Prevalence of healthcare-associated infections and antimicrobial resistance in acute care hospitals in Kyiv, Ukraine

Circulation of Antibiotic-Resistant Escherichia coli in Wild and Domestic Waterfowl in Ukraine

Background: Antibiotic resistance is becoming an increasingly urgent problem for human and animal health due to the widespread use of antibiotics in medicine, veterinary medicine, and agriculture. At the same time, the natural reservoirs of antibiotic-resistant pathogens remain unclear. Wild birds may play a role in this due to their biology. Escherichia coli is a representative indicator pathogen for antibiotic resistance studies. Materials and Methods: In 2020-2021, sampling of feces and cloacal swabs from six species of wild waterfowl (Eurasian wigeon Anas penelope, Eurasian teal Anas crecca, white-fronted goose Anser albifrons, red-breasted goose Rufibrenta ruficollis, graylag goose Anser anser, shelduck Tadorna tadorna) and from two species of domestic waterfowl (ducks and geese) was conducted in the Kherson, Zaporizhzhia, Odesa, Kharkiv, and Cherkasy regions of Ukraine. Biological material was collected, stored, and transported in cryotubes with transport medium (brain heart infusion broth [BHIB] with the addition of 15% glycerol) in liquid nitrogen. Bacteriological studies were carried out according to standard methods for the isolation and identification of microorganisms. Drug resistance of E. coli was carried out by a standard disk diffusion method. Results: Bacteria representing six families (Enterobacteriaceae, Yersiniaceae, Morganellaceae, Bacillaceae, Pseudomonadaceae, Staphylococcaceae) were isolated from clinically healthy wild birds (wigeon, Eurasian teal, white-fronted goose, red-breasted goose, mallard, graylag goose, shelduck) in the southern regions of Ukraine with isolation rates ranging from 26.7% to 100%. A total of 19 E. coli isolates were cultured from 111 samples from wild birds, and 30 isolates of E. coli were cultured from 32 poultry samples. E. coli was isolated from birds of all species. The prevalence of E. coli ranged from 5.0% to 33.3% in wild waterfowl and from 90.9% to 100% in domestic waterfowl. The prevalence of multidrug-resistant (MDR) E. coli ranged from 10.0% to 31.8% in wild and domestic waterfowl: 3 of 15 (20%) specimens from wild mallard were MDR in the Kherson region, as well as 7 of 22 domestic ducks (31.8%) and 1 of 10 geese (10%) in the Kharkiv and Cherkasy regions. Isolates from wild birds were the most resistant to ampicillin (AMP), amoxiclav (AMC), amoxicillin (AMX), doxycycline (DO), and chloramphenicol (C). Isolates from poultry were resistant to ampicillin, amoxiclav, doxycycline, amoxicillin, chloramphenicol, and enrofloxacin (EX). Most of the other E. coli isolates from wild waterfowl were classified as non-multidrug-resistant (non-MDR) forms. Analysis of antibiotic sensitivity phenotypes showed that only four antibiotic-resistant phenotypes were detected among non-MDR bacteria, whereas among the MDR bacteria, two antibiotic-resistant phenotypes were detected in mallards and six in domestic waterfowl. Conclusion: The results of this study showed that wild waterfowl in Ukraine, which live in natural conditions and do not receive any antimicrobial drugs, are carriers of E. coli that are resistant to a number of antibiotics that are actively used in industrial poultry.

Evaluating Healthcare-Associated Infections in Public Hospitals: A Cross-Sectional Study

BACKGROUND

Hospital-acquired infections (HAIs) pose a significant danger to global public health, mainly because their numbers are growing exponentially each year. Additionally, the rise of bacterial strains resistant to current treatment options further exacerbates this threat. This study aimed to examine the occurrences of HAIs identified in public hospitals at the county level.

METHODS

We conducted a cross-sectional study utilizing data provided to the Mures Public Health Directorate from all the public hospitals within the studied county. We examined HAIs reported during the period spanning from 2017 to 2021, which amounted to a total of 4603 cases.

