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.

PERINATAL INFECTIONS IN UKRAINE: RESULTS OF A MULTICENTER STUDY.

OBJECTIVE: The aim: To obtain the estimates of the сurrent incidence rate of perinatal infections, risk factors, as well as their associated impact on mortality and determine the antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a multicentre retrospective cohort study was based on surveillance data. This study included infants aged 0 to 6 days delivered in 2017-2019 at 11 Ukrainian regional perinatal centers. Definitions of perinatal infections and mortality were used from the CDC/WHO/UNICEF. RESULTS: Results: Of 18,348 liveborn infants, 472 (2.6%) perinatal infections were detected. The incidence of perinatal infection was 25.7 per 1000 live births. The most frequently identified types of infections were: bloodstream infections, 35.6 %, lower respiratory tract infections, 21.4%, Meningitis, 18.2%, Conjunctivitis, 11.9%, skin and soft tissue infections, 6.6%, Dacryocystitis, 3.8%, and urinary tract infections, 2.5%. Early mortality rates from perinatai infections was 51.1%, with an incidence of 13.1 deaths/1000 live births. Potential risk factors the development of perinatal infections and mortality were low birth weight, prematurity, low gestasional age, mode of delivery (manual aid), premature rupture of membranes, preterm premature rupture of membranes, prolonged rupture of membranes, turbid and meconeal amniotic fluid, infection of the mother during labor. resuscitation during delivery, invasive procedure, asphyxia. Main causative agents of perinatal infections were Escherichia coli, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, CoNS, Enterobacter cloacae, Pseudomonas aeruginosa. CONCLUSION: Conclusions: This study showing that the high incidence rate of perinatal bacterial infections, as well as their associated impact on mortality, and presents a significant burden to the Ukraine.

SURGICAL SITE INFECTION AFTER CESAREAN SECTION IN UKRAINE: RESULTS A MULTICENTER STUDY.

OBJECTIVE: The aim: To obtain the first national estimates of the current prevalence rate of SSI after CSEC and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a retrospective multhicentre cogort study based surveillance data was conducted from May 2017 to December 2019. The study population consisted of all women who had a cesarean section in 11 regional women hospitals of Ukraine. Definitions of SSI after cesarean section were used from the CDC/ NHSN. RESULTS: Results: A total of 2 326 CSEC operations and 14.7% SSI were identified within 30 days of the operation. Of these, 44.4% were superficial incisional SSI, 28.9% were deep incisional SSI, and 26.6% were organ/space SSI, 25.7% of which were classed as endometritis. Of all cases 70.5% of infections were detected post discharge. The most commonly identifed pathogen were Staphylococcus aureus (23.5%), Escherichiacoli (20%), Coagulase-negative staphylococci (8.1%), Enterococcus spp. (7.7%), Pseudomonasaeruginosa (7.7%), Enterobacter spp. (6.4%), and Streptococcus spp. (5.6%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 18.3% and of methicillin-resistance in S. aureus(MRSA) 13.9%. Resistance to third-generation cephalosporins was observed in 15.2% E.coli and 7.9% Klebsiellapneumoniae isolates. Carbapenem resistance was identified in 7.3% of P.aeruginosa isolates. CONCLUSION: Conclusions: The results of this study revealed high rates of SSI after CSEC and most causing pathogens were associated with resistant to antibiotic stranis. This knowledge is essential to develop targeted strategies to surveillance and reduce the incidence of postoperative infections.

BACTERIAL INFECTION CAUSES OF PREGNANCY LOSS AND PREMATURE BIRTH IN THE WOMEN IN UKRAINE.

OBJECTIVE: The aim: To find out whether or not the presence of pregnancy loss and preterm birth was associated with the history of healthcare-associated infection (HAI) of women reproductive tract. PATIENTS AND METHODS: Materials and methods: We performed a retrospective cohort study was based on surveillance data. This study included 1,027 fertile women aged 21-50 years admitted to 8 hospitals from 2017-2019 with complaints to pregnancy loss or preterm birth. Definitions HAI of women reproductive tract were used from the CDC/ NHSN. RESULTS: Results: Of 1,027 fertile women with complaints to pregnancy loss or preterm birth, 702 (68.4%) HAIs of reproductive tract were detected. The predominant HAIs were: postpartum endometritis (19.1), bacterial vaginitis (15.8%), chorioamnionitis (11.3%), vaginal cuff infection (9.1%), and parametritis (5.6%). According to the statistical data, a significant association between HAI of women reproductive tract and the history of pregnancy loss (p < 0.05) was determined. The presence of HAI had no effect on the first trimester miscarriage (p > 0.05), but HAI women reproductive tract had strongly affected the second trimester pregnancy losses (p < 0.05). Main causative agents of HAI were Escherichia coli (31.5%), Enterobacter spp. (18.4%), Klebsiella pneumoniae (12.5%), Enterococcus faecalis (11.6%),Staphylococcus aureus (10.2%), Pseudomonas aeruginosa (8.4%). CONCLUSION: Conclusions: This study identified a significant association between healthcare-associated infection of women reproductive tract and a history of miscarriage. However, there was no association between HAI and a history of preterm birth.