Temporal evolution of bacterial species and their antimicrobial resistance characteristics in wound infections of war-related injuries in Ukraine from 2014 to 2023.

BACKGROUND: This study continues surveillance of antimicrobial resistance associated with combat injuries in Ukraine. AIM: To compare species composition, antibiotic resistance profiles, and emergence of new resistance genes between 2014-2020 and 2022-2023. METHODS: Retrospective multicentre microbiological survey in Ukrainian hospitals. Antibiotic susceptibility, whole genome sequencing, and MLST typing were conducted on 154 organisms obtained from 125 casualties from 2022-2023. FINDINGS: The data reveals a predominance of gram-negative bacteria, particularly Acinetobacter baumannii (35.7%), Pseudomonas aeruginosa (14.9%), and Klebsiella pneumoniae (20.7%). High levels of carbapenem resistance was observed among A. baumannii (meropenem 72,2% [(39/54) 95% CI 58.4-83.5], imipenem 66.7% [(36/54) 95% CI 52.5-78.9]), Klebsiella (meropenem 90.6% [(29/32) 95% CI 75.0-98.0], imipenem 81.2% [(26/32) 95% CI 63.6-92.8]), and P. aeruginosa (meropenem 47.8% [(11/23) 95% CI 26.8-69.4], imipenem 60.8% [(14/23) 95% CI 38.5-80.3]) strains. A. baumannii ST-78 and ST-400 were prevalent from 2014 to 2020, while 5 strains of ST-1077 were newly identified. Pseudomonas aeruginosa strains showed diversity across 16 sequence types (STs), with ST-773 increasing in frequency and new STs emerging, but lacking carbapenemase genes. K. pneumoniae exhibited increased genetic diversity over time, with three STs from 2014 to 2020 and six new STs, including blaNDM-1, blaOXA-48, and blaKPC2 carriers, in recent years. CONCLUSION: There is a growing prevalence of multidrug resistant isolates from globally distributed sequence types.

The effect of local anesthetics against planktonic forms and film formation of S. aureus strains and its dependence on antiseptics activity.

Today surgical site infections (SSIs) remain the second among hospital acquired infections in Europe and the USA. Staphylococcus aureus as a pathogen of nosocomial infections occur more frequently in surgical hospitals. The work was aimed to establish the effect of local anesthetics against planktonic forms and biofilm-formation of S. aureus clinical strains and the relationship between the sensitivity of S. aureus strains to local anesthetics and antiseptics in vitro. The antimicrobial activity of local anesthetics (0.5%, bupivacaine, 2.0% lidocaine, 0.375% ropivacaine) and antiseptics (decamethoxine 0.02%, chlorhexidine 0.05%) against clinical strains of S. aureus was observed and studied their ability to produce biofilms. The antimicrobial effect of local anesthetics was lower compared to antiseptics, but we observed inhibition of growth and reproduction of S. aureus in their presence. The ropivacaine solution and the lidocaine solution demonstrated almost the same activity against the studied microorganism isolates. Along with this, bupivacaine solution had the highest activity against the studied microorganisms. The minimal inhibitory concentration of bupivacaine for S. aureus was 2.2 times lower than the minimal inhibitory concentration of lidocaine and 2.1 times lower than the minimal inhibitory concentration of ropivacaine significantly (p < 0.05). Scientific research on various aspects of the formation of bacterial biofilms is a relevant area that will change approaches to the prophylaxis and treatment of a number of infections, including SSIs.

Adjunctive inhaled amikacin in infants with Ventilator-Associated Pneumonia optimizes the complex antimicrobial therapy: pilot study.

