Nosocomial transmission of multi-drug-resistant organisms in Ukrainian hospitals: results of a multi-centre study (2019-2021)

Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study

Background

Conflict can have devastating effects on the development and spread of antimicrobial resistance. In Ukraine, early data post-injury are limited. We aim to explore extensively drug-resistant (XDR) Gram negative phenotypes and genotypes for infections arising early following conflict-associated wounds in Ukraine.

Methods

Carbapenem-resistant infections following conflict-associated wounds in Ukraine (February-May 2024) underwent extended antimicrobial susceptibility testing (AST) for 19 antimicrobial agents using 2025 European Committee for Antimicrobial Susceptibility Testing breakpoints. Carbapenemase genes were identified using a novel multiplex molecular resistance assay. Infections arising in the first seven days versus those arising after seven days since injury were compared by logistic regression. Significance was set at p < 0.05.

Findings

100 isolates were tested (53, 53.0% Klebsiella pneumoniae; 16, 16.0% other Enterobacterales; 18, 18.0% Acinetobacter baumanii and 13; 13.0% Pseudomonas aeruginosa). Gentamicin (p = 0.0046) and colistin (p = 0.049) resistance were higher in infections arising later. Overall, resistance rates for amikacin (74/100, 74.0%), cefiderocol (44/100, 44.0%) and ceftazidime-avibactam (26/79, 67.1%) were observed. Prevalent resistance genes included NDM + OXA-48-like (24/100, 24.0%), NDM-only (24/100, 24.0%) and KPC (9/100, 9%). Others included OXA 23-like/51-like, IMP and/or mcr1. Earlier infection isolates had a higher burden of carbapenemases/isolate (p = 0.006).

Interpretation

Extensively drug-resistant infections were observed early post-injury in Ukraine, with some trend to further resistance in those arising later in the patient pathway. A diverse presence of carbapenemase genes amid XDR Gram negative phenotypes highlights the importance of early screening for mechanisms of resistance in this setting.

Funding

This study was funded by the Healthcare Infection Society and CW+ Charity.

Cross-Sectional Assessment on Carbapenem-Resistant Gram-Negative Bacteria Isolated from Patients in Moldova

Information on the molecular epidemiology and carbapenem resistance mechanisms in Gram-negative bacterial isolates in Moldova is scarce. To close this knowledge gap, carbapenem-resistant Gram-negative bacteria were collected over an 11-month period in a routine diagnostic laboratory in Moldova. Antimicrobial susceptibility was phenotypically and genotypically assessed. Phylogenetic relationships were investigated and multi-locus sequence types were provided. The assessment indicated several clusters of phylogenetically closely related carbapenem-resistant Klebsiella pneumoniae (sequence types ST101, ST395 and ST377), Acinetobacter baumannii (ST2, ST19 and ST78) and Pseudomonas aeruginosa (ST357 and ST654) isolates next to a number of less frequently observed species and sequence types. A phylogenetic relationship to characterized isolates from neighboring Ukraine could be confirmed. Identified carbapenemase genes comprised blaOXA-23, blaOXA-72 and blaGES-11 in A. baumannii, blaKPC-3, blaNDM-1 and blaOXA-48 in K. pneumoniae, as well as blaVIM-2 in Pseudomonas aeruginosa. In conclusion, the assessment suggested the spread of carbapenem-resistant Gram-negative bacteria in Moldova which were partly pre-described from neighboring Ukraine, as well as likely spill-over events, facilitating the regional spread of carbapenem-resistant clones. Several isolates with very high genomic similarity further support the hypothesis of likely regional transmission events driven by several evolutionary successful clonal lineages.

Carbapenemase-Producing Enterobacterales from Patients Arriving from Ukraine in Poland, March 2022-February 2023

INTRODUCTION

Despite a scarcity of data, before 2022 Ukraine was already considered a high-prevalence country for carbapenemase-producing Enterobacterales (CPE), and the situation has dramatically worsened during the full-scale war with Russia. The aim of this study was to analyse CPEs isolated in Poland from victims of war in Ukraine.

