The aim: To evaluate the quality of cleaning and disinfection of surfaces scheduled for daily cleaning and degree of bacterial contamination of hospital rooms and the patients’ inanimate environment in Kyiv acute care hospitals, Ukraine. Materials and methods: We performed a multicenter prospectively study of the quality of cleaning and disinfection of surfaces scheduled for daily cleaning in 9 acute care hospitals by use of an ultraviolet fluorescence targeting method and microbial methods. Results: A total 9,104 environmental samples from were collected and tested. The cleaning and disinfection of surfaces were not being performed properly in most cases. Complete removal of the mark was 49.1%, partial removal was 37,5%, and mark was still visible, i.e. this area had not been processed was 13,4% when the ultraviolet fluorescence targeting method procedures were used, respectively. The predominant bacterial agents in hospital environment surfaces were: Escherichia coli, Enterobacter spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus spp., Citrobacter spp., Acinetobacter spp., and Enterococcus spp. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 31.5% and of methicillin-resistance in Staphylococcus aureus (MRSA) 14.9%. Vancomycin resistance was observed in 5.2% of isolated enterococci (VRE). Resistance to third-generation cephalosporins was observed in 12.7% E.coli isolates and was in 11.2% K. pneumoniae isolates. Carbapenem resistance was identified in 24.7% of P.aeruginosa isolates and 59.3% of Acinetibacter spp. isolates. Conclusions: In a hospital rooms, patient environmental surfaces can be a vehicle for the transmission of multidrug-resistant (MDR) bacterial agents that cause healthcare-associated infections.

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The aim: To obtain the first estimates the incidence of surgical site infection in patients undergoing neurosurgical procedures and antimicrobial resistance of responsible pathogens, and determine their impact on inpatient mortality in Ukraine. Materials and methods: We performed a multicenter prospective study was patient-based data of SSIs were according to CDC/NHSN methodology. This study included patients undergoing a neurosurgical procedure in 11 tertiary care hospitals from different regions of Ukraine from January 1st, 2018 to December 31st, 2020. Results: A total of 1697 neurosurgical procedures associated with a 90-day SSI were identified (19.4% of 8741 procedures). Of these, 69.5% SSI were identified after craniotomy and 30.5% after ventricular shunt. The Meningitis or ventriculitis (20.9%) were found to be the most common underlying condition among these patients followed by Intracranial infection (18.7%), and Osteomyelitis (14.6%) congenital malformation. Over a 90-day surveillance period, 387 died (4.4%). Fifty seven percent of deaths in SSI patients were attributable to infection. Meningitis or ventriculitis and Intracranial infection were associated with a higher mortality. Craniotomy was associated with a higher mortality more frequently than did Ventricular shunt. Escherichia coli were most commonly reported, accounting for 26.3% of all organisms, followed by Staphylococcus aureus, Enterobacter spp., Pseudomonas aeruginosa, Enterococcus spp., and Klebsiella pneumoniae. Meticillin resistance was found in 33.7% of S. aureus isolates, and vancomycin resistance was found in 12.7% of enterococci. Conclusions: The incidence of SSI and mortality after neurosurgical procedures in Ukraine is high. This is due to increase emergence of antimicrobial-resistant pathogens and risk factors in neurosurgery patients.

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Objective – to analyze the results of combined microsurgical and endovascular treatment of brain arteriovenous malformations (AVM).Materials and methods. Radiological and clinical data of 19 patients who underwent preoperative endovascular embolization and resection of the AVM at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» in 2014–2019 were analyzed. Among patients were 11 (57.9 %) women and 8 (42.1 %) men. The average age of patient was 28.4 year (from 15 to 54 years). All AVMs were I–III grade according to the Spetzler–Martin scale.Results. The average AVM size in its maximum dimension was 3.2 cm (range 3.1–6.8 cm). 14 (73.7 %) AVMs were supratentorial and 5 (26.3 %) – subtentorial, in 9 (47.4 %) cases AVMs were located in eloquent areas of the brain, in 1 (5.3 %) – in the motor area. Cerebral or subarachnoid hemorrhage were observed in 12 (63.2 %) cases, seizures – in 4 (21.1 %), headache not associated with bleeding – in 2 (10.5 %) and neurological deficiency not related to the bleeding – in 1 (3.7 %). In 16 (84.2 %) patients total AVM resection was achieved, 3 (15.8 %) patients underwent subtotal resection. Fourteen (73.7 %) patients had good results at discharge (10 (52.6 %) patients had 0 or 1 according to modified Rankin score, and 4 (21.1%) patients had 2), 5 (26.3 %) – 3 and 4. There were no mortality cases after combined endovascular and microsurgical treatment. Onset of new neurological deficits occurred in 5 (26.3 %) patients, and in 3 (15.8 %) cases it regress at discharge and in 2 (10.5 %) cases was permanent.Conclusions. Combined treatment (endovascular embolization and microsurgical resection) of AVMs of the low grade AVM (I–III grade of the Spetzler–Martin scale) allows achieving good treatment results. The use of preoperative endovascular embolization reduces blood flow through the AVM and prevents postoperative hemodynamic overload, intraoperative and/or postoperative bleeding.