 13-15%; sepsis – 4-5%, enteric, skin infections, of the sense organs, intraabdominal and cardiovascular system infections – approximately 2% of each group, endometritis and other gynecologic infections – 1%, mastitis in young mothers – 0,1%. 50-60% оf infections are microbiologically diagnosed and in 40-50% – unconfirmed and not examined microbiologically as a total. The most frequent causative agents are E. сoli and S. aureus (one third of infections) and a number of opportunistic bacterial agents, known for their multidrug resistance: Klebsiella spp., Pseudomonas spp., Acinetobacter spp., etc. The incidence rate of infections ranges within low limits – e.g. pulmonary infections – pediatric wards – up to 3‰; VAP/ pulmonary infections – in reanimations (ARICUs) 15/19‰, Intensive Care Units (ICUs) 5/8‰; UTI – reanimation, urology – 13‰; SSI  – burn units – 38‰, septic surgery – 23‰, vascular surgery – 11‰; sepsis – burn units  – 22‰, reanimation – 8‰, cardiovascular surgery – 6‰, ICUs – 5‰.
Key words: nosocomial infections, computerized information system, ventilator-associated pneumonia, pulmonary infections, surgical site infections, urinary tract infections, sepsis, Anesthesiology, Reanimation & Intensive Care Units, Intensive Care Units
Address for correspondence: R. Vatcheva-Dobrevska, M.D., tel. +359 882 53 95 65; e-mail: rdobrevski@gmail.com

 



Nosocomial infections in bulgaria, 1999-2011 – part two – etiological characteristics - Detski i infectsiosni bolesti, V. 6, 2014, No2, 27-39.
R. Vatcheva(1), M. Todorova(2), R. Filipova(2), T. Kamenova(2) and I. Ivanov(2)
(1)National Center of infectious and Parasitic Disease,
(2)Ministry of Health
Summary.
The study presents the second part of the analysis of nosocomial infections (NI) in the country for the period 1999-2011, relating to the etiological characteristics of the most important infections. On the example of ventilator-associated pneumonia the ten most common microbial species as of CIS-NI were compared to the rank distribution of the National Healthcare Safety Network, USA, 2006-2007, of selected pathogens, associated with NI cases. Both the systems demonstrated similarity in the isolates from tracheal aspirate (bronchoalveolar lavage) in relation to the opportunistic bacteria with confirmed multiresistance as P. aeruginosa (27%, USA – 16%), A. baumannii (29%, USA – 8%), K. pneumoniae, and regarding intestinal bacterial flora – facultative anaerobes: coliforms  (E. coli, Enterobacter spp.), enterococci, fungi, with a higher percentage of S. aureus for USA. The same microbial species are isolated in pulmonary infections, predominantly pneumonia. The basic causative agents of surgical site infections are S. aureus and E. coli (morе than 1/2 оf infections), еnterococci, Acinetobacter spp., Pseudomonas spp., Klebsiella spp., Enterobacter spp., P. mirabilis, Serratia spp.; single  cases of anaerobes (C. perfringens, C. difficile), Candida spp. In septic complications, in more than 1/2 оf the cases it refers to staphylococcal sepsis: S. aureus and coagulase-negative staphylococci. The isolation of the latter is an indirect indicator for catheter-associated bacteremia, infections not included in our system on separate reporting until now. The rest part of cases is related to isolates of the already listed nosocomial pathogens. In urinary tract infections, E.coli isolates are invariably 1/3 оf the cases at increasing relative frequency of еnterococci, Klebsiella spp., an isolation consistently of Pseudomonas spp., Enterobacter spp., P. mirabilis, A. baumannii, Serratia spp. In conclusion, the introduction of criteria, indices and modules at a next stage of CIS-NI actualization is recommended, after the patterns of surveillance systems working with particular details, including control of hospital strains antibiotic resistаnce. The joint analysis of resistance and HAI data would help to improve the system of HAI prevention and control, resistance spread and thereby patients outcome.
Key words: nosocomial infections, etiology, computerized information system, ventilator-associated pneumonia, pulmonary infections, surgical site infections, urinary tract infections, sepsis, Anesthesiology, Reanimation & Intensive Care Units, Intensive Care Units
Address for correspondence: R. Vatcheva-Dobrevska, M.D., tel. +359 882 53 95 65; e-mail: rdobrevski@gmail.com

 

 