METHODS

The study included 65 CPE isolates from March 2022 till February 2023, recovered in 36 Polish medical centres from 57 patients arriving from Ukraine, differing largely by age and reason for hospitalisation. All isolates were sequenced by MiSeq and ten Klebsiella pneumoniae isolates also by MinION. Taxonomy, clonality and resistomes were analysed for all CPEs, whereas phylogeny, serotypes, virulomes and plasmids were characterised for K. pneumoniae, and partially for Escherichia coli ST131, using various bioinformatic tools.

RESULTS

Multifactorial diversity of the isolates reflected the patients' clinical-epidemiological heterogeneity. The CPEs represented six species. Klebsiella pneumoniae was the most prevalent with 50 isolates and 15 sequence types (STs), mainly ST395, ST307, ST11, ST147 and ST23, producing NDM (-1/-5), OXA-48 (-48/-1242) or KPC (-2/-3)-like carbapenemases. Each of the STs produced groups of loosely related isolates, clusters of close relatives and/or unique isolates, correlating with K serotypes and carbapenemases. Many of these, especially NDM-1- and/or OXA-48-producing ST395 and ST307, were related to Russian organisms. Others, for example, NDM-1-producing ST11, clustered with those from Poland. Numerous K. pneumoniae isolates had specific virulence genes, including aerobactin iuc, largely due to spread of pNDM-MAR plasmids, showing both resistance and virulence. Two E. coli ST131 isolates belonged to clades B or C1 and produced KPC-3 or NDM-1, respectively.

CONCLUSIONS

Together with similar studies from Germany and The Netherlands, this work has documented broad dissemination of CPE in Ukraine, driven by a number of specific K. pneumoniae lineages circulating over a large territory of Eastern Europe.

Assessing and upgrading the cleanliness of the emergency department brief title: upgrading the emergency room's cleanliness

OBJECTIVE

To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).

SETTING

Tertiary referral hospital.

DESIGN

Prospective, 3-component, before-and-after intervention study.

METHODS

Phase 1 consisted of a 4-week baseline determination of ED patient-room cleanliness, using two means: (1) the fluorescence spray, applied before cleaning and assessed subsequently with an ultraviolet lamp. Results are expressed as % of removed spots/all spots (≥7/10 cleaned spots/room was considered clean; (2) ATP swabs obtained after cleaning, which test for presence of residual organic material; readings <45 were considered clean. Phase 2 consisted of revision and reorganization of established cleaning practices. Phase 3 consisted of adding one cleaning person in afternoon/evening shifts, for 4-weeks, during which room cleanliness was assessed as previously described.

RESULTS

Cleanliness of the 79 patient rooms, for which fluorescence tests were available from before and after cleaning for all three phases of the study, increased from a baseline of 50% ± 35 removed spots/all spots, to 61% ± 36 after the first intervention (CI95 -0.6 - 21, P = 0.54) and to 68% ± 35 after the second intervention (CI95 5 - 31, P = 0.004, as compared to the baseline). Subanalysis showed that evening shifts improved most remarkably, from 47% ± 32 (n = 45), to 60% ± 33 (n = 49) to 76%±29 (n = 29), respectively, from baseline through the second and third phase (P = 0.001). ATP testing appeared less sensitive for assessment of cleanliness but confirmed the assessment by fluorescence for overall cleanliness (CI95 1 - 14, P = 0.018).

CONCLUSIONS

Our data demonstrate that a two-step intervention significantly improves cleaning in a busy ED.

Phenotypic and genomic analysis of bacteria from war wounds in Dnipro, Ukraine

Objectives

To better understand the source and potential transmission routes of antibiotic-resistant bacteria infecting injured service members in Ukraine.

Methods

Phenotypic and genomic characterizations were performed on 11 Gram-negative pathogens cultured from war wounds at an intermediate evacuation hospital in Dnipro.

Results

The analysis revealed both susceptible and extensively drug-resistant strains present in cultures, including high-risk global clones carrying carbapenemases.

Conclusions

Globally distributed carbapenemase-producing lineages are being acquired early in the medical evacuation process.

