1 / 34

Paestum 20 maggio 2006

Paestum 20 maggio 2006. Significato, fattori di rischio e costi delle infezioni post-operatorie Nicola Petrosillo Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - Roma. Infezioni post-operatorie. SSI. UTI CVC-r VAP.

cordelia
Télécharger la présentation

Paestum 20 maggio 2006

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Paestum 20 maggio 2006 Significato, fattori di rischio e costi delle infezioni post-operatorie Nicola Petrosillo Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani” - Roma

  2. Infezioni post-operatorie SSI UTI CVC-r VAP

  3. - Le infezioni del sito chirurgico (SSI) contribuiscono in maniera significativa alla morbosità e letalità associate alle procedure chirurgiche . • Pazienti con SSI presentano prolungata degenza, incremento dei costi in termini di degenza, attività mediche, infermieristiche, diagnostiche e prescrizione di farmaci (Kirkland KB et al. Infect Control Hosp Epidemiol 1999; 20-725-30. Coello R et al.J Hosp Infect 1993; 25: 239-50. Rioss J et al. Gac Sanit 2003; 17:218:25).

  4. Surgical site infections In modern surgery, the rate of infections increases because of: 1) Longer and more complicated operations 2) Older patients 3) Use of prosthetic devices 4) Spread of immunosuppressive treatment (transplants) 5) Increase of immunodepressed patients 6) More invasive diagnostic procedures 7) Use (and overuse) of antimicrobials 8) Asepsis?

  5. Le infezioni della ferita chirurgica rappresentano una complicanza frequente Milioni di $/anno Infezione ferita chirurgica 140 Eventi avversi nel sistema sanitario australiano. Eventi avversi da Warfarin 102 Cadute 44 Embolie polmonari 40 Trombosi venose profonde 38 Emorragie app. dig. da FANS 32 Int. chirurgici non necessari 29 Ulcere da decubito 27 Fratture mal ridotte 12 Inf. vie urinarie da catetere 10 Haley RW, 1985 J QUAL CLIN PRACTICE 1999;19:7-12. Pneumotorace iatrogeno 4,5 Vomito postoperatorio 2 • Hanno un rilevante impatto • clinico ed economico

  6. Infezioni della ferita chirurgica – Fattori di rischio • Fattori chirurgici • Antisepsi cutanea inadeguata • Intervento d’urgenza • Impianto di protesi • Durata prolungata di intervento • Drenaggi chirurgici • Scarsa tecnica chirurgica • Contaminazione non prevista • Fattori ambientali • Portatore di Staph. o Strep. • Vestizione equipe • Attività eccessiva • Antisettici contaminati • Ventilazione non adeguata • Disinf./sterilizzazione non adeguata Fattori dell’ospite • Età avanzata • Comorbidità • Obesità • Malnutrizione • Diabete mellito • Immunodepressione • Altre infezioni • Malattie cutanee Fattori preoperatori • Degenza prolungata • Tricotomia • Profilassi antibiotica non adeguata

  7. Incidence of SSI in Italian Surgical Settings 108 SSI (58.7%) were detected during the hospital stay, and 104 (41.3%) after discharge. Petrosillo N, et al. ECCMID 2004

  8. Incidence of SSI in Italian Surgical Settings Petrosillo N, et al. ECCMID 2004

  9. The operating theatre Antisepsis–Crowding–Disinfection-Sterilization

  10. Astagneau P, J Hosp Infect 2001

  11. Risk factors for surgical site infections in older people. • Case-control study • Duke University • Elderly patients (> or =65) who underwent surgery • between 1991 and 2002 at the study hospitals. • 569 cases (SSI) and controls Kaye KS, et al. J Am Geriatr Soc 2006;54:391-6

  12. Risk factors for surgical site infections in older people. • In multivariate analysis, independent predictors of SSI included: • obesity (OR 1.77 95%CI=1.34-2.32), • chronic obstructive pulmonary disease (COPD) (OR=1.66, 95% CI=1.17-2.34), • and a wound class classified as contaminated or dirty (OR=1.65, 95% CI=1.01-2.72). • Having private insurance was associated with lower risk (OR=0.29, 95%CI=0.12-0.68). Kaye KS, et al. J Am Geriatr Soc 2006;54:391-6

  13. Predictors of wound infection in ventral hernia repair • A total of 1505 VHR cases were used for analysis; wound infection occurred in 5% (n = 74). • Best-fit logistic regression models demonstrated that • steroid use, • smoking, • prolonged operative time, • and use of absorbable mesh • were significant independent predictors of wound infection. Finan KR et al. Am J Surg 2005; 190:678-81