RESULTS

The medical departments reported the highest prevalence of HAIs at 48.25%. The most common infections included enterocolitis with Clostridioides difficile (32.61%), COVID-19 (19.83%), bronchopneumonia (16.90%), sepsis, surgical wound infections, and urinary tract infections. The five most frequently identified pathogens were Clostridioides difficile (32.61%), SARS-CoV-2 (19.83%), Acinetobacter baumannii (11.82%), Klebsiella pneumoniae (9.58%), and Pseudomonas aeruginosa (7.95%). Acinetobacter baumannii was the predominant agent causing bronchopneumonia, while Klebsiella pneumoniae was the leading cause of sepsis cases. Escherichia coli was the primary agent behind the urinary tract infections, and Staphylococcus aureus MRSA was identified as the main etiology for wound infections and central catheter infections. Throughout the study period, there was a significant rise in Clostridioides difficile and Gram-negative bacteria prevalence rates.

CONCLUSIONS

This study identified increased Clostridioides difficile in HAI cases during COVID-19, highlighting the need for careful antibiotic use and emphasizing the growing challenge of multi-resistant strains in post-pandemic state hospitals.

Analysis of Etiology of Community-Acquired and Nosocomial Urinary Tract Infections and Antibiotic Resistance of Isolated Strains: Results of a 3-Year Surveillance (2020-2022) at the Pediatric Teaching Hospital in Warsaw

Urinary tract infections (UTIs) remain the most common infections diagnosed in outpatients and hospitalized patients. This study was designed to determine the patterns of antibiotic resistance and the prevalence of uropathogens causing UTIs in pediatric patients hospitalized between 1 January 2020 and 31 December 2022 at Teaching Hospital in Warsaw. The most frequent species isolated from urine samples were E. coli (64.5%), Klebsiella spp. (11.6%), and Enterococcus spp. (6.1%). UTIs caused by Enterobacter spp., Enterococcus spp., and Klebsiella spp. were significantly more common in children younger than three months of age than in children older than three months (p < 0.001). Trimethoprim and trimethoprim-sulfamethoxazole were the least active compounds against Enterobacterales with the resistance of E. coli, Klebsiella spp., P. mirabilis, and Enterobacter spp. in the range of 26.7/25.2%, 48.4/40.4%, 51.1/40.4%, and 15.8/13.2% respectively. Ampicillin was also found to have resistance rates for E. coli of 54.9% and P. mirabilis of 44.7%. Cefalexin and cefuroxime were highly active towards Enterobacterales except for Klebsiella spp., in which the resistance level reached 40%. Regarding third- and fourth- generation cephalosporins, resistance in E. coli and P. mirabilis was observed in approximately 2-10% of the isolates, but in Klebsiella spp. and Enterobacter spp. ranged over 30%. The resistance of Enterobacterales to carbapenems, nitrofurantoin, and fosfomycin was below 1%. The quinolones resistance was very high for Klebsiella spp. (31.1%) and P. mirabilis (29.8%) and three times lower for E. coli (11.9%), P. aeruginosa (9.3%), Enterobacter spp. (2.6%), and E. faecalis (4.6%). Resistance to multiple antibiotic classes was identified in 396 Enterobacterales strains, 394 of which were multi-drug resistant (MDR) and 2 were extensive drug-resistant (XDR). In the case of E. coli, 30% of isolates were MDR, with the proportion of strains having this exact resistance pattern similar in all of the analyzed years; no E. coli XDR strains were isolated. The number of Klebsiella spp. MDR strains was much higher in 2022 (60%) than in 2021 (47.5%). In the analyzed time, only one strain of K. pneumonia XDR, producing New Delhi metallo-β-lactamase, was isolated. Monitoring infection trends is essential to improve control and limit the rise of bacterial resistance.

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

BACKGROUND

The increasing emergence and spread of multi-drug-resistant organisms (MDROs) in hospitals is a public health problem and continues to challenge infection control and hospital epidemiology practice worldwide.