How long do nosocomial pathogens persist on inanimate surfaces? A scoping review

Healthcare hygiene plays a crucial role in the prevention of healthcare-associated infections. Patients admitted to a room where the previous occupant had a multi-drug-resistant bacterial infection are at an increased risk of colonization and infection with the same organism. A 2006 systematic review by Kramer et al. found that certain pathogens can survive for months on dry surfaces. The aim of this review is to update Kramer et al.'s previous review and provide contemporary data on the survival of pathogens relevant to the healthcare environment. We systematically searched Ovid MEDLINE, CINAHL and Scopus databases for studies that described the survival time of common nosocomial pathogens in the environment. Pathogens included in the review were bacterial, viral, and fungal. Studies were independently screened against predetermined inclusion/exclusion criteria by two researchers. Conflicts were resolved by one of two senior researchers. A spreadsheet was developed for the data extraction. The search identified 1736 studies. Following removal of duplicates and application of the search criteria, the synthesis of results from 62 included studies were included. 117 organisms were reported. The longest surviving organism reported was Klebsiella pneumoniae which was found to have persisted for 600 days. Common pathogens of concern to infection prevention and control, can survive or persist on inanimate surfaces for months. This data supports the need for a risk-based approach to cleaning and disinfection practices, accompanied by appropriate training, audit and feedback which are proven to be effective when adopted in a 'bundle' approach.

Healthcare-associated infections after neurosurgical procedures in Ukraine: a multicentre study (2020-2022)

OBJECTIVE

Aim: To investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) after a neurosurgical procedure in Ukraine.

PATIENTS AND METHODS

Materials and Methods: Prospective multicentre surveillance was conducted from January 2020 to December 2022 in 10 regional hospitals of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network.

RESULTS

Results: Of 8,623 neurosurgical patients, 1,579 (18.3%) HAIs were observed. The most frequently of HAI types were pneumonia (38.4%), surgical site infection (34.2%), urinary tract infection (18.1%) and bloodstream infection (9.3%). Death during hospitalization was reported in 11.3% of HAI cases. There was an association between HAIs after neurosurgical procedures and patients with diabetes mellitus, end-stage renal disease undergoing dialysis, and leukaemia. The strongest independent associations were observed for intubation, urinary catheters, and vascular catheters. Klebsiella pneumoniae were most commonly reported, accounting for 25.1% of all organisms, followed by Escherichia coli (17.6%), Staphylococcus aureus (9.9%), Pseudomonas aeruginosa (8.9%), Acinetobacter baumannii (8.5%), coagulase-negative staphylococci (6.8%), and Streptococcus spp. (5.5%). In total, 76.3% isolates from neurosurgical patients were MDROs. Antimicrobial resistance in Ukraine varies greatly by bacterial species, antimicrobial group, and region.

CONCLUSION

Conclusions: Healthcare-associated infections are a cause for mortality and morbidity among neurosurgical patients. This is due to increase emergence of antimicrobial-resistant pathogens. Routinely collected surveillance data are of great value as a basis for studying the consequences of HAIs.

Epidemiology of healthcare-associated endometritis after surgical abortion in Ukraine: results a multicenter study

OBJECTIVE

Aim: To determine the current prevalence of healthcare-associated endometritis after surgical abortion and antimicrobial resistance of responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and Methods: We performed a prospective, multicentre cohort study was based on surveillance data of healthcare-associated endometritis after legal induced surgical abortion. Women who underwent induced surgical abortion at gynecological departments of 16 regional hospitals between 2020 and 2022 are included in the study. Definitions of endometritis were adapted from the CDC/NHSN. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST.

RESULTS

Results: Among 18,328 women who underwent surgical abortion, 5,023 (27.4%) endometritis were observed. Of all post-abortion endometritis cases, 95.3% were detected after hospital discharge. The prevalence of endometritis in different types surgical abortion was: after vacuum aspiration at < 14 weeks, 23.8%, and after dilatation and evacuation at ≥ 14 weeks, 32%. The most responsible pathogens of post-abortion endometritis are Escherichia coli (24.1%), Enterococcus spp. (14.3%), Enterobacter spp. (12,8%), Pseudomonas aeruginosa (8.3%), Proteus mirabilis (6.6%), Serratia marcescens (6.2%), Staphylococcus aureus (5.9%), and Stenotrophomonas maltophilia (5.7%). A significant proportion these pathogens developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group.

