Endometritis after hysteroscopic procedures in Ukraine: results a multicenter study

OBJECTIVE

Aim: To determine the current prevalence of endometritis after hysteroscopic procedures and antimicrobial resistance of responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of endometritis were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST.

RESULTS

Results: Among 13,872 patients with hysteroscopic procedures, 1027 (7.4%) endometritis were observed. Of these cases, 0.4% were detected after diagnostic hysteroscopy, and 7.0% were detected after operative hysteroscopy. Of all endometritis cases, 64.2% were detected after hospital discharge. The most commonly reported bacterial species were Escherichia coli (24.3%), followed by Enterobacter spp. (12.7%), Enterococcus spp. (8.3%), Pseudomonas aeruginosa (8.1%), Serratia marcescens (6.8%), Staphylococcus aureus (5.9%), Proteus mirabilis (5.8%), Klebsiella oxytoca (5.1%), Stenotrophomonas maltophilia (4.5%), Klebsiella pneumoniae (4.1%). A significant proportion of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group, and geographical region of Ukraine.

CONCLUSION

Conclusions: Our data suggest a high prevalence of endometritis after hysteroscopic procedures. Risk for endometritis was higher after operative hysteroscopy compared with diagnostic hysteroscopy. Many most of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials. These data underscore the importance of tracking antimicrobial resistance of responsible pathogens of HAIs in hospitals.

Postpartum infections and antimicrobial resistance of responsible pathogens in Ukraine: results a multicenter study (2020-2022)

OBJECTIVE

Aim: To determine the current prevalence of postpartum infections and antimicrobial resistance and antimicrobial resistance of responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of healthcare- associated postpartum infection were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST.

RESULTS

Results: Among 21,968 women, 6,175 (28.1%) postpartum infections were observed. Of all postpartum infection cases, 83.1% were detected after hospital discharge. The postpartum infection rates were 17.3% after cesarean section and 10.8% after vaginal delivery. The most common postpartum infection types were endometritis (17.3%), followed by urinary tract Infection (3.5%), mastitis (3.4%), surgical site infection (excluding endometritis) (2.4%), and episiotomy site infection (1.5%). The predominant postpartum infection pathogens in Ukraine were: Escherichia coli (10.4%), Enterococcus spp. (9.6%), Staphylococcus aureus (6.7%), Pseudomonas aeruginosa (5.8%), Enterobacter spp. (5.8%). In our study pathogens of postpartum infection had differently levels of resistance to antibiotics.

CONCLUSION

Conclusions: Our results indicate that postpartum infections requiring medical attention are common in Ukraine and that most postpartum infections occur after hospital discharge, so that use of routine inpatient surveillance methods alone will lead to underestimation of postpartum infection rates. Optimizing the antibiotic prophylaxis may reduce the burden of postpartum infection, but prevention is the key element.

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.

HEALTHCARE-ASSOCIATED TUBO-OVARIAN INFECTIONS IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2020-2022)

OBJECTIVE

The aim: To determine the current prevalence of healthcare-associated tubo-ovarian infections in female and antimicrobial resistance of the responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and methods: We performed a retrospective multicenter cohort study was based on healthcare-associated infections surveillance data. Definitions of health¬care-associated tubo-ovarian infections were used from the CDC/ NHSN. The susceptibility to antibiotics was determined by disk diffusion method according to the EUCAST.

RESULTS

Results: Among all the 1,528 of women in this study, the prevalence of healthcare-associated tubo-ovarian infections was 31.2%. Of these cases, Salpingitis, Oophoritis, and tubo-ovarian abscess were 47.5%, 34% and 18.5%, respectively. Of all cases tubo-ovarian infections in female, 74.7% were detected after hospital discharge. The predominant pathogens were: Escherichia coli (27.7%), Enterobacter spp. (12.2%), Klebsiella pneumoniae (9.6%), Staphylococcus aureus (8.2%), Pseudomonas aeruginosa (8.1%), and Enterococcus faecalis (7.5%), followed by Proteus mirabilis (5.1%), Streptococcus spp. (4.5%), Staphylococcus epidermidis (4.4%), and Acinetibacter spp. (4%). Methicillin-resistance was ob¬served in 16.8% of S. aureus (MRSA). No strains S.aureus and E. faecalis resistant to vancomycin. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 24.7%. The prevalence of ESBL production among E. coli isolates was 28.6% and among K. pneumoniae 12.8%. Resistance to third-generation cephalosporins was observed in 14.9% E.coli and 11.3% K. pneumoniae isolates. Carbapenem resistance was identified in 11.3% of P.aeruginosa isolates.