AIM

The aim of this study was to characterize the epidemiology of transmission of MDROs via healthcare workers (HCWs) and the environment in the hospital wards/patient rooms.

METHODS

A multi-centre prospective observational study was conducted in 17 hospitals in Ukraine. Species identification was performed with standard microbial methods. β-Lactamase genes were investigated by polymerase chain reaction. Pulsed-field gel electrophoresis (PFGE) was used to determine the genetic similarity between isolates.

FINDINGS

Among 51,656 isolates, 19.5% were MDROs. The proportions of MDROs among isolates from patients with healthcare-associated infections, environmental surfaces and HCWs (hands, gown/gloves) were 29.2%, 16.3% and 24.2%, respectively. In 51.9% of the tested isolates, identical MDROs were found in clinical isolates, environmental samples and HCWs' hands. Meticillin resistance was found in 32.4% of Staphylococcus aureus (MRSA) isolates, and vancomycin resistance was found in 28.9% of enterococci (VRE). Resistance to third-generation cephalosporins was detected in 48.4% of Enterobacterales, and carbapenem resistance in 19.1%. Overall, 37.4% of MDROs had broad-spectrum β-lactamase genes, including extended-spectrum β-lactamase (35.8%), OXA-type (29.7%), AmpC-type (25.1%), KPC-type (25.7%) and metallo-β-lactamases, including IMP-type (5.7%), VIM-type (31.7%) and NDM-1 (21.3%).

CONCLUSIONS

In Ukrainian hospitals the prevalence of healthcare-associated infections caused by MDROs continues to increase, while infection control gaps in healthcare settings facilitate their transmission between patients.

Qualidade das práticas de profissionais dos programas de controle de infecção no Brasil: estudo transversal

RESUMO Objetivo Analisar a qualidade das práticas de profissionais dos programas de controle de infecção em relação aos componentes de estrutura, processo e resultado. Método Trata-se de um estudo de abordagem quantitativa, do tipo descritivo e transversal realizado em 114 serviços de controle de infecção hospitalar das cinco regiões oficiais do Brasil. Coletaram-se os dados por meio de um instrumento estruturado, cujas propriedades psicométricas foram validadas previamente. O tratamento dos dados foi realizado pela análise de componentes principais e o teste não paramétrico Kruskal-Wallis. Resultados O melhor índice de qualidade dos programas de controle de infecção foi atribuído à região Sul, aos hospitais que continham 300 leitos ou mais, aos que utilizavam o critério National Healthcare Safety Network para vigilância das infecções e aos locais que realizavam busca ativa prospectiva como método de vigilância. Conclusão e implicações para a prática O índice de qualidade dos programas de controle de infecção está relacionado à localização, ao tamanho do hospital e ao método adotado para vigilância de infecções. A criação de um índice de qualidade, até então inédito em estudos nacionais, chama atenção para o desempenho precário dos serviços de saúde.

Epidemiology of healthcare-associated infections and mechanisms of antimicrobial resistance of responsible pathogens in Ukraine: a multicentre study

BACKGROUND

Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) have a high impact in terms of morbidity, mortality, and costs.

AIM

To estimate the prevalence and incidence of HAIs, and to describe phenotypic and genotypic features of antimicrobial resistance in responsible pathogens in Ukraine.

METHODS

Prospective multicentre surveillance was conducted from January 2019 to December 2021 in 17 regional hospitals of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network.

FINDINGS

Among 37,968 patients, 6218 (16.4%) HAIs were observed. Of all HAI cases, 14.8% were detected after hospital discharge. The most frequently reported HAI types were pneumonia (24.4%), urinary tract infections (19.8%), surgical site infections (15.3%), and bloodstream infections (11.2%). Of all HAIs, 11.9% were defined as part of an outbreak. Death during hospitalization was reported in 12.6% of HAI cases. In total, 85.1% isolates from patients were found to be MDROs. Meticillin resistance was found in 41.2% of S. aureus (MRSA) isolates, and vancomycin resistance was found in 11.8% of enterococci. Antimicrobial resistance to third-generation cephalosporins was detected in 48.4% of all Enterobacterales. Antimicrobial resistance to carbapenems was detected in 71.3% of all non-fermentative Gram-negative bacteria. Of the all isolates tested, 25.1% were found to be multidrug-resistant (MDR).

