Y Hpc TP. Ho Chi Minh * Tap 18 * So 1 * 2014 Nghien cmi Y hpc
TY LE MAC MC«, TAC NHAN, c m PHI Dlfeu TRI VA YEU TO NGUY CO CUA NHIEM KHUAN VET MO TAX BENH VIEN DA KHOA THONG NHAT
DONG NAI
Nguyen Thanh Hdi', Nguyen Hoang My Le"' TOM
T A TMuc tidi: Muc dich cua nghidi cuu nay xdc dinh iy le mac mdi ciia nhidn khiidii vd mova moi lidi quan ydi to'nguy ccr, tdc nhdn, du phi dieu tri.
Phucmg phdp: ehung toi mo td doc 2520 benh nhan phau thudt, tai ca bdih nhan nay thuoc 5 loai phdu thugt: Nidi, Tidi hoa, Chdn thutmg chinh hinh, Sdn phu Idioa, Lidi chuydi khoa. Chdn dodn nhidn Miuan vd mo dua tieu chuan ciia Trung tdm kidn sodt va phbng ngua bddi Hoa Ky (CDC). Diing Mo hinh hdi quy logistic, phep kiem Fisher hay Chi binh phumig dexd moi tuang quan.
Kft qud: ti-ong so 2520 benh nhdn khao sdt ty le nu:nam Id Z,S:l va tuoi trung binh 34, tuoi nho nhdt Id 15 cao nhdt Id 99. Ty le nhiem Ihuah vd mo'diung Id 6,07% (153/2520), trong do nhiem khuan vd mo'nong diian 4,5% (114/2520), nhidn khuah vd mo sau 1,5% (32/2520), nhiim kliudn co quan 0,27% (7/2520). PMn tich da hen cho thay rang ydi to nhom tuoi, benh mqn tinh, hut thuoc, chi sd'dumig huyd, thang didn ASA, chi so'bach cau, logi phdu thuat vd chi so khoi (BMI) lidi quan vdi nhidn khuan vd movdi p < 0,01, phan tich dan biai mot vdi yeu tolidi quan vai nhiem khuan vd movdi p < 0,01 nhu. Klioa, gidi tinh, thai didn pMu thugt, dii sobadi cdu, chi so'NNIS, then gian nam -vidi tiung binh cua bdih nhan nhidn khuan vd mold 9,9 ngdy ddi hem so vdi bdih nhan khong nhidn kliudn vd mo (5,2 ngdy). Tdc nhdn phdn lap thudng gap nhdi la Staphylococcus aureus A1RSA+ (18,95%, 18/95); Esdierichia coU (15,79%, 15/95) vd chi phi didi tii tdng.
Kei luan: Ty lemacmdi ciia nhiem kinidn vel mo Id 6,07%, phdig ngiea nhidn khuan vet mo'cdn gidm sdt tich cue vd can thiep ldm thay dot yeu to' nguy ca. Tdc nhan gdy benh phdn lap nhieu nhdt Id vi khuan Staphylococcus aureus (MRSA+), Escherichia coli vd chi phi dieu tri tdng.
Tic khoa: ydi to'nguy ca, nhidn khuan vd mo.
A B S T R A C T
INCIDENCE, PATHOGENS, TREATMENT COSTS AND RISK FACTORS OF SURGICAL SITE INFECTION IN THONG NHAT-DONG NAI GENERAL HOSPITAL
N g u y e n T h a n h Hai, N g u y e n H o a n g My Le
* Y H o c TP. H o Chi M i n h * Vol. 18 - N o 1 - 2014:203 - 208
Purposes- The aim of this study zoas to determine the inadence of Surgical site infections (SSI) and assodated nsk factors, pathogais and tieatment costs.
Methods: We prospectively collected data of 2520 patiaits operated, all patiaits have operated in five categories of surgical procedures: Urologic; gastrantestinal; Trauma-orthopedic; obstetric and gynecdogic and Department of The multi spedalty The Centasfor Disease Control and Prevention (CDC) criteria are used for diagnosis of SSI. logistic regression model, Fisher's exact or dii-squared tests were used for categorical Comparisons.
