Postpartum infections and antimicrobial resistance of responsible pathogens in Ukraine: results a multicenter study (2020-2022).

OBJECTIVE: Aim: To determine the current prevalence of postpartum infections and antimicrobial resistance 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 healthcare- associated postpartum infection 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 21,968 women, 6,175 (28.1%) postpartum infections were observed. Of all postpartum infection cases, 83.1% were detected after hospital discharge. The postpartum infection rates were 17.3% after cesarean section and 10.8% after vaginal delivery. The most common postpartum infection types were endometritis (17.3%), followed by urinary tract Infection (3.5%), mastitis (3.4%), surgical site infection (excluding endometritis) (2.4%), and episiotomy site infection (1.5%). The predominant postpartum infection pathogens in Ukraine were: Escherichia coli (10.4%), Enterococcus spp. (9.6%), Staphylococcus aureus (6.7%), Pseudomonas aeruginosa (5.8%), Enterobacter spp. (5.8%). In our study pathogens of postpartum infection had differently levels of resistance to antibiotics. CONCLUSION: Conclusions: Our results indicate that postpartum infections requiring medical attention are common in Ukraine and that most postpartum infections occur after hospital discharge, so that use of routine inpatient surveillance methods alone will lead to underestimation of postpartum infection rates. Optimizing the antibiotic prophylaxis may reduce the burden of postpartum infection, but prevention is the key element.

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.

PREVALENCE OF AEROBIC VAGINITIS AFTER GYNECOLOGICAL SURGERIES AND ASSOCIATED ADVERSE PREGNANCY OUTCOME IN UKRAINE.

OBJECTIVE: Aim: To determine prevalence of Aerobic Vaginitis (AV) after gynecologic surgery, risk factors and antimicrobial resistance of responsible pathogens, and adverse pregnancy outcomes in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter retrospective cohort study was conducted from January 2020 to December 2022 in fifteen medical clinics from eight regions of Ukraine. Smears were analyzed using Donders' classification method and Dong's modified AV diagnosis for Gram stains. Definitions of HAIs were adapted from the CDC/NHSN. Antibiotic susceptibility testing of bacteria was determined by Kirby-Bauer disc diffusion test according to the protocol of the EUCAST. RESULTS: Results: Prevalence of AV among women's undergoing gynecologic surgery in Ukraine was 68.7%. Of the total AV cases, 70.3% were in non-pregnant and 29,7% in pregnant women. The most common pathogen of AV was Escherichia coli, followed by Enterococcus faecalis, Streptococcus agalactiae, Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Among the S. aureus strains, 11,6% of MRSA (Methicillin resistant S.aureus) were isolated whereas none of the CoNS were cefoxitin resistant. History of vaginal infection, history of post-operative infection and antibiotic use acted as an important risk factor of AV incidence rate. The presence of AV worsened pregnancy outcomes, by increasing the incidence of preterm birth, the premature rupture of membranes, miscarriage, neonatal jaundice, and neonatal infection. CONCLUSION: Conclusions: Aerobic Vaginitis after gynecological surgeries in Ukraine is a common medical problem in women that is associated with significant morbidity, adverse pregnancy outcome, and hence frequent medical visits.

HEALTHCARE-ASSOCIATED BACTERIAL VAGINOSIS AFTER GYNECOLOGICAL SURGERIES AND ASSOCIATED ADVERSE PREGNANCY OUTCOME IN UKRAINE.

OBJECTIVE: The aim: To determine the prevalence of healthcare-associated bacterial vaginosis after gynecological surgeries and associated adverse pregnancy outcomes in Ukraine. PATIENTS AND METHODS: Materials and methods: Multicenter retrospective cohort study was conducted from January 2019 to December 2021 in eleven medical centers from eight regions of Ukraine. Vaginal cultures were obtained preoperatively from 3,502 women undergoing gynecologic surgery. Diagnosis of Bacterial Vaginosis is based on the Nugent and Amsel criteria. RESULTS: Results: Healthcare-associated bacterial vaginosis (HA BV) was diagnosed in 1,498 of 3,502 women, giving a prevalence rate of 42.8%. HA BV was significantly associated with preterm birth (risk ratio [RR], 2.68; 95% confidence interval [CI], 1.44-4.98), miscarriage (RR, 6.11; 95% CI, 3.22-14.11), low birth weight (RR, 3.20; 95% CI, 1.29-7.94), and premature rupture of membranes (RR, 6.75; 95% CI, 3.11-14.67). CONCLUSION: Conclusions: The HA BV after gynecological surgeries prevalence is high in Ukraine, with a concomitant adverse pregnancy outcome, including preterm birth, low birth weight, premature rupture of membranes, and miscarriage. A significant number of cases of bacterial vaginosis are associated with long-term use of antibiotics to treat post-operative infections.

URINARY TRACT INFECTIONS IN PREGNANT WOMEN IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2020-2022).

OBJECTIVE: The aim: To obtain the first national estimates of the current prevalence rate of urinary tract infections (UTIs) in pregnant women and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: Prospective multicentre cohort study was conducted from January 2020 to December 2022. The study population consisted of 36,876 pregnant women from 17 regions of Ukraine. Antibiotic susceptibility was done by the disc diffusion test as recommended by European Committee on Antimicrobial Susceptibility Testing guidelines. RESULTS: Results: A total 29.5% pregnant women were found to have UTIs. Among these cases, 36.5% Asymptomatic bacteriuria, 51.7% Cystitis and 11.8% Pyelonephritis were observed. Of all cases, 87.9% were defined as healthcare-acquired UTIs and 12.1% community-acquired UTIs. The most common uropathogen was Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Many uropathogens isolated from UTI cases were found to be multidrug resistant. CONCLUSION: Conclusions: UTIs in pregnant women in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics. Optimizing the management and empirical antimicrobial therapy may reduce the burden of UTIs in pregnant women, but prevention is the key element.