BACKGROUND AND AIM: VAP remains the second leading cause of death among the patients with nosocomial infections and its incidence varies significantly from 5% to 60% reaching on average 10 %. It is of crucial importance to develop novel treatment approaches and optimize the existing ones. Thus, the aim of this pilot study was to study the laboratory-microbiological effect of inhaled aminoglycosides in a complex treatment of patients with ventilator-associatedpneumonia(VAP).  Methods: To study the laboratory-microbiological effect of adjunctive inhaled aminoglycosides in the treatment of VAP, twenty enrolled patients were randomly subdivided into 2 groups (n=10). Amikacin was administered via a nebulizer starting from the first day of VAP manifestation. Inhalations were performed BID for 7 days via a nebulizer integrated into the breathing circuit. We assessed: cell membrane alterations in leukocytes, Annexin V/7-AAD staining for leukocytes, ROS detection assay for leukocytes. RESULTS: Adjunctive administration of inhaled amikacin reduced the fluorescence intensity ratio more efficiently compared with the intravenous antimicrobial treatment with no aerosolized amikacin following both 48 h and 96 h of treatment. The amount of dead necrotic annexin V-negative, 7-AAD-positive leukocytes was significantly lower under the use of inhaled amikacin than at the beginning of treatment. Conclusions In this pilot study, we found that administration of aerosolized amikacin combined with the systemic antimicrobial therapy improves the clinical outcome of patients with VAP, effective early microbial decrease in the sputum, reduces reactive oxygen species generation in leukocytes and the degree of leukocyte apoptosis and necrosis, decreases VAP-mediated cell membrane alterations of circulating leukocytes.

Perioperative hemodynamic protective assessment of adaptive support ventilation usage in pediatric surgical patients.

BACKGROUND: The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. METHODS: The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). RESULTS: Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. CONCLUSIONS: In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions.

In vitro evaluation of the antimicrobial activity of antiseptics against clinical Acinetobacter baumannii strains isolated from combat wounds.

Healthcare-associated infections (HCAIs) are among the most prominent medical problems worldwide. In the context of increasing antibiotic resistance globally, the use of antiseptics as the main active agent and potentiator of antibiotics for the treatment of purulent-inflammatory complications of traumatic wounds, burns, and surgical wounds can be considered to tackle opportunistic infections and their prevention during war. This study presents a comparative investigation of the antimicrobial efficacy of antiseptics used for surgical antisepsis and antiseptic treatment of skin, mucous membranes, and wounds against multidrug-resistant clinical isolates of Acinetobacter baumannii as a wound pathogen of critical priority (according to the WHO). It was found that strains of A. baumannii, which have natural and acquired resistance to antimicrobial drugs, remain susceptible to modern antiseptics. Antiseptic drugs based on decamethoxine, chlorhexidine, octenidine, polyhexanide, and povidone-iodine 10% and 2% provide effective bactericidal activity against A. baumannii within the working concentrations of these drugs. Chlorhexidine and decamethoxine can inhibit biofilm formation by A. baumannii cells. In terms of bactericidal properties and biofilm formation inhibition, chlorhexidine and decamethoxine are the most effective of all tested antiseptics.

Optimization of the target strategy of perioperative infusion therapy based on monitoring data of central hemodynamics in order to prevent complications.

Enhanced Recovery After Surgery (ERAS) protocols are increasingly used in the perioperative period around the world. The concept of goal-directed fluid therapy (GDT) is a key element of the ERAS protocols. Inadequate perioperative infusion therapy can lead to a number of complications, including the development of an infectious process, namely surgical site infections, pneumonia, urinary tract infections. Optimal infusion therapy is difficult to achieve with standard parameters (e.g., heart rate, blood pressure, central venous pressure), so there are various methods of monitoring central hemodynamics - from invasive, minimally invasive to non-invasive. The latter are increasingly used in clinical practice. The current evidence base shows that perioperative management, specifically the use of GDT guided by real-time, continuous hemodynamic monitoring, helps clinicians maintain a patient's optimal fluid balance. The manuscript presents the analytical data, which describe the benefits and basic principles of perioperative targeted infusion therapy based on central hemodynamic parameters to reduce the risk of complications.

Dependence of the dynamics of changes in the quality of life of patients with bacterial vaginosis on local levels of TNF-α and IL-1ß.