Results: Among 2520 surgical hospitalizations in the sample, the female:male ratio was 2.3:1 and the mean
* Phong Quan ly chat lirgng Benh vien DK Thong Nhat Dong Nai
Tdc gia lien lac: BS.Nguyen Thanh Hai DT: 0913.610602 EmaiL n^venthanhJiain9@'yahoo.com,vn
Hoi Nghi Khoa Hpc Ky Thuat BV, Binh Dan 2014 203
Nghien cmi Y hpc Y Hpc TP. Ho Chi Minh * Tap 18 * So 1 * 2014
age at presaitation uvs 34 \/cars old (SD 13.9), age arangefrom 15 to 99.153 cases of SSI iivre idaitped 6.07%
(153/2520, There zvere 4.5% (11412520) Superficial hidsioiml SSI. 1.3% (3212520) deep Indsional SSI and 017^/o (7/2520) Organ Space SSI In multiple logistic regression analysis, thefollmoingfiidors zvere indepaident ri^ fadors for tlie deodopmait of SSI (p < 0.01): age, diroiiic disease, smoking, blood glucose, ASA score, white blood cell count, surgical zoound dass. Body mass index BM, factors assodated mth SSI found by univariate analysis (p < 0.01) indiuied Department gaider.tlie time of surgery, zdiiie blood cell count, NNIS risk index, hospital stay of patiaits xoith SSI was extaidcd by an average of 9.9 days compared to patiaits zoitlwut SSI (5.2 days) (p < 0.01). The most common organism isolated zvere Staphylococcus aureus MRSA+ (18.95%, 18/95);
Escherichia coh (15.79%, 15/95) and increased costs of treatmait.
Conclusions: The Inadence of Surgical site infections was accounted for 6.07%, prevention of SSI should indude active survdllance and interventions targding modifiable risk fiidors. The most common organism isolated uvre Staphylococcus aurais (MRSA-*-), Esdieridiia coli and mcreased costs oftreatinait
Key -words: risk fadors. Surgical site infedimis.
DATVANDE
Nhiem khu&i benh vien (NKBV) hien dang la van de hue xue, duoc dac biet quan tam khong chi 6 cac nuoc phat trien ma con la uu tien hang dau doi voi cac nuoc dang phat trien. NKBV la van de het siic nhay cam, la chi so chat luong b^nh vi?n. Ngay nay, giam ty le NKBV dang la mot thach thuc th|t su doi voi cac nha quan ly b?nh vi^n"^").
Hi#n nay, nhiem khuah vet mo la mpt trong nhung loai nhiem khuah thuong gap o benh vi?n va la moi lo ngai trong dieu tri ngoai khoa do thoi gian dieu tri keo dai, cham hoi phuc, ton kem hen bac va co nguy co tir vong cao. Tai cac nuoc dang phat trien nhu Viet Nam, nhiem khuan vet mo dung hang ttiu hai sau viem phoi b?nh vi^n. Nhieu nghien ciiu cho thay co nhieu yeu to lien quan deh nhiem khuan vet mo va vi^c can thiep vao cac yeu to do co the lam giam t)' le nhiem khuan vet mo.
Nghien cuu hieu qua kiem soat cua nhiem khuah benh \'ien (SENIC) cho thay rSng 6% ciia NKBV CO the ngan ngua duoc b^ng nhiing bien phap can thi^p toi thieu nhu (kiem soat tieu duong, thuoc la, beo phi.. .f^l
Kiem soat nhiem khuan benh vi#n trong Enh vi^ ngogi khoa nham dam bao cac dieu kien an toan cho phlu thuat va lam giam t>- le nhiem khuah vet mo la uu tien hang dau 6 cac benh
vien. Do do, chiing toi tien hanh nghien cuu de tai nay nham muc dich tim hieu j'eu to nguy co Clia NKVM, tu do trieh khai chuong trinh kiem soat nhiem khuah thich hpp.
