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. ß-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 ß-lactamase genes, including extended-spectrum ß-lactamase (35.8%), OXA-type (29.7%), AmpC-type (25.1%), KPC-type (25.7%) and metallo-ß-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.

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.

Periapical healing of mandibular molars after root-end sealing with dentine-bonded composite.

AIM: The purpose was to present the frequency of periapical healing in first and second/third mandibular molars, after root-end resections sealed with a dentine-bonded resin composite. METHODOLOGY: Root-end sealing of resected mandibular molar roots was made with dentine-bonded composite (Gluma-Retroplast) as a cover on the entire slightly hollowed root-end, in an attempt to prevent leakage. RESULTS: Out of the 834 roots recalled between 6 months and 12.5 years postoperatively, 92% showed complete apical healing, 1% uncertain healing and 7% exhibited failure. The healing result of 681 first molar roots was not significantly different (P = 0.21) from that of 153 second/third molar roots, and there was no significant difference in healing between mesial and distal roots (P = 0.32 for first molars, P = 0.86 for second/third molars) or amongst six age groups (P = 0.94). In the patient group: 71-89 years, 36 roots showed an average of 97% with complete healing. Out of 25 failures who were retreated surgically, 80% showed complete healing when examined subsequently. CONCLUSION: Root-end sealing of mandibular molars with dentine-bonded resin composite is a promising technique giving 92% complete healing in cases examined between 6 months and 12 years postoperatively.

Surgical endodontics of upper molars: relation to the maxillary sinus and operation in acute state of infection.

Findings in 200 cases of root resection of first maxillary molars showed perforation to the sinus in half of the cases. In 42% of the cases, the first maxillary molar had root resection performed in a subacute or acute state of infection. Only two cases developed postoperative sinusitis. Antibiotic treatment was indicated preoperatively in 3% and postoperatively in 5%. Postoperative symptoms, such as pain and swelling, were usually moderate, possibly because of a nontraumatizing operation technique, a careful removal of infected tissue, and a good drainage by loose suturing.

Retrograde sealing of accidental root perforations with dentin-bonded composite resin.

Surgical treatment was performed on 100 iatrogen perforations, of which 94 showed radiolucency of bone adjacent to the perforation and 83 presence of an exposed post. The perforations were in all cases sealed with a resin composite (Retroplast) bonded to adjacent root dentin with a dentin bonding agent (Gluma). Cases were examined after approximately 1 yr (first recall) and, if necessary after 1 1/2 to 11 yr (mean: 4.1 yr) (latest recall). It was observed that the presence or absence of bone on the root between the perforation and cervix at the time of operation had no significant effect on the healing result, and that the radiographic classification "partial" healing with a border of cortical bone or a lamina dura often remained unchanged for many years. At latest recall, the healing result of 65 teeth originally having root perforation elsewhere than at the furcation was: 71% complete, 11% partial, 3% uncertain, and 15% failure. This is significantly different from the healing result of 27 molar teeth originally having perforation at the furcation: 30% complete, 41% partial, 11% uncertain, and 18% failure.

Effect of root canal contents on healing of teeth with dentin-bonded resin composite retrograde seal.

Healing results were compared among 551 infected roots apically sealed with a dentin-bonded resin composite (Gluma-Retroplast). These roots contained either 1) root filling to apex after resection, 2) insufficient root filling, or 3) empty root canals with necrotic pulp remnants. At 2- to 4-yr follow-up, complete bone healing was found to be 92%, 85%, and 81% in groups 1, 2, and 3, respectively. The results from groups 1 and 3 were significantly different, and the results from group 2 did not differ significantly from that of groups 1 or 3. Reasons for "Failures" were found to be mainly loose filling or uncovered canal. After 21 roots classified as "Failures" were reoperated, 76% of these showed "Complete Healing" after 1 yr.

Retrograde root filling with dentin-bonded modified resin composite.