CONCLUSION

Conclusions: Results this study suggest a high prevalence of endometritis after surgical abortion in Ukraine. A significant proportion of women were affected by endometritis caused by bacteria developed resistance to several antimicrobials. Optimizing the antibiotic prophylaxis may reduce the burden of endometritis after surgical abortion, but prevention is the key element.

Enzymatic Synthesis of a Novel Coumarin Aminophosphonates: Antibacterial Effects and Oxidative Stress Modulation on Selected E. coli Strains

The objective of the present study was to evaluate the synergistic effect of two important pharmacophores, coumarin and α-amino dimethyl phosphonate moieties, on antimicrobial activity toward selected LPS-varied E. coli strains. Studied antimicrobial agents were prepared via a Kabachnik-Fields reaction promoted by lipases. The products were provided with an excellent yield (up to 92%) under mild, solvent- and metal-free conditions. A preliminary exploration of coumarin α-amino dimethyl phosphonate analogs as novel antimicrobial agents was carried out to determine the basic features of the structure responsible for the observed biological activity. The structure-activity relationship revealed that an inhibitory activity of the synthesized compounds is strongly related to the type of the substituents located in the phenyl ring. The collected data demonstrated that coumarin-based α-aminophosphonates can be potential antimicrobial drug candidates, which is particularly crucial due to the constantly increasing resistance of bacteria to commonly used antibiotics.

CATHETER-ASSOCIATED URINARY TRACT INFECTIONS AFTER CAESAREAN SECTION IN UKRAINE: RESULTS A MULTICENTER STUDY (2020-2022)

OBJECTIVE

The aim: To obtain the first national estimates of the current prevalence rate of catheter-associated urinary tract infections (CAUTIs) after caesarean section (CSEC) and antimicrobial resistance of causing pathogens in Ukraine.

PATIENTS AND METHODS

Materials and methods: Prospective multicentre surveillance was conducted from January 2020 to December 2022 in 15 women hospitals of Ukraine. Definitions of CAUTIs were adapted from the CDC/NHSN. Antibiotic susceptibility was done by the disc diffusion test as recommended by European Committee on Antimicrobial Susceptibility Testing guidelines.

RESULTS

Results: A total of 15,892 catheterized women undergoing primary CSEC and 13.6% CAUTI were identified. The most common uropathogen was Escherichia coli, Proteus mirabilis, and Enterococcus species followed by Providencia stuartii and Pseudomonas aeruginosa. Many uropathogens isolated from CAUTI cases were found to be multidrug resistant.

CONCLUSION

Conclusions: This study showed that CAUTIs in catheterized women undergoing primary CSEC in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics. Optimizing the management and empirical antimicrobial therapy may reduce the burden of CAUTIs in catheterized women undergoing primary CSEC, but prevention is the key element.

URINARY TRACT INFECTIONS IN PREGNANT WOMEN IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2020-2022)

OBJECTIVE

The aim: To obtain the first national estimates of the current prevalence rate of urinary tract infections (UTIs) in pregnant women and antimicrobial resistance of causing pathogens in Ukraine.

PATIENTS AND METHODS

Materials and methods: Prospective multicentre cohort study was conducted from January 2020 to December 2022. The study population consisted of 36,876 pregnant women from 17 regions of Ukraine. Antibiotic susceptibility was done by the disc diffusion test as recommended by European Committee on Antimicrobial Susceptibility Testing guidelines.

RESULTS

Results: A total 29.5% pregnant women were found to have UTIs. Among these cases, 36.5% Asymptomatic bacteriuria, 51.7% Cystitis and 11.8% Pyelonephritis were observed. Of all cases, 87.9% were defined as healthcare-acquired UTIs and 12.1% community-acquired UTIs. The most common uropathogen was Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Many uropathogens isolated from UTI cases were found to be multidrug resistant.

CONCLUSION

Conclusions: UTIs in pregnant women in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics. Optimizing the management and empirical antimicrobial therapy may reduce the burden of UTIs in pregnant women, but prevention is the key element.