VULVOVAGINAL CANDIDIASIS AFTER GYNECOLOGICAL SURGERIES AND ADVERSE PREGNANCY OUTCOME IN UKRAINE: A MULTICENTRE STUDY.

OBJECTIVE: The aim: To investigate the epidemiology and microbiology of vulvovaginal candidiasis (VVC) after gynecological surgeries, and adverse pregnancy outcomes in Ukraine. PATIENTS AND METHODS: Materials and methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 and recruited pregnant and non-pregnant women aged 15-65 years who had sought medical help for vaginal dysbiosis the seven medical clinic from five regions of Ukraine. RESULTS: Results: Between 2020 and 2022, 2,341 women were followed in gynecological practices, and 1,056 (41.5%) women were diagnosed with VVC during the same period. Of the total VVC cases, 31.9% were in non-pregnant and 68.1% in pregnant women. The use of antibiotics (OR=3.48), use hormonal contracep¬tives (OR=2.75) and pregnancy (OR=1.13) were associated with an increase in the risk of VVC diagnosis. Diabetes mellitus (OR=0.44) were additional risk factors. The most common pathogen of VVC was C. albicans, Nakaseomyces glabratus (C. glabrata), followed by Pichia kudriavzevii (C. krusei), C. parapsilosis, C. tropicalis, C. kefyr, C. guillieromondii, C. lusitaniae, and C. rugosa. We found no significant difference in adverse pregnancy outcomes between Candida-positive and Candida-negative women. CONCLUSION: Conclusions: Vulvovaginal candidiasis after gynecological surgeries in Ukraine is a common medical problem in women that is associated with significant morbidity, and hence frequent medical visits. High prevalence rate of vulvovaginal candidiasis in the present study warrants, the importance of conducting continuous epidemiological surveys to measure changes in species distribution from C. albicans to non-albicans Candida species in Ukraine.

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.

PREVALENCE AND RISK FACTORS OF INFERTILITY IN UKRAINE: RESULTS A MULTICENTER STUDY (2019-2021).

OBJECTIVE: The aim: To assess the current prevalence and identify the risk factors for infertility among couples of reproductive age in Ukraine. PATIENTS AND METHODS: Materials and methods: We conducted a retrospective multicentre cohort study was based on reproductive health surveillance data among married populations from January 1st, 2019 to December 31st, 2021 in Ukraine. Definitions of infertility were used from the WHO. RESULTS: Results: Among all the 6,885 participants in this study, the prevalence of infertility was 25.4%. The prevalence of primary infertility was 5.8%, and the prevalence of secondary infertility was 19.6%. The levels of infertility in the regions of Ukraine had significant differences. It was found that among those women who had primary infertility, more were from rural than urban, while for secondary infertility women the situation was reversed. Infertility was associated with age, history of gynecological surgery, decreased ovarian reserve, age of marriage, long-term air-conditioning environment, and history of endometriosis. There were differences among factors associated with infertility, primary infertility and secondary infertility. The factors associated with primary infertility were age of marriage, age of first sexual intercourse, long-term air-conditioning environment, decreased ovarian reserve and age. A factors associated with secondary infertility were history of gynecological surgery and decreased ovarian reserve. CONCLUSION: Conclusions: The results of this study revealed high level the prevalence rate of infertility among couples of reproductive age in Ukraine is high. This applies to both primary and secondary infertility of married women. The most women who had experienced infertility have not sought medical or professional help for the problem.

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.

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.

VAGINAL CUFF INFECTION AFTER HYSTERECTOMY IN UKRAINE.

OBJECTIVE: The aim: To obtain the first estimates of the current prevalence of vaginal cuff infection after hysterectomy 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 consisted of women who had an abdominal, vaginal or laparoscopic hysterectomy from 2017 to 2019 in 7 women hospitals of Ukraine. Definitions of vaginal cuff infections were used from the Centers for Disease Control and Prevention's National Healthcare Safety Network, USA. RESULTS: Results: Total 12.6% women's after hysterectomy had vaginal cuff infections. Of these cases, 20.3% after abdominal, 15.5% vaginal and 4.1% laparoscopic hysterectomy were identified. The predominant pathogens of VCUF infections were: Escherichia coli (18.6%), Enterobacter spp. (12.4%), Staphylococcus aureus (10.8%), Streptococcus spp. (9,7%), Klebsiella pneumoniae (8.2%), Pseudomonas aeruginosa (7.6%), Enterococcus faecalis (7,0%) and Proteus spp. (7.0%). Methicillin-resistance was observed in 12.9% of S. aureus (MRSA) and 9.7% CoNS. Carbapenem resistance was identified in 7.3% of P.aeruginosa isolates. Resistance to thirdgeneration cephalosporins was observed in 8.9% K. pneumoniae and E.coli 11.9% isolates. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 22.7%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (32.6%, vs 12.3%). CONCLUSION: Conclusions: Vaginal cuff infections in women after hysterectomy are common in Ukraine and most of these infections caused by antibiotic-resistant bacteria. The incidence of VCUF infections after hysterectomy differs depending on the type of surgical procedure.