RESUMEN
Objective of the research - to specify respiratory tract bacterial microflora in patients suffering from community-acquired pneumonia (CAP) during initial and repeat examination. To determine local factors affecting microflora in the cohort examined. Materials and methods. Surveillance subject - 241 patients with CAP differed by their status and age who stayed in two healthcare facilities of the Khabarovsk city. Examination of respiratory smears was performed. Results. Indices of Gram-negative enterobacteria (30.8% [22.6-39.7%]) and Gram-negative nonfermentable bacteria (14.5% [8.6-21.7%]), isolated from patients hospitalized in healthcare institution No. 1 and mostly comprised of the elderly (aged over 61 years - 82.0%;74.3-88.6%) with more severe disease state including patients at the ICU, were higher compared to data obtained from healthcare institution No. 2 (19.8% (13.4-27.0);6.1% (2.7-10.8) respectively). Prevalent pathogen was Klebsiella pneumoniae - 13.6% (7.8-20.6) and 10.7% (6.0-16.5). Identification of Acinetobacter baumannii complex 6.4% (2.6-11.7) and 3.1% (0.8-6.7) - should be also noted. A high percentage of drug-resistant bacterial variants was observed and for Klebsiella pneumoniae totaled 66.7% (41.8-87.4) and 57.1% (32.2-80.2) at the healthcare institutions No. 1 and No. 2, respectively. A. baumannii complex drug resistant variants were found in 85.7% (52.7-99.97) at healthcare institution No. 1. All isolates of A. baumannii complex at the healthcare institution No. 2 were drug resistant. High prevalence of Candida spp. was revealed in both healthcare institutions reaching 54.5% (45.2-63.7) and 58.0% (49.5-66.3), respectively, with minimal detection rate of classic pathogens such as S. pneumoniae - 5.4% (2.0-10.4) and 5.3% (2.1-9.8) and H. influenzae - 3.6% (0.9-7.9) and 3.8% (1.2-7.7), respectively. Repeat examination of 122 patients conducted 7-10 days later showed diverse changes in microflora spectrum regardless of the healthcare institution that was manifested as loss or emergence of drug-resistant variants as well as simultaneous presence of different variants of the same pathogen. Conclusion. The results obtained evidence about complexity and variety of mechanisms underlying microorganism community formation during the course of infectious process in patients. Local factors influencing microflora characteristics of patients at the two healthcare institutions were revealed.
RESUMEN
Microbiological monitoring after infectious diseases in the system of epidemiological surveillance implies simultaneous pathogen identification both among patients and in hospital environment. Our aim is to assess potential hospital environmental hazard for the two in-patient infectious disease hospitals of the Khabarovsk city by using bacteriological and epidemiological analysis during new coronavirus disease pandemic. Materials and methods. Bacteriological assessment of nasopharyngeal microflora in 241 patients suffering from community-acquired pneumonia that were hospitalized in the two prevention and treatment facilities of the Khabarovsk city was performed. Sanitary-bacteriological control of hospital environment (428 hospital environment samples and 91 air samples) was carried out in parallel. Bacteriological assessment was performed with classical methods. Identification of isolated bacteriological pathogens and evaluation of drug-resistant strains were carried out by utilizing bacteriological analyzer Vitek 2 Compact. Results. Nine different pathogens (Pseudomonas aeruginosa, Pseudomonas stutzeri, Acinetobacter baumannii, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus) were isolated in 20 out of 428 samples - 4.7% [2.7-6.7]. Half of isolated agents - 2.3% [0.9-3.8] - were represented by drug-resistant isolates (10 out of 20 isolates) including 5 carbapenem-resistant isolates (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae) and 5 isolates with multiple drug resistance (Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus). Air samples contained pathogenic biological agents found in 6 out of 91 samples - 6.6% [1.5-11.7], and half of them - 3.3% [0.6-7.9] - were identified as drug-resistant variants, including S. aureus. S. haemolyticus. One of the surveyed hospitals was recognized as more hazardous due to microflora isolated from intensive care unit (A. baumannii and P. aeruginosa were resistant to 3rd- 4th generation cephalosporins and carbapenems). Conclusion. Revealed circulation of wide range of microorganisms isolated from environment of two in-patient hospitals indicates high risk of healthcare-associated infections formation. Intensive care units can serve as a reservoir of healthcare-associated infections due to high percentage of patients with severe disease cases ("main reservoir" of drug-resistant strains).