BACKGROUND AND AIM: Bacterial vaginosis is among serious health problem for women of reproductive age which influences on their local changes in inflammatory mediators and quality of life. The aim was to assess the dependence of the dynamics of changes in the quality of life of patients with bacterial vaginosis on local levels of TNF-α and IL-1ß. METHODS: In the prospective study 37 women aged 19-40 years with bacterial vaginosis were treated according to the Centers for Disease Control and Prevention. Patients received vaginal suppositories of clindamycin phosphate (100 mg) once daily for 3 days before bedtime. TNF-α, IL-1ß levels in vaginal secretions by means of ELISA test), as well as the quality of life according to the RAND 36-Item Health Survey 1.0 were studied as in control group (once - to determine the reference values) and in the dynamics (the 1st day - before treatment, on the 7th day - after treatment) in the main group. RESULTS: After the treatment microscopy of smears-imprints of vaginal secretions showed the complete absence of pathological microflora. The treatment was well tolerated by all patients. In the result there was proved the role of bacterial vaginosis in a violation of the quality of life of patients mainly due to the mental component of health, even after clinical and laboratory recovery. CONCLUSIONS: There was proved the relation of vaginal TNF-α and IL-1ß with physical and mental health in patients with bacterial vaginosis which can have a prognostic significance of the disease.

Determination of CCL2 / MCP-1 levels in the serum of children with melanocytic nevus in the postoperative period after using different methods of surgical treatment.

To date, there are many methods and ways to remove pigmented skin tumors, which have their own indications and contraindications for use, early or late complications.The aim of the study was to determine the level of CCL2 / MCP-1 in the serum of patients with melanocyte skin nevi in the postoperative period with different methods of their removal.Materials and methods of research. The study involved 60 children with melanocyte skin nevi of different localization, who were hospitalized in the pediatric surgery clinic in the period from 2018 to 2020. All patients were divided into 3 groups : I group - the excision of the formation took place with a scalpel, group II - excision of the formation was performed using a high-intensity surgical laser, group III - excision of the formation using a high-frequency electrosurgical device "BOWA-ARC 350.Results and discussion. The results of studies showed an increase in the level of CCL2 / MCP-1 in the plasma of patients of group I in 2,6 times 12 hours after surgery and 3,15 times in 24 hours after surgery. A similar dynamics of increase in the level of CCL2 / MCP-1 in plasma was observed in patients of group II, but was more pronounced. The largest increase in CCL2 / MCP-1 levels was in comparison group III.Conclusions. High levels of CCL2 / MCP-1 in the plasma of patients of groups II and III 12 and 24 hours after surgery convincingly indicate the presence of a pronounced inflammatory reaction under the influence of thermal damaging factor on skin tissues.

Research of the activity of local anesthetics and antiseptics regarding clinical isolates of Acinetobacter baumannii as pathogens of postoperative infectious complications.

BACKGROUND: About 60% of all nosocomial infections are caused by microorganisms found in biofilms. Acinetobacter baumannii, as a pathogen of nosocomial infections, occur more frequently in surgical hospitals. The aim of the study was to study the in vitro formation of A. baumannii monotype biofilms under the influence of local anesthetics and antiseptics Materials and methods. The antimicrobial activity of local anesthetics (0.25-0.5%, bupivacaine, 2.0% lidocaine, 0.75% ropivacaine) and antiseptics (decamethoxine 0.1%, octenidine 0.1%, chlorhexidine 0.05%) ) against clinical strains of A. baumannii and studied their ability to produce biofilms. RESULTS: The bacteriostatic effect of local anesthetics on A. baumannii within the current concentrations of these drugs, which provide analgesic effect, has been proven. The given results indicate that A.baumanni cultures have a pronounced ability to form biofilms. Clinical strains of opportunistic microorganisms A. baumannii circulating in the hospital environment are highly sensitive to antiseptics decamethoxine and octenidine, chlorhexidine has a weak bactericidal effect against acinetobacteria. The results of studying the effect of local anesthetics on the process of formation of the strain "young" biofilms showed the presence of a dose-dependent effect. The greatest inhibitory activity against "young" biofilms was detected under the combined action of the antiseptic decamethoxine (in concentrations, not exceeding 3.9 µg / ml) and anesthetics (OD-0,199-0,223) (p <0,05). CONCLUSIONS: Scientific research on various aspects of the formation (or destruction) of bacterial biofilms is a relevant and promising area that will change approaches to the prophylaxis and treatment of a number of infections, including postoperative infectious complications.

