Surgical Site Infections and Antimicrobial Resistance in Kyiv City Hospitals, Ukraine

Abstract

Introduction: Surgical site infections (SSIs) are associated with increased morbidity and mortality. Scant information is available on the SSI in Ukrainian hospitals. The aim: to determine the incidence of SSIs and estimates antimicrobial resistance of the major responsible pathogens in Kyiv city hospitals. Materials and methods: This study was conducted from January 2011 to December 2013 in 3 hospitals. Definitions of SSIs were adapted from the CDC/NHSN. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Results: Among 9,162 patients, 1,912 (20.9%) SSIs were observed. The high SSI case in appendectomy (29.8 %), gastric, small and large bowel surgeries (28.4 %), cholelithiasis (25.7%), and orthopedic procedures (22.9 %). Low infection rate in excision of dermoid cysts, lipoma (5.3%) and lower segment caesarean structure (6.5%). Staphylococcus aureus were most commonly reported, accounting for 27,8% of all organisms, followed by Escherichia coli (18.4 %), Pseudomonas aeruginosa (11.9 %) and Enterococcus faecalis (11.6 %). The antimicrobial resistance in the isolates associated with SSIs showed, among the Gram-positive bacteria, that 43.8% and 4.7% of CoNS isolates were β-lactam (oxacillin) - and glycopeptide (teicoplanin) - resistant, respectively. Meticillin resistance was reported in 35.7 % of S. aureus isolates Conclusions: SSIs and antimicrobial resistance of the responsible pathogens is an actually problem. One essential step in the prevention of SSIs is to implement a national system for their surveillance.

Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture

“…In 2019, Ukraine set the National Action Plan of AMR to improve regulations and strengthen surveillance of the spread of resistance [153]. Published studies in the field originate from large tertiary care centers [153][154][155][156][157][158][159][160]. The Surveys of Antibiotic Resistance (SOAR) (2016-2017) conducted to determine the antibiotic susceptibility of S. pneumonia, and H. influenzae isolates from communityacquired respiratory tract infections showed high susceptibility to tested antibiotics and an increase in antibiotic resistance to trimethoprim/sulfamethoxazole and macrolides among S. pneumoniae [161][162][163][164].…”

Health Risks During Ukrainian Humanitarian Crisis

“…Antimicrobial-resistant hospital strains were detected in both gram-positive and gram-negative bacteria. 20 …”

“…Antimicrobial-resistant hospital strains were detected in both gram-positive and gramnegative bacteria. 20 The WHO's Antimicrobial Resistance Surveillance in Europe report finds a significant incidence of antibiotic resistance in bacteria such as Acinetobacter species and Klebsiella pneumoniae. 21 In Ukraine, in 2020, more than 50% of carbapenem-resistant isolates of Klebsiella pneumoniae had been reported compared with < 1% reported in Germany and in Sweden.…”

Transferable military medical lessons from the Russo-Ukraine war

“…In a study of >9000 surgical patients, rates of surgical site infection were high (21%) with methicillin resistance reported in 35.7% of Staphylococcus aureus isolates. 13 With antibiotics previously available over the counter, in August 2022 the Ukrainian Ministry of Health implemented a new process where all patients are required to obtain a prescription from a doctor before buying antibiotics. However, a combination of a sustained influx of patients with complex wounds, delays to treatment, long turnaround time of laboratory tests and transport of patients over large geographical distances has created a 'perfect storm' for a major problem with antimicrobial resistance in Ukraine.…”