RESUMEN
Microbiological monitoring after infectious diseases in the system of epidemiological surveillance implies simultaneous pathogen identification both among patients and in hospital environment. Our aim is to assess potential hospital environmental hazard for the two in-patient infectious disease hospitals of the Khabarovsk city by using bacteriological and epidemiological analysis during new coronavirus disease pandemic. Materials and methods. Bacteriological assessment of nasopharyngeal microflora in 241 patients suffering from community-acquired pneumonia that were hospitalized in the two prevention and treatment facilities of the Khabarovsk city was performed. Sanitary-bacteriological control of hospital environment (428 hospital environment samples and 91 air samples) was carried out in parallel. Bacteriological assessment was performed with classical methods. Identification of isolated bacteriological pathogens and evaluation of drug-resistant strains were carried out by utilizing bacteriological analyzer Vitek 2 Compact. Results. Nine different pathogens (Pseudomonas aeruginosa, Pseudomonas stutzeri, Acinetobacter baumannii, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus) were isolated in 20 out of 428 samples — 4.7% [2.7–6.7]. Half of isolated agents — 2.3% [0.9–3.8] — were represented by drug-resistant isolates (10 out of 20 isolates) including 5 carbapenem-resistant isolates (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae) and 5 isolates with multiple drug resistance (Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus). Air samples contained pathogenic biological agents found in 6 out of 91 samples — 6.6% [1.5–11.7], and half of them — 3.3% [0.6–7.9] — were identified as drug-resistant variants, including S. aureus и S. haemolyticus. One of the surveyed hospitals was recognized as more hazardous due to microflora isolated from intensive care unit (A. baumannii and P. aeruginosa were resistant to 3rd–4th generation cephalosporins and carbapenems). Conclusion. Revealed circulation of wide range of microorganisms isolated from environment of two in-patient hospitals indicates high risk of healthcare-associated infections formation. Intensive care units can serve as a reservoir of healthcare-associated infections due to high percentage of patients with severe disease cases (“main reservoir” of drug-resistant strains).
RESUMEN
Objective. Detection of additional factors favoring progression of COVID-19 and developing lethal outcomes in hospitalized patients. Materials and methods. Analysis of 98 medical records of lethal cases of patients that underwent hospitalization with diagnosis of COVID-19 associated pneumonia of two in-patient facilities of the Amur oblast and Khabarovsk krai was performed. Two groups were formed: first included medical records of patients hospitalized in severe condition (n = 52) and second group included patients with state of moderate severity (n = 46). Length of hospitalization stay, time from admission to the medical facility to progression of the disease, time from hospitalization to death and bacterial pathogens species composition isolated from lungs tissue autopsy material were analyzed. Statistical assessment of obtained data was performed with StatSoft Statistica 12.0. Results. Majority of patients of 1st and 2nd groups (66.7 ± 6.80% and 69.6 ± 6.78%) were hospitalized on fourth day of the COVID-19 clinical manifestations onset or later. Two thirds of patients hospitalized in severe condition progressed to critical health status on 1st–3rd day of hospitalization. Majority of second group patients (65.2 ± 7.02%) deteriorated from moderate severity to severe health condition on 4th–14th day of hospital stay. Bacteriological assessment analysis of autopsy material revealed that material obtained from first group showed more frequent absence of bacterial flora growth compared with second group both in the Amur oblast (44.4 ± 9.74% и 29.4 ± 11.39%) and in the Khabarovsk krai (в 40.0 ± 10.0% and 27.6 ± 8.45% of cases). Klebsiella pneumoniae (57.7 ± 5.86%) and Candida spp. (18.3 ± 4.59%) were revealed more frequently in the structure of diagnosed pathogens. Substantial proportion of pathogens (81.7 ± 4.59%) were isolated in autopsy material of patients which hospital stay was 4 days and longer. Prolonged hospital stay was associated with more frequent detection of K. pneumoniae and Candida spp. in patients that suffered from COVID-19 pneumonia and eventually died from the disease. With duration of hospitalization of 4 days and longer Acinetobacter baumannii – an extremely virulent pathogen with natural drug resistance was isolated from autopsy material. Conclusion. Factors influencing unfavorable outcomes of COVID-19 include signs of secondary bacterial infection as well as detection of aggressive drug-resistant bacterial microflora that most likely had nosocomial origin due to prolonged hospitalization. © 2021, Dynasty Publishing House. All rights reserved.