Muc tieu tong quat
Xac dinh ty le nhiem khuah vet mo va moi lien quan voi cac yeu to nguy ca.
Muc tieu cu the
- Xac dinh ty le mac mdi nhiem khuah vet mo (NKVM) sau phau thu|t tai Benh vien Da khoa Thong Nhat Dong Nai.
- Xac dinh moi lien quan giiia ty le NKVM va mot so yeii to nguy co: tuoi, gjdi, loai phau thuat tinh trang Iiic phau thuat, khang sinh du phong, thoi gian phau thuat,...
- Xac dinh ty le tac nhan gay NKVM thuang gap va tinh khang thuoc.
- Chi phi >' te trong NKVM va khong NKVM.
DOITTJtJNG-mUtJNGIWAPNGHIENaJll Dan sd chpn mau
Benh nhan phau thuat tai 5 Khoa (San, Ngoai CTCH, LCK Ngoai Ni#u, Ngoai Tong Quat) aia benh vien Da khoa Thong Nhat Dong Nai tir 6/8/2012 den 06/9/2012 va tir 5/3/2013 den 5/5/2013.
Phirong phap nghien cmi Mo ta doc.
Y Hpc TP. Ho Chi Minh * Tap 18 * Sd 1 * 2014 Nghien cihi Y hpc
KET QUA VA BAN LUAN D^c diem ehung
Oiling toi nghien cuu 2520 b^nh nhan phau thuat (so benh nhan tham gia bao hiem 53,73%), trong do nir chiem ty le 69,37%, ty le niinam = 2,3:1. Tudi trung binh la 34 tudi (SD 13,9), tudi nho nhat la 15 tuoi. Ion nhat la 99 tuoi. Khoa San chiem da so 49,68% ke den la Khoa Ngoai Tdng quat 21,94%, Khoa CTCH 14,88%, Khoa LCK 9,4%, it nhat la Khoa Ngogi Nieu 4,09%. Phau diugt cap cuu la 71,2%, phau thuat npi soi 18,1%, b$nh nhan dimg khang sinh chiem ty 1^ cao 99,96% (01 Ioai khang sinh chiem ty 1^ 28,45%, 02 loai khang sinh 66,03%, 03 logi 4,92%, 04 loai tro len chiem 0,6%), ty le diing khang sinh dif phong thap chiem ty le L27%.
Tudi trung binh benh nhan trong nghien cuu chiing toi la 34 tuoi (SD 13,9), tuoi tre va da sdnii la phii hop vdi die thii cua b?nh vien Da khoa Thdng Nhat Ddng Nai, do benh nhan san nhgp vien sinh va md nhieu 6 lua tudi sinh nd. Ty le diing khang sinh chiem 99,96%, cao hon mpt sd tac gia nhu Le Thi Uen {2004)<"') la 87,29%, Nguyin Vi?t Himg (2009) 99,3%. Ngupc lai, ty 1?
dimg khang sinh du phong a nghien cuu nay la 1,27% thap so vdi tac gia Nguyen Viet Hiing (2009)('«1 34,7%. Trong khi dd khang sinh dy phong dupe nhieu nghien cuu chiing minh cd hi?u qua trong vi^c phong ngira NKVM nhu tac gia Mai Phuong Mai'"', Burkef" va To chiic Y te thegidit").
Ty Ie mac mai n h i l m k h u ^ vet mo, loai nhiem khuan vet md
Ty le mdc mai nhihn khuan vet mo Theo nghien ciiu ehung toi, ty le mac mdi nhiem khuah vet md chiem 6,07% phii hpp tac gia Kieu Chi Thanh'^-'i trong khi cac tac gia khac ty \% nay tir 2,2 - S,4%'-^^-\
Phdn loai nhihn khuan vet ino
Trong nghien aiu nay, ty 1^ nhiem khuan vet md nong chiem da so vdi 4,5%, ke den la nhilm khuah vet md sau la 1,3%, it nhat la nhiim
khuan co quan chiem 0,27%. Trong khi do cac tac gia ty le NKVM nong (1,6 - 6,2)i"-'), ty le NKVM sau (0,36 - 0,64)'^'*'; ty le nhiem khuan co quan theo tac gia Ho VP (2011)''' la 9,85%.
