MORPHOLOGICAL FEATURES OF MAXILLARY SINUS CYSTS BASED ON THE STUDY OF PARTICULAR HISTOCHEMICAL AND IMMUNOHISTOCHEMICAL FACTORS OF INFLAMMATION.

OBJECTIVE: The aim: To study the morphological structure and immunohistochemical markers of inflammatory cells in the maxillary sinus cyst wall. PATIENTS AND METHODS: Materials and methods: Biopsy samples of maxillary sinus cysts of 92 operated patients aged 18 to 74 years were studied. We used standard staining with hematoxylin and eosin, PAS reaction, and immunohistochemical analysis with monoclonal antibodies to CD68 (macrophages) and CD3 (T- lymphocytes) to determine morphological features and severity of inflammation and PanCK AE1/AE2 antibodies to identify epithelium state. RESULTS: Results: All patients were divided into 2 groups: 29 patients with retention cysts and 63 with lymphagiotatic cysts (pseudocysts), depending on the unilateral or bilateral epithelial lining of the cyst wall. Retention cysts had the bilateral epithelial lining with a saving its function and structure. The thinned connective tissue layer was filled with separate clusters of lymphocytes and macrophages. Lymphagiotatic cysts were characterized by the unilateral epithelium lining of the wall with signs of degeneration, desquamation, and loss of the mucus-forming function. Dense infiltration of the connective tissue layer by inflammatory cells with pronounced expression is observed. CONCLUSION: Conclusions: Immunohistochemical analysis with monoclonal antibodies to CD3 and CD68 demonstrated that the inflammatory infiltrate of pseudocysts is represented by T-lymphocytes and different sizes of macrophages. The inflammatory infiltration of the pseudocyst wall was significantly severe compared to retention cysts.

MOLECULAR EPIDEMIOLOGY OF THE TRANSMISSION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN KYIV ACUTE CARE HOSPITALS, UKRAINE.

OBJECTIVE: The aim: To evaluate the potential of transmission of methicillin-resistance Staphylococcus aureus (MRSA) in Ukrainian acute care hospitals. PATIENTS AND METHODS: Materials and methods: We performed a multicenter cross-sectional study. Definitions of HAI were used from the CDC/ NHSN. The susceptibility to antibiotics was determined by disk diffusion method according to the EUCAST. The cefoxitin-resistant isolates S.aureus were analyzed for the presence of the mecA gene and femA endogenous control gene using PCR. The virulence factor encoding genes (lukS-PV and lukF-PV) were detected by PCR. RESULTS: Results: Of 2,421 patients with HAIs caused S.aureus included in the study, 28.7% patients had MRSA. Prevalence of nasal carriage rate of MRSA among healthcare workers (HCWs) was 33.3%. MRSA contamination of hands and uniforms/gowns of HCW were 32.2% and 29.7%, respectively. MRSA contamination in the inanimate environment surfaces in near- and extended patients areas were 26.9%. The predominant MRSA contamination in hospital environment surfaces were: room inner door knob (32.8%), bed rails (28.9%), room light switch (28.9%), chair (27.9%), bedside table handle (20.6%), bedside table (20.5%), and tray table (13.7%). The PVL gene was present in 38.7% of MRSA strains, isolated from patients with HAIs and in 55.7% of MRSA, isolated from environment surfaces in patient area. In addition, the PVL genes were detected in over 56.3% of MRSA isolated from HCWs carrier. CONCLUSION: Conclusions: The majority of MRSA is acquired during hospitalization. Environmental surfaces may serve as potential reservoirs for nosocomial MRSA and facilitate transmissions via contact.

IMPACT OF THE NASAL VALVE SHAPE ON THE OLFACTORY FUNCTION AND SUBJECTIVE PERCEPTION OF THE NASAL BREATHING.

OBJECTIVE: The aim: To study the impact of the internal nasal valve shape on respiratory and olfactory nose function as well as on quality of life. PATIENTS AND METHODS: Materials and methods: The study involved 17 volunteers who noted satisfaction of nasal breathing in the absence of changes during endorhinoscopy. The study was con¬ducted in two stages: stage 1 involved assessing initial indicators of quality of life by the SNOT-22 questionnaire, performing active anterior rhinomanometry, and estimating the olfactory function (Sniffin' Sticks); stage 2 consisted in re-assessing the mentioned indicators after changing the shape and lumen of the internal nasal valve. The sodium alginate self-hardening gel was used for simulating the narrowing of the nasal valve. It was applied to the mucous in the upper part of the nasal valve area, obturating the diffuser above the level of attachment of the middle nasal turbinate to a depth of 3-4 mm from nasal vestibule. RESULTS: Results: Air resistance did not change significantly after partial blockage of the internal nasal valve, although, 16 out of 17 patients showed signs of hyposmia with an average Sniffin' Sticks test score 8.68 ± 0.15. CONCLUSION: Conclusions: The simulated partial blockage of the internal nasal valve lumen in its upper part in the area of the diffuser does not significantly affect the resistance of the air passing through the nasal passages, but the olfactory function is impaired, which is reflected the quality of life.

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.