BIOFILM FORMING ACTIVITY OF NON-FERMENTING GRAM-NEGATIVE BACTERIA.

OBJECTIVE: The aim: To study the influence of chemical, physical factors on the biofilm forming activity of P. aeruginosa, A. baumannii. PATIENTS AND METHODS: Materials and methods: Biofilm forming activity of P. aeruginosa (10 isolates) and A. baumannii (10 isolates) was studied in nutrient media of different composition. There was used the method in 96-well crystalline violet staining plates with spectrophotometry (STAT FAX®4300, wavelength of 620 nm). RESULTS: Results: Results showed that in standard medium (trypto-soy broth), strains of P. aeruginosa (90%) and A. baumannii (60%) obtained high biofilm forming activity. A. baumannii formed biofilms even in sterile water. Biofilm forming activity of urease positive P. aeruginosa increased in the medium with 1.0% urea. Both Acinetbacteria and Pseudomonas intensively produced their biofilms in the presence of 5% serum or sub-bacteriostatic concentrations of levofloxacin in the media. High concentrations of sodium chloride inhibited their biofilm activity. CONCLUSION: Conclusions: Isolates of Acinetobacter and Pseudomonas obtain the protective biofilm-forming ability under such adverse environmental conditions as insufficient nutrients, high osmotic pressure, the presence of antibiotics but at high concentrations sodium chloride biofilm-formation is stimulated only in the first bacteria and suppressed in the second one.

PROGNOSTIC PARAMETERS OF THE SUSCEPTIBILITY OF STAPHYLOCOCCUS SPP. TO AMINOGLYCOSIDES AND DOXYCYCLINE.

OBJECTIVE: The aim: To perform microbiological investigation and analytic mathematic prediction of clinical isolates of S. aureus to aminoglycosides in patients with severe burns. PATIENTS AND METHODS: Materials and methods: We analyzed resistance of 199 S. aureus strains to aminoglycosides (gentamicin, tobramycin and amikacin) and doxycycline from 435 patients treated in the regional hospital due to burns for the period from 2011-2017. RESULTS: Results: We created predictive curves for the prediction of susceptibility of S. aureus strains to aminoglycosides and doxycycline based on the changes in S. aureus resistance during the years of observation and expressed in mathematic equations. Susceptibility of S. aureus to gentamicin was 42.86 % at the end of observation and will decline in future. Despite tobramycin was efficient against 72.86 % of strains in 2017, mathematic modeling indicates rapid decline in its efficacy in future. Efficacy of amikacin was dropping during the last years, but according to the equation it efficacy will increase over 60 % in 2018. S. aureus susceptibility to doxycycline was 65.38 % in 2017 and mathematic modeling indicates its gradual decline in the nearest future. CONCLUSION: Conclusions: Predicitive values of S. aureus susceptibility indicates not sufficient efficacy of these drugs in patients with infectious complications of burns. Tendency of the slight decline of S. aureus susceptibility to doxycycline still indicates sufficient levels of its efficacy in the nearest future. This justify its use as a second-line therapy with the causative agent in patients with burns.

The research of antimicrobial efficacy of antiseptics decamethoxin, miramistin and their effect on nuclear DNA fragmentation and epithelial cell cycle.