Mdi lien quan mpt sd yeu to nguy co va NKVM
Moi lien quan giiia cdc Klwa vd nhiein khuan vet mo
Theo nghien ciiu nay, ehung toi ghi nhgn ty le nhiem khuah vet mo d Khoa CTCH chiem ty le cao nhat la 10,13% (38/375), ke den la Khoa Ngoai Tong quat 7,41% (41/553), Khoa Ngoai Nieu 5,83% (6/103), Khoa San 5,03% (63/1252), it nhat Khoa Lien chuyen khoa vdi 2,11% (5/237).
Mdi lien quan nay ed y ngMa thong ke vdi p <
0,01 (p = 0,000).
Moi lien quan giua gidd tinh vd nhiem khuan vet mo
Qua nghien a i u nay, chiing toi ghi nhgn ty 1^
nhiem khuah vet md d b^nh nhan nam la 7,77%
(60/772) cao hon so vdi benh nhan nii 5,32%
(93/1748). Mdi lien quan nay CO y nghia thdng ke p < 0,05 (p = 0,018). Nhan djnh nay aia ehung toi phii hop vdi tac gia Chuang SC va es (2004) (14) va tac gia (14) qua phan tich don bi&i vdi p <
0,05. Trong khi do tac gia Trinh Ho TinW^, Nguyin Vi^t Himg<"6), Ki^u Chi Thanh'*' thi mdi li^n quan nay khong cd y nghia thdng k§.
Moi lien quan giiia thai dian phdu thudt vd nhiem khuan vet mo
Phan b'ch don bien chiing toi ghi nhan ty 1^
nhiem khuan vet md 6 b^nh nhan md khoang thdi gian (00 gid 01 - 07 gid 59) cao nhat vdi 12,18%, ke den la khoang thdi gian (16 gio 00 - 24 gid 00) la 6,33%, it nhat la khoang thdi gian (8 gid 00 - 16 gid 00) vdi 4,97%. Mdi lien quan nay cd y nghia thdng ke p < 0,01 (p = 0,000).
Moi lien quan giua ngdy ndm vien trung binh vd nhihn khuan vet mo
Chiing tdi g ^ nhan b?nh nhan nhiem khuah vet md cd so ngay nam vi^n trung binh cao hon benh nhan khong nhiem khuMi vet mo la 4,7
Hpi Nghi Khoa Hpc Ky Thuat BV. Binh Dan 2014 205
Nghien cixu Y hpc •i Hoc TP. Hd Chi Minh * Tap 18 * Sd 1 * 2014 ngay va su khac biet nay cd y n ^ a thdng ke p <
0,01 (p = 0,000), phii hpp \'di nhieu y van trong va ngoai nudc'i-^^'*'.
Mm lien quan giOa chi so badi cau vd nJtihn khtMt vet mo
Theo nghien ctiu chiing toi, ty le nhiem khuah vet md d benh nhan c6 dii sd bach cau (8,1 - 31,7) cao nhat la 8,84% (98/1108), ke deh la benh nhan chi so tiach cau (1,6 - 5,9) la 5,49%
(10A82) va t\' 1^ nhiem khuah vet mo d b?nh nhan ed dii so bach rau (6,0 - 8,0) it nhat la 3,66%
(45A230). Mo! lien quan nay cd y nghia tiiong ke p < 0,01 (p = 0,000), phii hpp vdi tac gia"^'"'.
Moi lien quan giOa dii so nguy ca NNIS vd nhihn khudk vet mo
Phan tich don bi&i b3ng mo hinh hoi quy logistic (Logistic Regression Model) khong kem tiiy dipn Rcfcust vdi bien NTSTS (cd tinh khuynh hudng), ehiing toi ghi nhan NNIS tang tiiem 1 diem thi t\' le nhilm khuah \et md tang len 4,S7 lan vdi PR = 4,87; KTC 95"o (2,58 - 9,17); p < 0,001, ghi nhgn nay ciing phii hpp vdi tac gia Pauline Harrington va cs (2013)(^>^.