CONCLUSION

This study found a high prevalence of HAIs; those caused by MDROs varied widely depending on the bacterial species, antimicrobial group, and geographical region of Ukraine. MDROs were one of the main causes of HAI-associated deaths.

The quality of professional practices in infection control programs in Brazil: a cross-sectional study

ABSTRACT Objective To analyze the quality of professional practices in infection control programs regarding structure, process, and outcome. Method This is a quantitative, descriptive, and cross-sectional study carried out in 114 hospital infection control services in the five official regions of Brazil. The data were collected using a structured instrument whose psychometric properties were previously validated. Data treatment was performed by principal component analysis and non-parametric Kruskal-Wallis test. Results The best quality index of infection control programs was attributed to the South region, to hospitals that had 300 beds or more, to those that used the National Healthcare Safety Network criterion for infection surveillance and to places that carried out an active prospective search as their surveillance method. Conclusion and implications for practice: The quality of infection control programs is related to hospital location, size, and infection surveillance method. The creation of a quality index, hitherto unheard of in Brazilian studies, draws attention to the precarious performance of health services.

Ozone Disinfection for Elimination of Bacteria and Degradation of SARS-CoV2 RNA for Medical Environments

Pathogenic bacteria and viruses in medical environments can lead to treatment complications and hospital-acquired infections. Current disinfection protocols do not address hard-to-access areas or may be beyond line-of-sight treatment, such as with ultraviolet radiation. The COVID-19 pandemic further underscores the demand for reliable and effective disinfection methods to sterilize a wide array of surfaces and to keep up with the supply of personal protective equipment (PPE). We tested the efficacy of Sani Sport ozone devices to treat hospital equipment and surfaces for killing Escherichia coli, Enterococcus faecalis, Bacillus subtilis, and Deinococcus radiodurans by assessing Colony Forming Units (CFUs) after 30 min, 1 h, and 2 h of ozone treatment. Further gene expression analysis was conducted on live E. coli K12 immediately post treatment to understand the oxidative damage stress response transcriptome profile. Ozone treatment was also used to degrade synthetic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA as assessed by qPCR CT values. We observed significant and rapid killing of medically relevant and environmental bacteria across four surfaces (blankets, catheter, remotes, and syringes) within 30 min, and up to a 99% reduction in viable bacteria at the end of 2 h treatment cycles. RNA-seq analysis of E. coli K12 revealed 447 differentially expressed genes in response to ozone treatment and an enrichment for oxidative stress response and related pathways. RNA degradation of synthetic SARS-CoV-2 RNA was seen an hour into ozone treatment as compared to non-treated controls, and a non-replicative form of the virus was shown to have significant RNA degradation at 30 min. These results show the strong promise of ozone treatment of surfaces for reducing the risk of hospital-acquired infections and as a method for degradation of SARS-CoV-2 RNA.

INFECTIONS ASSOCIATED WITH OBSTETRIC AND GYNECOLOGICAL SURGERIES AS A CAUSE OF FEMALE INFERTILITY IN UKRAINE

OBJECTIVE

The aim: To assess the role of surgical site infections types associated with obstetric and gynecological surgeries as a cause of infertility among women reproductive age in Ukraine.

PATIENTS AND METHODS

Materials and methods: We conducted a retrospective multicentre cohort study was based on reproductive health surveillance data among women reproductive age from 2019 to 2021. Definitions of infertility were used from the WHO and surgical site infections were used CDC/ NHSN.