A retrograde root-end cover with a special resin composite (Retroplast) combined with the dentin bonding agent Gluma (Bayer AG) has been used since 1984 by the authors. Its content of silver, added to promote radiopacity, has been found to lower the working time and storage stability of the composite and might cause discolorations. Since 1990, silver has therefore been replaced with ytterbium trifluoride, which eliminates these side effects. The purpose of this study was to compare the clinical results obtained with these two resin composites and to evaluate the healing results after several years in function. Apical fillings (351) with the modified Retroplast showed the following radiographic healing pattern 1 yr after surgery: 80% complete healing, 2% scar tissue, 12% uncertain healing, and 6% failure. No significant difference in this healing pattern was found, compared with that obtained with the silver-containing Retroplast. Cases with ytterbium trifluoride classified as scar tissue and uncertain healing at 1 yr when examined at 2 to 4 yr postoperatively showed 89% complete healing. 0% scar tissue, 1% uncertain healing, and 9% failure. This result is significantly different from that obtained 1 yr after surgery. Based on calculations, it was predicted that with time 90% will become complete healing, whereas 10% will become failure.

Long-term evaluation of retrograde root filling with dentin-bonded resin composite.

The purpose of this study was to investigate the long-term stability of apical retrograde root fillings using a dentin-bonded resin composite. Radiographs were used to establish the degree of healing around the apically filled roots. Patients examined were those who had previously showed complete healing 1 yr after surgery. Thirty-three of the first 34 consecutively placed resin composite apical fillings performed since the introduction of this method in 1984 were examined. Six of these fillings were examined 8 yr after surgery, and 27 of these fillings were examined 9 yr after surgery. Only one patient showed recurrence of periapical inflammation 8 yr after operation, probably caused by a root fracture. It was concluded that the bond established between dentin and the resin composite was stable during the observation period, and that the filling material had not been harmful to the surrounding tissues. If complete bone healing has been observed, it could be expected to remain stable, unless new factors, such as root fracture, occurred.

Retrograde root filling with composite and a dentin-bonding agent. 1.

A method is described, by which retrograde root filling with a composite resin can be performed. The cavity design is a slightly concave dissection of the apical part of the root, which is treated with the bonding agent Gluma followed by an application of Retroplast. Retroplast is a chemically curable composite containing silver for radiopacity and aerosil to obtain a suitable consistency. Endodontically treated teeth with a eugenol-containing root canal sealer did not affect the strength of the bond between Retroplast and apical dentin. A tight seal between the composite and the cavity surface was observed by light and SEM microscopy, and histology of tissue surrounding fillings placed in monkeys revealed absence of inflammatory cells around the filling and a close contact between filling and fibroblasts with collagenous fibers. In some cases, cementum and Sharpey's fibers formed in contact with the filling. Fillings placed in humans performed successfully in most cases, and the main causes of failure were either inadequate hemostasis during filling, or root fracture unnoticed by the time of filling. The retrograde technique promises a new treatment principle, with a root canal effectively sealed and the periapical ligament restored after apicoectomy.

Retrograde root filling with composite and a dentin-bonding agent. 2.

Investigations on retrograde root filling using a composite resin, Retroplast, bonded to the root surface with the dentin-bonding agent Gluma have been described. Here, detailed information is given about the surgical procedures. The aim was to obtain a thin retrograde composite filling on the root apex, made slightly concave, sealing the main root canal, accessory canals as well as dentinal tubules. Hemostasis was obtained primarily by applying 1% adrenaline and by using a needle suction tip, and care was taken not to damage the surrounding tissues by the various chemicals. The healing results, after up to 1 year, of 388 cases of various tooth types, treated with either retrograde composite or with amalgam were compared. The healing classification included four categories: 1) complete healing; 2) fibrous healing; 3) uncertain; and 4) failures. In the composite group, the healing rates were as follows: 74% showed complete healing, 4% fibrous healing, 15% uncertain, and 7% were failures. In the amalgam group, 59% showed complete healing, 3% fibrous healing, 30% uncertain, and 8% were failures. Complete healing occurred significantly more often after filling with Retroplast than after filling with amalgam (p less than 0.00005). Significantly fewer cases with complete healing occurred in lower front teeth in proportion to other tooth types. The number of immediate postoperative complications did not differ significantly between the composite and the amalgam groups.

