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.

Endovascular Treatment of Intracranial Pial-Dural Arteriovenous Fistula: A Case Report.

Intracranial pial arteriovenous fistula (PAVF) is a rare cerebrovascular pathology characterized by abnormal direct high-flow connection between the pial or cortical feeding artery and draining vein. Dural arteriovenous fistula (DAVF) is a pathological shunt between the meningeal arteries and dural sinuses or meningeal veins. In case of association between PAVF and DAVF, diagnosis and treatment are more challenging. The high-flow arteriovenous shunt and deep venous drainage make PAVF more preferable for endovascular treatment; however, their embolization during single-session procedures can lead to extensive thrombosis of the draining veins and unfavorable outcomes. We present a case report of endovascular embolization of an intracranial PAVF-DAVF in a 2.5-year-old child. At the time of admission, the patient had hydrocephalus, mental retardation, pyramidal insufficiency, and seizures. Occlusion of the fistula was performed during two stages of embolization to reduce the risk of severe venous stasis and venous thrombosis. Guglielmi detachable coils (GDCs) and a liquid embolic agent (Histoacryl with Lipiodol) were used for embolization. The patient recovered well after the procedure, with significant mental improvement. This suggests that the deployment of GDCs in the afferent artery near a fistula before embolization with a liquid embolic agent can minimize the risk of uncontrolled penetration of the embolization into the draining veins and dural sinus. A multisession procedure can be an effective and reasonable method of PAVF and DAVF occlusion among existing treatment options.

CEREBRAL ARTERIOVENOUS MALFORMATION WITH PARANIDAL ANEURYSMS. CLINICAL COURSE AND OUTCOME AFTER ENDOVASCULAR EMBOLIZATION.

The association of cerebral arteriovenous malformations (bAVM) and associated paranidal aneurysms, that is closely related to the AVM nidus, carry a high risk of rapture and re-rapture after initial hemorrhage. This association is consider as therapeutic challenge and supportive data about their natural history and best treatment modalities are still lacking. In this article we report our experience of their treatment. We reviewed 443 cases of patients with AVMs between 2004 and 2018, who were treated at our institution and found 73 (16,5%) cases of AVM association with paranidal aneurysms (22 (30,2%) arterial - prenidal, 20 (27,4%) intranidal, and 19 (26,0%) venous - postnidal). Twelve (16,4 %) patients had multiple aneurysm. All patients received endovascular treatment with n-butyl cyanoacrylate (NBCA), ONYX or Embolin embolization. We evaluated clinical and radiological data, treatment and outcomes at discharge. Among 73 patients (32 (43,8 %) women and 41 (56,2 %) men, mean age - 34 years, 8 - 65 years) with AVM and paranidal aneurysms who were enrolled in our study, hemorrhage was the most frequent presenting symptom (47 patients (64.4%). The timing of procedure varied between 3 - 23 days. Total occlusion of AVM was achieved in 23 (31,5%) cases, in all other cases partial or target occlusion with obligatory aneurysm embolization was done. Seven (9,6%) patients had complication (5 ischemic and 2 hemorrhagic) after procedure. Clinical improvement was seen in all groups at discharge. Mean change of mRS score between admission and discharge was 0,2-0,5 point. Excellent or good outcome (mRS - 0,1,2) was observed in 58 (79,5%) patients at discharge. Unfavorable outcome (mRS - 3-5) had 13 (17,8%) patients, mRS - 6 - 2 (2,7%) patients. Patients sustaining AVM and multiple paranidal aneurysms had higher risk of hemorrhage comparing with single one (OR-17,5 (95% CI -1,0-309,8 (p=0,010). Relationship between AVM with paranidal aneurysms and hemorrhagic presentation is obvious, however definite source of hemorrhage is difficult to evaluate. To our belief arterial prenidal and intranidal aneurysms especially multiple are the most dangerous and should be in therapeutic focus after it's finding. Endovascular embolization has the potential to be effective and safe in treatment of AVM with paranidal aneurysms.

[Estimation of the results of endovascular occlusion of the sac-like aneurysms of the middle cerebral artery basin].

The problem of treatment of a sac-like aneurysms of middle cerebral artery (SLAMCA) is actual due to peculiarities of their localization and structure present. Clinical and neurological status of the patients was estimated. Positive results (0-3 points, according to Rankin's scale) were noted in 131 (87.9%) patients, satisfactory (4-5 points)--in 12 (8.1%), nonsatisfactory (6 points)--in 6 (4%). Postoperatively a total occlusion of SLAMCA was achieved in 69.7% observations, residual neck--in 18.6%, partial occlusion--in 11.7%. There were established the occlusion type (deconstruction, reconstruction) and the collateral blood flow ways; possible complications and their predictors were analyzed. The results of the investigation performed have permitted to analyze the state dynamics in the patients, suffering SLAMCA in the early postoperative period.

[Cerebral aneurysm occlusion in patients with critical vasospasm in acute period of disease].

Aneurismal hemorrhages are often complicated by vasospasm (VS). The pharmacological vasodilatation using during endovascular operations allows making the occlusion on the peak of vasospasm to prevent the repeated aneurysmal rupture. An advantage of the superselective introduction (CI) consists in creation of the high concentration of medical substance in the damage segment that allows applying biologically highly active preparations, thus reducing their general influence on a body. Except pharmacological influence, CI causes considerable reflex stimulation of a blood flow owing to the direct irritation of sympathetic nervous system angioreceptors. 153 patients with aneurysms were operated on a vasospasm peak; CI was applied in 24 cases. The severity of the condition defined by WFNS: I - 32 (20,9 %), II - 41 (26,8 %), III - 49 (32 %), IV - 30 (19,6 %), V - 1 (0,7 %). All patients were in the acute period of a hemorrhage (prior to 21 days). CI was spent in the presence of a critical vasospasm (> or = 70 %). Results estimated by a principle of satisfactory dilatation (sufficient restoring of a vessel lumen for operating system carrying out)--22 (92 %) and unsatisfactory dilatation--2 (8%) cases. Some features were found: extension of all capillary network, absence of any ischemic or hemorrhage complications, artery expansion in 5-6 min after infusion, dilatation was disagreed with a possible physiological artery lumen, extension of all artery, instead of a local vassel segment, absence of vasospasm recurrence throughout the subsequent 1-1,5 h. Method of the medical substance superselective introduction directly in to the constricted artery allows to conduct endovascular occlusion of aneurysms on a peak of the critical vasospasm.