RESULTS

Results: Among all the 3,825 of infertility women in this study, the prevalence of surgical site infection (SSI) was 67.9%. The prevalence of SSI among primary infertility group and secondary infertility group women was 67.5% and 71.4%, respectively. There were differences among SSI type associated with infertility, primary infertility and secondary infertility. In logistic multivariate regression analyses, infertility was associated history of induced abortion (p < 0.001), history of obstetric and gynecological surgeries (p < 0.001), Salpingitis (p < 0.001), Oophoritis (p < 0.001), Endometritis (p < 0.001), Adnexa utery (p=0.009), and Pelvic abscess or cellulitis (p=0.043). The main factors associated with primary infertility were history of Salpingitis (33.6%) and Oophoritis (28.2%) after gynecological surgery. A factors associated with secondary infertility were history of Endometritis (27.2%), Pelvic abscess or cellulitis (11.2%), Salpingitis (10.1%), Adnexa utery (9.4%), Oophoritis (4.8%), and Chorioamnionitis (3.9%).

CONCLUSION

Conclusions: One of the main causes of infertility in women of reproductive age in Ukraine are SSIs after obstetric and gynecological surgeries, and induced abortion. This applies to both primary and secondary infertility group women's in this cohort study.

Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees

Aim

Millions of Ukrainian children have been internally displaced or fled to other countries because of the Russian war. This systematic review focused on their health needs and future challenges for clinicians.

Methods

A systematic literature search of the Medline, Embase and MedRxiv databases from 1 January 2010 to 31 March 2022 identified 1628 papers on the health of Ukrainian children and 112 were relevant to this review.

Results

In 2019, under‐5 mortality was 8 per 1000 live births in Ukraine. Underweight and adverse childhood experiences, including child abuse, were frequent compared to other European countries, while childhood obesity seemed less common. Alcohol consumption was common in women of reproductive age, including during pregnancy, risking foetal alcohol syndrome. Neonatal screening programmes provided low coverage. Vaccine hesitancy was common and vaccination rates were low. Other concerns were measles, HIV, antibiotic resistance and multi‐resistant tuberculosis. Many children are expected to suffer from psychological and physical trauma due to the war. Other healthcare challenges include low COVID‐19 vaccination rates and a preference for secondary and tertiary care, rather than primary care. Many people cannot afford medication.

Conclusion

Ukrainian children often have poor health and host countries need to be aware of their needs.

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.

PREVALENCE OF HEALTHCARE-ASSOCIATED CERVICITIS AND ANTIMICROBIAL RESISTANCE OF THE RESPONSIBLE PATHOGENS IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2019-2021)

OBJECTIVE

The aim: To obtain the first estimates of the current prevalence of healthcare-associated cervicitis (HACs) and antimicrobial resistance of responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and methods: We conducted a retrospective multicentre cohort study was based on surveillance data from January 1st, 2019 to December 31st, 2021 in Ukraine. Antibiotic susceptibility testing was determined by Kirby-Bauer disc diffusion test according to the protocol of the European Committee on Antimicrobial Susceptibility Testing.

RESULTS

Results: Of the 6,885 participants in this study, 1746 women (25.5%) met the clinical definition of cervicitis. Prevalence of HACs and cervcits caused sexually transmitted pathogens were 12.7% and 8.3%, respectively. The incidence of HACs among women with a history of gynecological procedures was 25.4%. The main causes of HACs were legal induced abortions (28.8%), vaginal hysterectomy (23.9%), and postpartum instrumental examination (12.8%). The predominant pathogens of HACs were: Escherichia coli, Enterobacter spp., Klebsiella spp., Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis. Methicillin-resistance was observed in 20.8% of S. aureus (MRSA). Vancomycin resistance was observed in 7.4% of isolated enterococci (VRE). Resistance to third-generation cephalosporins was observed in 13.1% Klebsiella spp. and E.coli 17.5% isolates. Carbapenem resistance was identified in 11.6% of P.aeruginosa isolates. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (33.5%, vs 8.7%). The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 34.6%.

CONCLUSION

Conclusions: This study showed that the prevalence of healthcare-associated cervicitis in Ukraine is high, and many cases were caused by antibiotic-resistant pathogens.