OBJECTIVE: Introduction: Nowadays, the study of biological safety of modern cationic surface-active antiseptics with a wide antimicrobial spectrum has acquired particular importance. The aim was to study antimicrobial effectiveness of antiseptics decamethoxin, miramistin and their influence on nuclear DNA fragmentation and cellular cycle. PATIENTS AND METHODS: Materials and methods: A comparative microbiological study of antimicrobial efficacy and a cytometric study of the effect of decamethoxin 0,02% and miramistin 0,01% on the cellular cycle were carried out. Antimicrobial activity of decamethoxin and miramistin was estimated by their minimal inhibitory and minimal microbicidal concentrations against opportunistic microorganisms using serial double dilution technique. Decamethoxin and miramistin cytotoxicity on anterior corneal epithelial cells, after their two-week daily instillation into the eyes of a Vistar line male rats was studied using flow cytometry. The parameters of epithelial cellular cycle, nuclear DNA fragmentation and apoptosis under the influence of antiseptics were registered. RESULTS: Results: High antimicrobial effect of decamethoxin and miramistin against Gram-positive, Gram-negative bacteria with the significant advantages of decamethoxin were found (р<0,001). Decamethoxin caused minimal influence on anterior corneal epithelial cells, the insignificant decrease of their proliferation index, low increase of apoptosis (0.68%), no difference of mitotic activity (p>0.05). But the use of miramistin resulted in the significant increase of nuclear DNA fragmentation, decrease of proliferative activity (р<0.05). CONCLUSION: Conclusions: Higher antimicrobial effect against a wide range of opportunistic pathogens is proved in decamethoxin 0,02% comparably to miramistin 0,01% (р<0,001). In prolonged antiseptic use of the first one there were found no cytotoxic and no pro-apoptotic effects on the epithelium (р<0,05).

The analytical prognosis of the susceptibility to aminoglycosides and doxycycline inacinetobacter baumanniiisoolated from burns of intensive care unit patients.

OBJECTIVE: Introduction: Clinical strains of A.baumannii are becoming highly important in hospital-acquired infections, especially because of their association with low susceptibility to antibiotics, which requires in-depth study with a prognostic determination of the dynamics of antimicrobial efficacy of antibiotics. The aim was to investigate of prognostic models of aminoglycoside antibiotics effectiveness on the basis of the mathematical analysis of real susceptibility of A.baumannii clinical strains, isolated from patients in BICU. PATIENTS AND METHODS: Materials and methods: In the research there were enrolled 435 patients who had undergone treatment of the 2ndb - 3rd degree burns at the burn department of the Vinnitsa Regional Clinical Hospital N. I. Pirogov during 2011-2016. In total, 222 clinical strains of A.baumannii were isolated in early period after burn trauma before antibiotic therapy. The susceptibility of clinical strains A.baumannii to the gentamicin, tobramycin, amikacin, doxycycline was defined by qualitative disco-diffusion and quantitative double dilution methods. RESULTS: Results: The results of the study demonstrated a low susceptibility of clinical strains of A.baumannii to the studied aminoglicosides and doxycycline. During 2011-2016 the highest sensitivity of Acinetobacter to gentamicin (65%), tobramycin (68,63%) was estimated in 2015. But determined in 2016-2017 following tendency of susceptibility criteria of Acinetobactergave the possibility to found prognostic decreasing of gentamicin and tobramycin efficacy against this pathogen (less than 50%) in critically ill with burns. CONCLUSION: Conclusion: A.baumannii, pathogens of infectious complications in patiens, were characterized by a decrease in sensitivity to gentamycin, tobramycin and amikacin. Despite of low efficacy rate of doxycycline the recovery of its effectiveness against A.baumannii is excepted.

Characteristics of infectious complications in critically ill patients.

OBJECTIVE: Introduction: Patients, undergoing treatment in the intensive care units (ICU) often (51&) suffer from the infections and predominantly (71&) receive antibiotics. The aim: We aimed to review scientific literature, that highlights recent developments in etiology and emerge problems of struggling infectious complications in critically ill. PATIENTS AND METHODS: Materials and methods: We performed a search of literature from 1994 to 2018 years in Google Scholar, PubMed, MedLine, Embase, Cochrane. Data from 70 articles devoted and books to the problem were accumulated and synthesized in the article. CONCLUSION: Conclusion: Antibiotic resistance is considered as challenging problem in medicine throughout the world. Strains of S.aureus with antibiotic resistance have acquired genes of resistance to methicillin, vancomycin. There was registered high occurrence of E. coli, K. pneumonia, Acinetobacter spp. and P. aeruginosa, which produce extended spectrum ß-lactamases, carbapenemases and have a rising levels of resistance to aminoglycosides and fluoroquinolones.