PREVALENCE OF NASAL CARRIAGE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AMONG HEALTHCARE WORKERS IN THE DEPARTMENTS OF OTORINOLARYNGOLOGY AND DENTISTRY IN KYIV, UKRAINE.

OBJECTIVE: The aim: To obtain the first estimates of the current prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) in the departments of Otorinolaryngology and Dentistry and to determine of genes virulence factors (Panton Valentine Leukocidine (PVL) genes). PATIENTS AND METHODS: Materials and methods: We performed a multicenter cross-sectional study. The susceptibility to antibiotics was determined by disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing. The virulence factor encoding genes, mecA, lukS-lukF, were detected by Polymerase Chain Reaction (PCR). RESULTS: Results: Incidence rate of S. aureus nasal carriage among HCWs was 36.2%, whereas MRSA carriage was 17%. Prevalence of MRSA carriage rate was 34.9% in Otorhinolaryngology departments and 9.7% in Dentistry. PCR testing confirmed that all MRSA strains were mecA gene-positive. The virulence factor encoding genes were detected in 82.3% of the S. aureus isolates from HCWs. Among S.aureus, the lukS-lukF genes were detected in over 59% of the strains. The lukS-lukF genes were detected in 55.5% of MRSA and in 58.9% of MSSA strains. LukS-lukF genes were most commonly co-present in MRSA strains. No significant difference was detected between the occurrences of lukS-lukF genes (P > 0.05). CONCLUSION: Conclusions: Personnell in otorhinolaryngology and dentistry departments have a high rate of nasal colonization of MRSA. This carrier state may be an important risk factor for transmission MRSA from physicians and nurses to patients and vice-versa. Screening for MRSA nasal carriage of HCWs is a key element in enabling infection control measures and early therapeutic decisions.

Bloodstream infections and antimicrobial resistance of responsible pathogens in Ukraine: results of a multicenter study (2013-2015).

OBJECTIVE: Introduction: Bloodstream infections (BSIs) are associated with high morbidity and mortality worldwide. However data of BSI from Ukraine are scarce. The aim: To obtain the first national estimates of the current incidence of BSI and antimicrobial resistance of responsible pathogens, and associated mortality in Ukraine. PATIENTS AND METHODS: Materials and methods: A retrospective multicenter cohort study was conducted at the 14 hospitals of Ukraine between January 2013 to December 2015. Definitions of BSIs were adapted from the CDC. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. RESULTS: Results: Among 20,544 patients, 3816 (18.6%) BSIs were observed. The rate of health care associated BSI was 92.4%. Death was reported in 68.4% BSI cases. The predominant pathogens were: Klebsiella pneumoniae (25.1%), Escherichia coli (17.5%), Staphylococcus aureus (9.9%), Pseudomonas aeruginosa (8.9%), and Acinetobacter spp.(8.5%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 24.8% and of methicillin-resistance in S. aureus (MRSA) 38.2%. Vancomycin resistance was observwd in 9.2% of isolated enterococci (VRE). Carbapenem resistance was identified in 33.1% of P.aeruginosa isolates and 63.2% of A. baumannii isolates. Resistance to third-generation cephalosporins was observed in 14.2% K. pneumoniae and E.coli 55% isolates. CONCLUSION: Conclusions: Healthcare-associated BSIs and antimicrobial resistance of responsible pathogens together with their associated impact on mortality, presents a significant burden to the Ukraine hospital system. Surveillance of BSIs may help to delineate the requirements for infection prevention and control.

Antimicrobial resistance of staphylococcus aureus causing of surgical site infections in ear, nose and throat surgery.

OBJECTIVE: Introduction: Staphylococcus aureus is one of the major pathogens that causes of surgical site infection (SSI). Scant information is available on the occurrence and antimicrobial susceptibility of S. aureus in patients with SSI in Ear, Nose and Throat (ENT) surgery. The aim: To assess the activity of antimicrobials against S.aureus, isolated from patients with SSI by the ENT departments of Kyiv hospitals. PATIENTS AND METHODS: Materials and methods: A total of 516 S. aureus isolates from of patients with SSI in ENT surgery. Antimicrobial susceptibility of S. aureus were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). RESULTS: Results: The most active antibiotics found in the study were linezolid and tigecycline, showing growth inhibition of 100% strains tested. Susceptibility to the other antimicrobials was also on a high level: 98,4% of strains were found susceptible to nitrofurantoin, 98.1% - to trimethoprim/sulphamethoxazole, 97.6% - to fusidic acid, 97.1% - to mupirocin, 95.9% - to teicoplanin, 94.7% - to vancomycin and fosfomicin, 90.6% - to moxifloxacin, 89.1% - to tobramycin, 87.3% - to gentamycin. Susceptibility to rifampicin (85.5%), cefoxitin (84.6%), levofloxacin (84.3%), erythromycin (82.6%), tetracycline (76.3%), and clindamycin (75.4%) was observed to be some lower. Resistance to oxacyllin S.aureus (MRSA) came up to 21.1%. CONCLUSION: Conclusions: S. aureus in ENT departments to be a serious therapeutic and epidemiologic problem. The constant monitoring of antimicrobials resistance in every hospital is required. Antibiotics application tactics should be determined in accordance with the local data of resistance to them.