Application of a Novel PM Model to Assess the Risk of Clostridioides difficile Infections in Medical Facilities as a Tool for Improving the Quality of Health Services and the Safety of Patients

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient's health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital's technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient's stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment.

Increased Involvement of Klebsiellapneumoniae and Enterococcusfaecium in Healthcare-Associated Infections of Intensive Care Units in Taiwan

Background: Healthcare-associated infections (HAIs) cause increases in length of stay, mortality, and healthcare costs. A previous study conducted in Taiwan obtained similar results to those reported in Korea and Japan in 2015. Changes in microorganisms have been noted in recent years. Understanding the recent condition of HAIs in intensive care units (ICUs) can enable healthcare providers to develop effective infection control protocols to reduce HAIs. Methods: We used the Taiwan Nosocomial Infection Surveillance System to evaluate the incidence densities of HAIs, the proportions of causative pathogens, and the proportions of antimicrobial resistance (AMR). The Poisson regression model was constructed to incidence density, and the chi-square test was used to assess proportion. Results: The incidence density of HAIs decreased 5.7 to 5.4 per 1000 person-days. However, the proportions of Klebsiella pneumoniae and Enterococcus faecium significantly increased. In addition, the proportions of carbapenem-resistant K. pneumoniae and vancomycin-resistant Enterococcus faecium significantly increased over time. Conclusion: Analysis of the microorganisms involved in HAIs in ICUs showed elevated proportions of K. pneumoniae and E. faecium with AMR. Infection control protocols have been implemented for several years and require improvements regarding environmental cleanliness and medical staff prevention.

Intensive animal farming operations and outbreaks of zoonotic bacterial diseases in Ukraine

In Ukraine zoonoses are a permanent threat to human health, some of them are bacterial diseases associated with farm animals. Complete avoidance of outbreaks of bacterial zoonoses is not possible but it is appropriate to study them to reduce the risks of transmission of zoonosis pathogens from industrial farms to the human population and the environment. The article highlights the results of a literature review on the potential role of industrial livestock farms in the spread of major bacterial zoonoses in Ukraine. About half of all of the country’s farmed animals are kept on farms using industrial technology; more than half of the establishments are classified as medium and large. The technology of keeping animals on such farms contributes to the development of diseases of obligate hosts caused by fecal bacteria. The systematic search and selection of literary sources, which are relevant to the topic of the study were carried out. The vast majority of analyzed publications are published in Ukrainian in local peer-reviewed scientific journals. An analysis of open-access official statistics from the state authorities of Ukraine was also conducted. The authors analyzed statistics and scientific papers published over the last 10–15 years discussing the outbreaks of food-borne zoonoses among humans and the studying their pathogens (Campylobacter spp., Salmonella spp., Escherichia coli (STEC strains), Listeria spp.) on industrial livestock farms. The main source of Campylobacter spp. and Salmonella spp. distribution are industrial poultry, including broilers and chickens, respectively. The STEC strains E. coli carriers are various types of farm animals, including cattle and pigs. The majority of infections documented in Ukraine are cases of salmonellosis in humans and animals. Despite reports of a significant prevalence of campylobacteriosis, colibacillosis and listeriosis in livestock farms, their association with outbreaks of food-borne zoonoses in humans remains poorly understood. The concept of an industrial livestock farm involves a permanent presence of a risk of outbreaks of bacterial zoonoses and their rapid spreading to the human population. This is due to concentrated maintenance of animals, standardized feeding, the priority of achieving the highest productivity of animals and economic indicators. Under such conditions, disturbance of hygienic norms and technologies significantly increases the risk of bacterial zoonoses on industrial farms. It is important to enforce the continuous control of the level of microbial pollution of farms, animal health, hygiene of milk production and processing, meat, eggs, etc. Farms have a negative impact on the ecological welfare of the surrounding territories. The problem of spread of antibiotic-resistant strains of bacterial zoonoses is a very serious one. Efforts for the formation of a national system of epidemiological supervision over bacterial zoonoses, comprising epidemiological, epizootological, ecological, microbiological, serological and molecular genetic monitoring, as well as the development on this basis of effective prophylactic and anti-epidemic measures are relevant and necessary.