CONCLUSION

Conclusions: A healthcare-associated tubo-ovarian infections of the female in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics.

EPISIOTOMY INFECTIONS IN THE PUERPERIUM AND ANTIMICROBIAL RESISTANCE OF RESPONSIBLE PATHOGENS IN UKRAINE

OBJECTIVE

The aim: To obtain the first estimates of the current prevalence rate of episiotomy infections in the puerperium and antimicrobial resistance of responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population consisted of all women who had a vaginal delivery in 7 Regional Women's Hospitals of Ukraine. Definitions of episiotomy infections were used from the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC/NHSN).

RESULTS

Results: Total 35.6% women after vaginal delivery had episiotomy done. The prevalence rate of episiotomy infections was 17.7%. The predominant pathogens were: Escherichia coli (49.2%), Enterobacter spp. (11.1%), Streptococcus spp. (9.1%), Enterococcus faecalis (6.5%), Klebsiella spp. (8.1%), followed by Pseudomonas aeruginosa (4.7%), Staphylococcus aureus (4.2%), Proteus spp.(2.9%) and Staphylococcus epidermidis (2.8%). The overall proportion of methicillin-resistance was observed in 17.3% of Staphylococcus aureus (MRSA). Vancomycin resistance was observed in 6.8% of isolated enterococci. Carbapenem resistance was identified in 8% of P.aeruginosa isolates. Resistance to third-generation cephalosporins was observed in 15.2% Klebsiella spp. and E.coli 16.4% isolates. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 26.4%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (31.4%, vs 12.5%).

CONCLUSION

Conclusions:Episiotomy infections in the puerperium are common in Ukraine and most of these infections caused by antibiotic-resistant bacteria. Optimizing the management and empirical antimicrobial therapy may reduce the burden of episiotomy infections, but prevention is the key element.

Surgical Site Infections and Antimicrobial Resistance in Kyiv City Hospitals, Ukraine

OBJECTIVE

Introduction: Surgical site infections (SSIs) are associated with increased morbidity and mortality. Scant information is available on the SSI in Ukrainian hospitals. The aim: to determine the incidence of SSIs and estimates antimicrobial resistance of the major responsible pathogens in Kyiv city hospitals.

PATIENTS AND METHODS

Materials and methods:This study was conducted from January 2011 to December 2013 in 3 hospitals. Definitions of SSIs were adapted from the CDC/NHSN. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing.

RESULTS

Results: Among 9,162 patients, 1,912 (20.9%) SSIs were observed. The high SSI case in appendectomy (29.8 %), gastric, small and large bowel surgeries (28.4 %), cholelithiasis (25.7%), and orthopedic procedures (22.9 %). Low infection rate in excision of dermoid cysts, lipoma (5.3%) and lower segment caesarean structure (6.5%). Staphylococcus aureus were most commonly reported, accounting for 27,8% of all organisms, followed by Escherichia coli (18.4 %), Pseudomonas aeruginosa (11.9 %) and Enterococcus faecalis (11.6 %). The antimicrobial resistance in the isolates associated with SSIs showed, among the Gram-positive bacteria, that 43.8% and 4.7% of CoNS isolates were β-lactam (oxacillin) - and glycopeptide (teicoplanin) - resistant, respectively. Meticillin resistance was reported in 35.7 % of S. aureus isolates.

CONCLUSION

Conclusions: SSIs and antimicrobial resistance of the responsible pathogens is an actually problem. One essential step in the prevention of SSIs is to implement a nationalsystem for their surveillance.