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.

HEALTHCARE ASSOCIATED DEEP PELVIC TISSUE INFECTION AND OTHER INFECTIONS OF THE FEMALE REPRODUCTIVE TRACT IN UKRAINE.

OBJECTIVE: The aim: To obtain the first estimates of the current prevalence of healthcare-associated deep pelvic tissue infection and other infections of the female reproductive tract (vagina, ovaries, uterus) including chorioamnionitis, and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population included 3,053 women's who underwent gynecological surgery or other procedures from 2017 to 2019 in 7 women hospitals in Ukraine. Definitions of healthcare-associated reproductive tract infection were used from the CDC/ NHSN. RESULTS: Results: The prevalence of healthcare-associated deep pelvic tissue infection and other infections of the female reproductive tract was 26.3%. Incidence of infection was: 13.3% Pelvic abscess or cellulitis, 14.6% Adnexa utery, 9.5% Salpingitis, 7.1% Oophoritis, 12.2% Parametritis, 4.6% Chorioamnionitis, and 38.8% Bacterial Vaginitis. The predominant pathogens were: Escherichia coli (25.6%), Enterobacter spp. (11.4%), Klebsiella pneumoniae (10.6%), Staphylococcus aureus (8.5%), Enterococcus faecalis (7.2%) and Pseudomonas aeruginosa (7.1%). Methicillin-resistance was observed in 14.3% of S. aureus (MRSA). The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 20.8%. The prevalence of ESBL production among E. coli isolates was 24.7% and among K. pneumoniae 11.9%. Resistance to thirdgeneration cephalosporins was observed in 12.8% E.coli and 9.2% K. pneumoniae isolates. Carbapenem resistance was identified in 8.5% of P.aeruginosa isolates. CONCLUSION: Conclusions: Healthcare associated deep pelvic tissue infection and other infections of the female reproductive tract in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics.

Prevalence of postpartum endometritis and antimicrobial resistance of responsible pathogens in ukraine: results a multicenter study (2015-2017).

OBJECTIVE: The aim: To obtain the prevalence of postpartum endometritis women and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a retrospective multicenter cohort study. The study population consisted of all women who had a vaginal delivery or cesarean section in 14 Regional Women's Hospitals of Ukraine. RESULTS: Results: Total 2460 of 25,344 patients were found to have postpartum endometritis, for an overall infection rate of 9.7%. The postpartum endometritis rates were 7.6% after vaginal delivery and 16.4% after cesarean section. Incidence of postpartum endometritis after cesarean section is affected mainly by the mode of delivery (scheduled caesarean deliveries (done before labor starts) - 13.8% and unscheduled caesarean deliveries (done after labor starts) - 22.5%. The predominant pathogens were: Escherichia coli (32.7%), Enterococcus faecalis (13.0%), Streptococcus spp. (12.1%), Klebsiella spp. (10.4%) and Enterobacter spp. (10%). Among the antimicrobial agents tested, the ertapenem, piperacillin/tazobactam, and cefotaxim were the most consistently active in vitro against Enterobacteriaceae in both vaginal deliveries and after cesarean section infections. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 22.8% and of methicillin-resistance in Staphylococcus aureus (MRSA) 15.4%. CONCLUSION: Conclusions: Postpartum endometritis and antimicrobial resistance of responsible pathogens presents a significant burden to the hospital system. Postpartum infections surveillance is required in all women's hospitals. This knowledge is essential to develop targeted strategies to reduce the incidence of postpartum infections.