Phenotypic and genotypic characterization of antibiotic resistance in military hospital-associated bacteria from war injuries in the Eastern Ukraine conflict between 2014 and 2020

BACKGROUND

Infections from the recent conflict in Ukraine have been poorly investigated.

AIM

To describe the phenotypic and genotypic mechanisms of antibiotic resistance in pathogens associated with war injuries in the Ukraine conflict.

METHODS

This report describes a retrospective multi-centre microbiological survey conducted in four Ukrainian military hospitals between 2014 and 2020. The phenotypes of 813 organisms obtained from 1061 tests of 162 patients were analysed. Fifty-two isolates underwent whole-genome sequencing.

FINDINGS

Resistance was highest in Acinetobacter baumannii, with 92.5% ((48/52) 95% confidence interval (CI) 81.8-97.9) resistant to fluoroquinolones, 83.0% ((43/52) 95% CI 70.2-91.9) resistant to aminoglycosides, and 67.9% ((37/52) 95% CI 53.7-80.1) resistant to carbapenems. In contrast, resistance to carbapenems was 55.6% ((30/52) 95% CI 41.4-69.1) in Pseudomonas aeruginosa, 42.9% in Escherichia coli ((12/28) 95% CI 24.5-62.8), and 32.8% in Klebsiella pneumoniae ((20/34) 95% CI 21.3-46.0). Multi-drug-resistant strains harboured an abundance of antibiotic resistance genes. K. pneumoniae co-produced class A and D β-lactamases, in one case with blaNDM-1 and rmtC 16S rRNA methyltransferase. A. baumannii carried class A and D β-lactamases but not metallo-β-lactamases; in four isolates, carbapenemases were present with the RmtASE gene armA. P. aeruginosa harboured a wide range of class A and D β-lactamases along with metallo-β-lactamases, as well as the RmtB4 RmtASE gene. Gram-positive cocci were generally sensitive to the tested antibiotics.

CONCLUSION

The incidence of resistance among the studied pathogens was higher than that in Ukrainian civilian hospitals and European countries. The discovery of P. aeruginosa, A. baumannii, and K. pneumoniae co-producing carbapenemases and RmtASEs is of particular importance, and hospitals should be vigilant for their emergence.

Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture

Data on comprehensive population-based surveillance of antimicrobial resistance is lacking. In low- and middle-income countries, the challenges are high due to weak laboratory capacity, poor health systems governance, lack of health information systems, and limited resources. Developing countries struggle with political and social dilemma, and bear a high health and economic burden of communicable diseases. Available data are fragmented and lack representativeness which limits their use to advice health policy makers and orientate the efficient allocation of funding and financial resources on programs to mitigate resistance. Low-quality data means soaring rates of antimicrobial resistance and the inability to track and map the spread of resistance, detect early outbreaks, and set national health policy to tackle resistance. Here, we review the barriers and limitations of conducting effective antimicrobial resistance surveillance, and we highlight multiple incremental approaches that may offer opportunities to strengthen population-based surveillance if tailored to the context of each country.

Construction and validation of instrument to assess the quality of infection control programs

OBJECTIVE

To build and validate an instrument to assess hospital infection control programs.

METHOD

Methodological study that was developed in seven stages. The instrument items were categorized into the structure, process and result components. 10 expert judges participated, who evaluated the psychometric properties and validated the content using the Likert scale. The pre-test was carried out with 98 health professionals, from April to July 2018. For reliability analysis, Cronbach's alpha test was used.

RESULTS

Regarding the content validity index, the score made by expert judges ranged from 0.777 to 1.00, with mean of 0.902 (± 0.076). The Cronbach's alpha test showed good internal consistency of the items (0.82).