Phan tich da bioi cho cac yeu to nhom tudi, benh m?n tinh, hut tiiudc^ chi sd dirong huyei, thang dion ASA, load phau thuat chi so khdi (BMI) voi nhiem khu:^ vet md
Trong n ^ e n eiiu nay, ty le nhiem khuah vet md d nhdm tudi (41 - 59) cao gap 2,05 Ian so vdi nhdm tuoi (15 - 40), PR = 2,05; KTC 95%. (1,40 - 3t00), p < 0,01 (p = 0,0000). Tuong tu, ty le nhilm khuan vet md d nhdm tudi (60 - 99) cao gap 4,28 Ian so vdi nhdm tudi (15 - 40), PR = 4,28; KTC 95% (2,91 - 6,29), p < 0,01 (p = 0,0000). Moi lien quan nay phii hpp vdi eae tac gja'"'.
Trong nghien ciiu na\', ty Ie nhiem khuah vet md d benh nhan cd kem benh man linh cao gap 3,65 Ian so vdi l>enh nhan khong kem benh man tinh, PR = 3,65, KTC 95% (2,72 - 4,89), p < 0,01 (p = 0,000). Mdi lien quan nay phii hop vdi cac tac gia"'"-'"'.
Theo nghien eihi nay, t\- le nhiem khuan vet
md d benh nhan cd hut thuoc cao gap 1~>7 Ian so vdi benh nhan khong hiit thuoc, PR = 1,57; KTC 95% (1,15-2,14), p < 0,01 (p = 0,004), phii hpp vdi tacgiati'.
Trong nghien ciiu nay, t\' le nhiem khuah vet md o benh nhan co ehi so dudng huyet > 120 mg°o rao gap 4,67 Ian so vdi benh nhan cd ehi so dudng huyet < 120 mg%, PR = 4,67; KTC 95%
(3,29 - 6,64), p < 0,01 (p = 0,0000), phii hpp vdi nghien ciiu aia tac gjafi-^'f'.
Theo nghien ciiu cua diiing toi, ty Ie nhilm khuah vet md d nhdm ASA 2 diem cao gap 2,08 Ian so vdi nhdm ASA 1 diem, PR = 2,08; KTC 95% (1,45 - 3,00), p < 0,01 (p = 0,000). Tuong tu, t>- le nhiem khuah vet md d nhdm ASA > 3 diem rao gap 3,08 Ian so vdi nhdm ASA 1 diem PR = 3,08; KTC 95% (2,16 - 4,41), p < 0,01 (p = 0,000).
Mdi lien quan nay phii hpp vdi cac tae
gia(i-i.io.tri2i
Trong nghien cuu nay, chiing toi phan b'ch da bi& h)iing md hinh hoi quy logistc thi ty le nhiem khuah vet mo khac biet giiia rac nhdm (6,0 - 10,0), (1,6 - 5,9), (10,1 - 31,7) khong cd y n ^ a thong ke vdi p > 0,05. Tuy nhien, phan tieh don bi&i thi ty 1? nhiem khuah vet md d benh nhan ed chi so bach rau (8,1 - 31,7) cao nhat la S.&i^o (98A108), ke den la benh nhan chi sdbach rau (1,6 - 5,9) la 5,49% (10/182) va ty le nhilm khuah vet md d benh nhan cd chi so bach cau (6,0 - 8,0) it nhat la 3,66% (45/1230). Mdi hen quan nay cd y nghia thong ke vdi p < 0,01 (p = 0.000) va phii hop \'di cae tac gia'^'^^.