[Use of xenogeneic spleen perfusate in the complex treatment of patients with destructive pulmonary tuberculosis]. / Primenenie perfuzata ksenoselezenki v kompleksnom lechenii bol'nykh destruktivnym tuberkulezom legkikh.

The first experience gained in the use of xenospleen perfusate in the management of 13 patients with disseminated fibrous-cavernous tuberculosis is presented. The disease was accompanied by an evident intoxication and respiratory insufficiency. Traditional ways of treatment failed to be effective in all the patients, thus indicating an intravenous drop by drop administration of xenogeneic spleen perfusate in the dose of 10 ml per kg body weight. The antiinflammatory (immunomodulation) effect manifested itself in the body temperature drop, less intoxication and infiltration processes in the lungs, as well as a better hemogram.

[Retrograde root canal filling using resin and a dentin bonding agent: operative procedures]. / Retrograd rodfyldning med plast og dentinbinder: operationsteknik.

Using a specially designed filled resin and the bonding agent Gluma, the aims were to obtain a thin retrograde filling covering the slightly concave root surface which would close all root canals and avoid excess filling material. To achieve a strong bond, the resin must be applied to an absolutely dry Gluma surface, free of all traces of blood or saliva. Hemostasis was obtained primarily by applying 1% adrenalin and by use of a needle suction tip. Absence of moisture was obtained by removing all soft tissues from the cavity, using dry compressed air and avoiding condensed moisture from a cool resin. To avoid loosening of the filling, the working time of the resin must not be exceeded, and removal of excess filling material must not be done before polymerization is complete. Contamination of the various chemicals and filled resin must be avoided in order to avoid damage to the surrounding tissues.

[Retrograde root filling utilizing resin and a dentin bonding agent: indication and applications]. / Retrograd rodfyldning med plast og dentinbinder: Indikation og anvendelsesmuligheder.

With Gluma a methacrylate-based resin may be chemically bonded to dentin with considerable strength. Resin may therefore be used for retrograde root fillings. Whereas a retrograde amalgam filling demands a box-like preparation, retroplast (Gluma and resin) may be applied to a slightly concave root surface. It may therefore be employed in areas normally inaccessible with amalgam technique. Retroplast can thus be used on roots of all molars and to restore root perforations, root resorptions, cracks, grooves and defects of the root. In addition on lateral canals, on extremely thin roots and to cover perforating root canal posts, this technique can also be used. Dentin/root-cement transplantation may be performed for the purpose of reattachment. The article discusses the technique and its applications with examples showing that it may result in satisfactory healing.

[Retrograde root filling utilizing resin and a dentin bonding agent: frequency of healing when compared to retrograde amalgam]. / Retrograd rodfyldning med plast og dentinbinder: helingsfrekvens sammenlignet med retrograd amalgam.

Gluma, an aqueous solution containing 5% glutaraldehyde and 35% HEMA, may bond resin chemically to dentin with considerable strength and without cracks. In retrograde root filling, Gluma and resin (retroplast), can adhere to a flat or slightly concave root surface, so that it may be employed to otherwise inaccessible roots. Gluma may cause toxic reactions, but properly used, it is tolerated well. Of 400 consecutive cases with retroplast, 388 were controlled (99 front teeth, 86 premolars and 203 molars) up to 1 year after operation. The healing after these was compared with a series of retrograde amalgams with the same number and distribution in the various tooth types 1 year postoperatively. The result after retroplast was 74% complete healing, 4% fibrous healing, 15% uncertain and 7% failures. After retrograde amalgam 59% complete healing, 3% fibrous healing, 30% uncertain and 8% failures. Complete healing occurred significantly more often after retroplast than after amalgam (P less than 0.00005). After retroplast significantly fewer cases with complete healing occurred in lower front teeth than in other tooth types. There were no significant differences in the occurrence of postoperative complications after retroplast and amalgam. There were two patients with serious osteitis after retroplast.