  14. Staphylococcus aureus BloodstreamInfection After Cardiac Surgery:Risk Factors and Outcome Olsson C, et al. Infect Control Hosp Epidemiol 2006; 27:83-5

  15. Staphylococcus aureus BloodstreamInfection After Cardiac Surgery:Risk Factors and Outcome Olsson C, et al. Infect Control Hosp Epidemiol 2006; 27:83-5

  16. Deep wound infection after proximal femoral fracture: consequences and costs. • 61 cases (SSI) vs 122 controls • Infected cases had greatly increased hospital stay (P<0.001), • were 4.5 times less likely to survive to discharge (P=0.002), • and if they survived, were three times less likely to return to their original residence (P=0.05). Pollard TC et al. J Hosp Infect 2006; 63: 133-9.

  17. Deep wound infection after proximal femoral fracture: consequences and costs. • The total cost of treatment per infected case was pound 24 410 compared with pound 7210 for controls (P<0.001). • Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Pollard TC et al. J Hosp Infect 2006; 63: 133-9.

  18. Impatto economico delle infezioni ospedaliere Costi addizionali per il sistemasanitario e per l’intera società Costi per il singolo paziente (morbosità, mortalità, extra-degenza) Jarvis, 1996 Responsabilità medico-legali per gli operatori

  19. Costi delle infezioni ospedaliere Diretti:- giorni addizionali di degenza- risorse impegnate per la diagnosi - costo del trattamento- monitoraggio del decorso clinico Indiretti:- letalita'- perdità di produttività - danni funzionali- danni psicologici- peggioramento delle condizioni di base

  20. SSI – a European perspective of incidence and economic burden • Review of European studies published • after 1988 • Incidence, prevalence, prospective • cohort surveillance • Overview of the costs associated with • SSI in Europe Leaper DJ, van Goor H, Reilly J, Petrosillo N, et al. Int Wound J 2004

  21. SSI – a European perspective of incidence and economic burden • 48 studies selected 10 of them prospective cohort studies (7 case-matched or case-controlled) • Hospitals ranged from 1-214 • Units ranged from 1 to 132 • Study patients ranged from 43 to 236,334 Leaper DJ, van Goor H, Reilly J, Petrosillo N, et al. Int Wound J 2004

  22. SSI – a European perspective of incidence and economic burden SSI rate covered a range between 2-5 percent Leaper DJ, van Goor H, Reilly J, Petrosillo N, et al. Int Wound J 2004

  23. SSI – a European perspective of incidence and economic burden Leaper DJ, van Goor H, Reilly J, Petrosillo N, et al. Int Wound J 2004

  24. SSI – a European perspective of incidence and economic burden Leaper DJ, van Goor H, Reilly J, Petrosillo N, et al. Int Wound J 2004

  25. SSI – a European perspective of incidence and economic burden Leaper DJ, van Goor H, Reilly J, Petrosillo N, et al. 2004

  26. SSI – a European perspective of incidence and economic burden Costs of additional hospitalization days associated with SSI Leaper DJ, van Goor H, Reilly J, Petrosillo N, et al. 2004

  27. Excess cost associated with Staphylococcus aureus poststernotomy mediastinitis. • Retrospective case-control study • S. aureus PSM was associated with longer • average length of hospital stay, 42.6+/-18.7 vs • 10.4+/-4.0 days(p=0.005). • The mean cost per patient in New Zealand $ • was 30,527 dollars+/-10,489 dollars for controls • and 76,104 dollars +/- 31,460 dollars for cases, • and the mean excess cost associated with • S. aureus PSM was 45,677 dollars per patient. 1 NZ $ = 0,5 euro Upton A et al. N Z Med J 2005;118:U1316.

  28. Extra charge and extra length of postoperative stay attributable to surgical site infection in six selected operations. • Appendectomy, herniorrhaphy, mastectomy, • cholecystectomy, colectomy,and craniotomy. • Mean of extra hospital chargeattributable to SSI • was 43,658 (95% C.I; 30,228-57,088) baht and • mean of excess postoperative stay was 21.3 • (95% C.I; 16.6-26.0) days. 1 baht = 0,02 euro Kasatpibal N et al. J Med Assoc Thai 2005;88:1083-91.

  29. Le SSI: anche un problema di costi • 30 milioni/anno di procedure chirurgiche in Europa • Numero casi SSI: 450.000-6.000.000. • Costo giornaliero letto/degenza: 325 Euro • Degenza prolungata media: 10 gg • Costo europeo complessivo: 1.47- 19.1 miliardi Euro.

  30. … ma non solo costi

More Related