Trong nghien aiu nay, ty le nhiem khuan vet md d benh nhan mo sach - nhiem rao gap 5,88 Ian so vdi benh nhan md sach, PR = 5,88, KTC 95% (2,39 - 14,42), p < 0,01 (p = 0,000), ty le nhilm khuah vet mo d t»eiih nhan mo nhiem rao gap 7,4r Jan so vdi benh nhan md' sach, PR - 7,47, KTC 95% (2,62 - 21,32). Tuong tu, t}> le nhilm khuah vet md d benh nhan mo bai rao gap 7,48 Ian so vdi benh nhan md sgeh, PR = 7,48, KTC 95% (1,32 - 8,27), p < 0,05 (p = 0,011). Moi Uen quan nay phii hpp vdi cac tae gja'^"-'-'.
Y Hpe TF. Hd Chi Minh * Tap 18 * So 1 * 2014 Nghien ctru Y hpc
Tuy nhien, theo Cao Van Minh (2002)i=), Kieu Chl Thanh (2011f> thi su khac biet nay khong cd y nghia thdng ke vdi p > 0,05.
Trong nghien cuu nay, ty le nhiem khuan vet md d nhdm 25 < BMI < 30 cao gap 2,35 Ian so vdi nhdm BMI < 25 PR = 2^5, KTC 95% (1,69 - 3,28), p < 0,01 (p = 0,0000). Tuong tu, ty Ie nhiem khuan vet md d nhdm BMI > 30 rao gap 3,01 Ian so vdi nhdm BMI < 25, PR = 3,0; KTC 95% (1,32 - 8,27), p
< 0,05 (p = 0,011), phii hpp vdi tac giaP-^).
Tac nhan gay nhiem khuan vet md va ty le khang khang sinh cua vi khuan Tdc nhdn gdy nhiem khuan vet mo
Trong nghien ctiu nay, tac nhan gay nhiem khuan vet mo do Staphylococcus aureus (MRSA+) gram duong ehiem da sd vdi ty Ie 18,95%, hang thii 2 la E.coli 15,79% phii hpp vdi Kieu Chi Thanh (2012)<^. Trong khi dd tac gia Nguyen Viet Hiing (2009)'i« va Kieu Chi Thanh (2010)'*' ghi nhan E.eoli chiem hang dau.
Ty le khdng khdng sinh cua vi khuan Trong nghian cuu ehung toi, da so vi khuan phan lap duoc deu khang tren 04 Ioai khang sinh, trong dd chiing Pseudomonas aeruginosa khang 12 loai khang sinh ty Ie khang tir 66,7% - 100% gdm: Ampidlline, Amofadavulanie, Ceftadizine+Qavulanic, Ampi+Sulfac, Cefpodoxim, Cefotaxime, Cehiroxim, Doxycyline, Ertapenem, Levofloxacin, Trime+sulfam, Ticarcillin/A.davulanic va Adnebacter baumaniui khang 16 Ioai khang sinh ty le khang tu 60% 100% gom:
AmpidUine, Amot-adavulanic, Amikadne, Ciprofloxacme, Cefpodoxim, Cehiroxim, Cefotaxime, Cefatadizine, Ertapenem, Cefepime, Gentamydne, Imipenem, Levofloxacin, Trime+sulfam, Ticardllin/A.davulanic, Piperadllin/a.davulanic. Nghien ciiu nay phii hpp vdi cac tac gia"^-".
Chi phi dieu tri NKVM va khong NKVM Trong nghien ciiu nay, chiing tdi ghi nhan chi phi dieu tri d benh nhan nhiem khuan vet
md ia 6.226.448 dong (so trung vi), chi phi dieu tri d benh nhan khong bi nhiem khuan la 3.604.492 ddng (so trung vi). Su khac bi?t nay ed y nghia thdng ke p < 0,01 (p = 0,000), phii vdi cac tae gia trong va ngoai nudd"'^-™*'.