CONCLUSION

An instrument to assess hospital infection control programs was developed and validated, which showed good reliability and can be efficiently used at national level.

Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Benin

BACKGROUND

Surgical site infections are related to high morbidity, mortality and healthcare costs. Because the emergence of multidrug-resistant bacteria in hospitals is becoming a worldwide challenge for surgeons who treat healthcare-associated infections, we wished to identify the causative agents involved in these infections and the rate of multidrug-resistant bacteria in six public hospitals in Benin.

METHODS

Using standard microbiological procedures, we processed pus specimens collected from obstetrics and gastrointestinal surgery wards. Mass spectrometry (MALDI-TOF) was used for confirmation. For the antibiotic susceptibility test, we first used the Kirby-Bauer disk diffusion method. The secondary test (by microdilution) used the Beckton Dickinson Phoenix automated system (Becton Dickinson Diagnostic, USA).

RESULTS

We included 304 patients, whose median length of stay was 9 days. A total of 259 wound swabs (85.2%) had positive aerobic bacterial growth. In obstetrics, S. aureus (28.5%, n = 42) was the most common isolate. In contrast, Gram-negative bacteria (GNB) were predominant in gastrointestinal surgery, the most dominant being E.coli (38.4%, n = 31). Overall, 90.8% (n = 208) of aerobic bacteria were multidrug resistant. Two-thirds of S. aureus (65.3%, n = 32) were methicillin-resistant Staphylococcus aureus (MRSA), three of which carried both MRSA and induced clindamycin resistance (ICR). GNB showed high resistance to ceftazidime, ceftriaxone and cefepime. Extended-spectrum beta-lactamases were presented by 69.4% of E.coli (n = 43/62) and 83.3% of K. pneumoniae (n = 25/30). Overall, twelve Gram-negative bacteria (5.24%) showed resistance to at least one carbapenem. No isolates showed a wild-type susceptible phenotype.

CONCLUSION

This study shows the alarming prevalence of multidrug-resistant organisms from surgical site infections in Benin hospitals. To reduce the spread of such bacteria in Benin, periodic surveillance of surgical site infections and strict adherence to good hand-hygiene practice are essential.

Healthcare Associated Infections-A New Pathology in Medical Practice?

Background: Hospital-acquired infections (HAI) contribute to the emotional stress and functional disorders of the patient and in some cases, can lead to a state of disability that reduces quality of life. Often, HAI are one of the factors that lead to death. The purpose of this study was to analyze the cases of HAI identified in public hospitals at the county level, through case report sheets, as they are reported according to the Romanian legislation. Methods: We performed a cross sectional study design based on the case law of the data reported to the Mures Public Health Directorate, by all the public hospitals belonging to this county. We tracked hospital-acquired infections reported for 2017-2018, respectively, a number of 1024 cases, which implies a prevalence rate of 0.44%, 1024/228,782 cases discharged from these hospitals during the studied period. Results: The most frequent HAIs were reported by the intensive care units (48.4%), the most common infections being the following: bronchopneumonia (25.3%), enterocolitis with Clostridioidesdifficile (23.3%), sepsis, surgical wound infections and urinary tract infections. At the basis of HAI were 22 pathogens, but the five most common germs were Clostridioidesdifficile, Acinetobacterbaumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Bronchopneumonia have been most frequently reported in intensive care units, the most common being identified the Acinetobacterbaumannii agent. Sepsis and central catheter infections also appeared predominantly in intensive care units, more often with Klebsiella pneumoniae. The enterocolitis with Clostridioidesdifficile, were the apanage of the medical sections. Infections with Staphylococcus aureus have been identified predominantly in the surgical sections at the level of the surgical wounds. Urinary infections had a similar distribution in the intensive care units, the medical and surgical sections, with Klebsiella pneumoniae being the most commonly incriminated agent. Conclusions: We showed a clear correspondence between the medical units and the type of HAI: what recommends the rapid, vigilant and oriented application of the prevention and control strategies of the HAI.