Epidemiological surveillance of HIV/AIDS in mеn who have sex with mеn and in injecting drug users in Europe and in Bulgaria - Detski i infectsiosni bolesti, V. 6, 2014, No2, 40-48.
V. Doycheva, Y. Mitova, S. Angelova and Ts. Mincheva
Department of Epidemiology, Medical University – Sofia
Summary: HIV infection is of major public health importance in Europe. In 2011, 53 974 HIV diagnoses were reported by 50 of the 53 countries in the WHO European Region, of which 28 038 were reported by the countries in the European Union and European Economic Area (EU/EEA). The surveillance results suggest that HIV transmission continues in many countries, with an overall rate of 7.6 diagnoses per
100 000 population for the WHO European Region and 5.7 in the EU/EEA. The highest rates are in the East of the Region. The main transmission mode varies by geographical area, illustrating the wide diversity in the epidemiology of HIV in Europe; heterosexual transmission is the main mode of transmission in the entire WHO European Region but sexual transmission between men is the most common mode in the EU/EEA. The number of AIDS cases has continued to decline in many countries, although the number has increased in several countries in the East. In Bulgaria, in 2008 two particularly vulnerable groups affected by HIV infection are outlined – men who have sex with men and the injecting drug users.
Key worlds: Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), men who have sex with men, injecting drug users, epidemiological surveillance
Address for correspondence: V. Doycheva, MD, tel. +3592 952 38 44, e-mail: v.doycheva@abv.bg

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Vol. 6, 2014, № 1

PEDIATRIC DISEASES
ORIGINAL PAPERS

V. Velev, N. Najdenova, N. Darvenjshka, V. Ilchova, I. Tomova, K. Ivanova, A. Mangarov and M. Tiholova. Studies of intestinal campylobacteriosis in children. - Detski i infectsiosni bolesti, V. 6, 2014, No1, 3-6. (Abstract)

B. Naydenova-Stoeva. Bone metabolic markers in patients with cystic fibrosis - Detski i infectsiosni bolesti, V. 6, 2014, No1, 7-15. (Abstract)

G. Markovа and V. Milkova. Predisposing factors for drugs in the life of bulgarian teens - Detski i infectsiosni bolesti, V. 6, 2014, No1, 16-21. (Abstract)


INFECTIOUS DISEASES
ORIGINAL PAPERS

S. Angelova, Y. Mitova, V. Doycheva, Ts. Mincheva and E. Petrova. Main epidemiological findings on the spread of nosocomial infections in Bulgaria (2000-2012)- Detski i infectsiosni bolesti, V. 6, 2014, No1, 45-50. (Abstract)

 

 

 

PEDIATRIC DISEASES

ORIGINAL PAPERS

Studies of intestinal campylobacteriosis in children. - Detski i infectsiosni bolesti, V. 6, 2014, No1, 3-6.
V. Velev(1, 2), N. Najdenova(1, 2), N. Darvenjshka(1, 2), V. Ilchova(2), I. Tomova(2), K. Ivanova(3), A. Mangarov(1, 2) and M. Tiholova(1, 2)

(1)Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical Univerity -- Sofia, (2)Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Iv. Kirov” -- Sofia, (3)National Reference Laboratory of Enteric Pathogens, National Centre of Infectious and Parasitic Diseases -- Sofia
Summary: The aim of the study was to determine the incidence of campylobacteriosis for a specified period and to investigate the clinical characteristics and appropriate approaches to etiological treatment. A total of 62 children with etiologically specified bacterial intestinal infections (ESBII) were diagnosed and treated in the Second Paediatric Ward of the Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Iv. Kirov”– Sofia. The study included all the patients with acute diarrhoea, with abnormal frequency of impurities and over 3 bowel movements per 24 h, for the period from March to.August. 2012. We used clinical, paraclinical and epidemiologic research methods -- blood tests, urine tests and bacteriological methods for etiologic diagnosis. The clinical structure of the intestinal infection and the effect of treatment with antibiotics and probiotics were analysed. Using disk-diffusion method the sensitivity of the strains to commonly used antibiotics in practice was established. Campylobacteriosis are the second most frequent following Shigellosis and represent 32% of the specified ESBII, with Salmonellosis and Esherihiosis succeeding after them. In children, unlike the majority of adults, the disease occurs mainly in a moderate severe form and more rarely in a mild form. The manifestation of colitis is leading -- in 90% of patients, who have bloody diarrhoea, with average 8-10 bowel movements per day in 50% of patients. 75% has abdominal pain, and 85% is with fever. The isolated strains were all sensitive to Erithromicin and Azithromicin, most of them were resistant to aminopenitsilins and Cephalothin (100%), and 80% -- to nelidix acid. Campylobacteriosis is one of the most common diseases among patients hospitalized for acute diarrhoea. Etiological diagnosis is available and highly sensitive. With the early placement of etiological diagnosis the patients can be treated appropriately and avoiding unnecessary polypragmasy with inappropriate antibiotics.
Key words: campylobacteriosis, blood diarrhoea, macrolide, probiotics
Address for correspondence: Valery Velev, M.D., Department of Infectious Diseases, Parasitology and Tropical medicine, Medical University – Sofia