KETLUAN
Chiing tdi nghien ciiu 2520 benh nhan phau thugt (benh nhan tham gia bao hiem 53,73%), trong dd nir ehiem ty le 69,37%, nam la 30,63%, ty le nii: nam = 2,3:1. Tuoi trung binh la 34 tuoi (SD 13,9), tudi nhd nhat la 15 tudi, Idn nhat la 99 tudi. Khoa San ehiem da so 49,68% (chuah bj da cho benh nhan san da so edn ego long chiem 99,2%), ke den la Khoa Ngogi Tdng quat 21,94%, Khoa CTCH 14,88%, Khoa LCK 9,4%, it nhat la Khoa Ngoai Nieu 4,09%. Phau thuat cap cuu la 71,2%, phau thugt npi soi 18,1%, b^nh nhan dimg khang sinh chiem ty le cao 99,96%
(01 Ioai khang sinh chiem tj' le 28,45%, 02 loEii khang sinh 66,03%., 03 Ioai 4,92%, 04 logi trd len chiem 0,6%), ty le dimg khang sinh du phong thap chiem ty le 1,27%.
Ty I# mac mdi nhiem khuan vet md chiein 6,07% trong dd ty le nhiem khuan vet mo nong chiem da sd vdi 4,5%, ke den la nhiem khu& vet md sau la 1,3%, it nhat la nhiSm khuah co quan chiem 0,27%..
Phan bd ty le nhiem khuan vet mo: Ty 1?
nhiem khuah vet md d benh nhan mo cap ciiu (7,16%) nhieu hon benh nhan mo chuong trinh (3,27%); Benh nhan cd thii thuat xam lah (5,19%) thap hon benh nhan khdng cd thii thugt xam Ian (9,4%).
Trong nghien eihi nay, phan tich don bien mpt vai yeu to lien quan vdi nhiem khuan vet md vdi p < 0,01 nhu: Khoa, gidi tinh, thoi diem phau thuat, chi sd bach eau, chi sd NNIS tang them 1 diem thi ty Ie nhiem khuah vet mo tang len 4,87 lan vdi PR = 4,87; KTC 95% (2,58 - 9,17);
p < 0,01. Thdi gian nSm vi#n trung binh oia benh nhan nhiem khuah vet mo la 9,9 ngay dai hon so vdi benh nhan khong nhiem khuan vet md (5,2 ngay).
Hpi Nghi Khoa Hpc Ky Thuat BV. Binh Dan 2014
Nghien cihi Y hpc Y Hpc TP. Hd Chi Minh * Tap 18 * Sd 1 * 2014
Phan tich da bien cho thay r ^ g yeu to nhdm tuoi, benh man tinh, hiit thuoc, chi sd dudng huyet, thang diem ASA, chi sd bach cau, ioai phiu tiiuat, ehi sd khdi (BMI) lien quan vdi nhiem khuan vet md vdi p < 0,01.
Tac nhan gay nhiem khuan vet mo thudng gap nhat la Staphylococais aureus (MRSA+);
Esdieridiia coU va ehi phi dieu tn t>enh nhan nhiem khuah vet md rao hon so vdi benh nhan khdng nhiem khuain vet md.
TAI LIEU THAM KHAO
1 Burke JF (1961) The effective penod of prei'enhve antibiotic action in experimental indaons and dennal lesions. Surgery, 50,161-168
2. Cao Van M n h va cs (2002), Tmh lunh nhilm khuan v 9 mo ngoji khoa-b$nh wen Thanh Nhan-nam 2002, Tgp chi Y HQC thiic hanK so chuyen de Hpi thao khoa hoc Ch&ig nhilm khuan b?nh vien' 56-60