 

 

Bone metabolic markers in patients with cystic fibrosis - Detski i infectsiosni bolesti, V. 6, 2014, No1, 7-15.
B. Naydenova-Stoeva

Pediatric Clinic, UMHAT “Aleksandrovska” -- Sofia
Summary: In the research project, the difference between the processes of bone formation and bone resorption was studied in adolescent patients with cystic fibrosis, compared to healthy controls. In adolescents with cystic fibrosis there was a statistically significant increase in the level of markers of bone formation, probably as a compensatory reaction of the organism to the increased bone resorption in this group (levels of beta-CrossLaps did not differ significantly, compared to controls, however, median levels of beta-CrossLaps were higher). This difference remained constant when only men from the two groups were compared, while no significant differences in the markers of bone formation were found between women. When a comparison between men and women in the patient population was made, men were found to have significant higher median levels of beta-CrossLaps, compared to the median levels in women. The levels of N Mid Osteocalcine and AP were also significantly higher in men, however, the significance was less pronounced. In patients with cystic fibrosis the levels of all bone markers were found to decrease with age, and that was especially evident for N Mid Osteocalcine level. Such age-related decline was not found in the control group. The level of N Mid Osteocalcine positively correlated with the level of AP in the two groups, which comfirms that the increase of AP was due to the elevation of its bone-specific fraction. Moreover, the increase of beta-CrossLaps correlated positively with the increase of N Mid Osteocalcine level.
Key words: cystic fibrosis, bone markers
Address for correspondence: Bozhana Naydenova-Stoeva, M.D., Pediatric Clinic, UMHAT “Aleksandrovska” -- Sofia, e-mail: jany_2005@mail.bg

 

 

Predisposing factors for drugs in the life of bulgarian teens - Detski i infectsiosni bolesti, V. 6, 2014, No1, 16-21.
G. Markovа(1) and V. Milkova(2)

(1)Faculty of Nursing, Medical University -- Pleven, (2)Faculty of Nursing, Medical University -- Pleven
Summary: In Bulgaria, the number of people addicted to drugs exceeds 100 000. The initial age of drug use is less than 15-16 years. The study aims to differentiate predisposing factors for drug in the life of Bulgarian teens. Sociological method -- anonymous group survey of 78 students aged 14-16 years from the „Todor Kirkov“ School -- Lovech, documentary method -- available materials by the National Focal Point for Drugs and Drug Addiction. Statistical data processing was performed with the program StatGrafWin. The results obtained provide information of both the awareness of teens about drugs, their use and the dangers of it and the reasons, due to which drugs are a part of the lives of adolescents.
Key words: drugs, teens, predisposing factors
Address for correspondence: Gergana Markovа, Faculty of Nursing, Medical University -- Pleven, 5800-Pleven

 

INFECTIOUS DISEASES

ORIGINAL PAPERS

Main epidemiological findings on the spread of nosocomial infections in Bulgaria (2000-2012) - Detski i infectsiosni bolesti, V. 6, 2014, No1, 45-52.
S. Angelova, Y. Mitova, V. Doycheva, Ts. Mincheva and E. Petrova

Department “Epidemiology”, Medical University -- Sofia
Summary: Nosocomial infections (NI) are one of the major causes of morbidity and mortality in modern society, not only in the developing, but also in the developed countries. The aim of the study was to outline the trend of distribution of NI in Bulgaria for the period from 2000 to 2012, tracing the main epidemiological indicators -- overall morbidity, the relative share of leading clinical forms and dynamics of etiological structure. The epidemiological analysis used official data from the automated information system "Nosocomial infections". The complex epidemiological method (also including the method of epidemiological analysis) has been employed to process the aforementioned data. For the period from 2000 to 2012, the total morbidity caused by NI in hospitals throughout the country was 12.7‰. The leading clinical form for the entire period is the acute catarrh of the upper respiratory tract -- 31.56%, and the dominant isolates are Coliform bacteria (18.10%) and Staphylococcus aureus (15.17%).
Key words: nosocomial infections, medical facilities, etiological structure, common morbidity, structure in clinical localization, outbreaks
Address for correspondence: S. Angelova, M.D., Department “Epidemiology”, Medical University -- Sofia,
e-mail: a.svetla.angelova@abv.bg

 

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Last update: 21.05.2015