3 Chuang SC et al (2004) Risk factors for wound infection after chdec\'stectomy J Formos Med Assoc, 103(8). 607-612.
4 Dmh Van Trung et al (2012). Study of surgical site infection in clean and dean-contammated abdominal surgical at military central hoqjital 108 Joural of clinical mediQne(16), 21-28 5 Ho VP, Stan SL, Trenche\'a K, Bane PS. Milsom JW, Lee SW,
et al (2011), Differing risk factors for masicmal and orpn/space surgical site infections followmg abdaninal colorectal surgery, Dis Colon Btectum, 54(7), 818-825 6. Kieu Chi Thanh (2010), Nghien ciiu thuc tiding nhiem khuiui
vet mo tai khoa ngogi tieu hoa b§nh vi^n 103 trong 2 nam 2009-2010 Tap chi Y hgc Lam sang, nha xuat ban Dai hgc H u e 96-99
7 Kieu Chl Thanh et al (2012). Shidy on rate and causes of surgical a l e infection at some surgery departments in Hospital 103 m a period of june 20n-April 2012. Joural of dinical mediane(16), 3-8
8 Le Thi Anh Thu va cs (2000) Hieu qua kmh te ctia chuong tnnh rua tay nhanh tai giuong tren b o i h nhan phau thuat than kinh Tap chi Y Hgc thijc hanh, so chuyen tEe H a thao khoa hpc Chwig nhiem khuan benh v i e a 122-127.
9 Le Thj Hong Chung va cs (2011), Tmh hinh nhilm khuah vet mo tgi benh vien Da nang. tap chi Y hpc Lam sang(15): 88-94 lu Luu Th) Lien & Nguyen Quoc Tuan va cs (2004) Tmh hinh
nhilm khuan benh vien tai Benh vien Lao va benh p h a Ha Npi nam 2004 Tgp chi Y Hpc thuc hanK so chuyen de H ^
thao khoa hgc Chong nhilm khuan benh vien: 45-47 Mai Phuong Mai (2012) Khang a n h du phong trong phau thu^t Benh \-ik\Tii Du 1-11
Makamovic J, Markowc-Denic L. Bumbaarevic M &
Marinkovic) (2006) InddHice of surgical a t e inlections m the departments of orthopedics and traumatdogy Vojnosanit PregL 63(8). 725-729
Mangram A), Horan T C Pearson ML, et al (1999). Guidelme for Pre\'CTiticMi of Surgical Site Infection American Joumal of Infection Control. 27(2), 97-134-
Nguyen Thanh Hai va cs (2011) Khao sat ly le nhilm khuan benh \ien va m S lien quan voi cac yeii to nguv co tgi Baih
\ i e n Da khoa Thong Nhat nam 2011. Tap chi Y hoc Lam sang, nha xuat ban Dai hgc Hue (8) 92-95
Nguyin Thi Thanh Ha va cs (2004) Nhilm khuan benh \1en- t y l e W e n m a c , y S i to nguy CO lgi benh wen phia nant Tgp chl Y hpc thuc himh, so chuyen de Hoi thao khoa hpc Chciig nhilm khuah benh vien 81-87
Nguyin Viet Himg va cs (2009) N ^ e n cuu tinh lunh nWlm khuan vet mo lai mot so khoa, B?nh \ien Trung itong H u e Tap chi Y hpc Lam sang, nha xuat ban Dgi hpc Hue. 30-36.
Pauline Hamngton, et al (2013) Protocol for Ihe Survdllance of Surgical Site InfecUon Public Health England Pham Himg Van va cs (2009) Nhien cuu da tiling lam khao sat tinh hinh de khang khang sinh cua tnjc khuan Gtam am de moc gay nhilm khuan benh vi|n phan Igp tit 1/2007 d o i 5/2008 YhgcTpHoChiMinh,13{2) 138-150.
Tartter PI et al (1996) Randomized tnal comparing packed ted cdi blood transfu^on with and without leukocvte depletion for gastrointestinal surgery Am J Surg 176(5), 46Z IntematiMial Health, 14(10), 1338-1346.
Tnnh Ho Tmh va cs (2012). Tmh hinh nhiem khuah vet mo tai mpt so Khoa Ngogi b^»h v i ^ da khoa tinh Bmh Dinh nam 2012 Tap chi Y hpc Lam sang(15): 71-76,
Worid Health Organization. (2009). The team tvill CCTisistentl>
use methods known fo minimize the risk for surgical site infection WHO guidelmes for safe surger>'", WHO Library Catalogumg-m-PublicaLon Data, 43-61.
Zavasdd AP et al (2010). Multidrug-reastant Pseudomonas aeruginosa and Acinetiiiacter baumannii resistance mechanisms and implications for therapy. Expert Rev Anti Infect Ther, 8(1), 71-93
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