Microbiological monitoring, being an integral component of epidemiological surveillance of healthcare associated infection (HAI), is one of the most important components in hospital patient safety. The purpose of monitoring is the etiological interpretation of pathogens, the identification of microbial hospital strains and development of strategies as well as tactics for combating them. In modern conditions development of healthcare and humanity as a whole, the most important problem is the steady increase in the number of HAI caused by antimicrobial drug-insensitive pathogens and decreased drug effectiveness used in therapy. The structure of infectious conditions in the hospital is specific and is determined by the profile and nature of the treatment, nosology and age of patients. The main pathogens in the etiological structure of HAI are Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumanii, Enterococcus faecalis and Enterococcus faecium. The study estimated the prevalence of bloodstream infections pathogens resistant to antimicrobial agents in healthcare facilities in St. Petersburg. We retrospectively analyzed data on the antimicrobial resistance for the six clinically significant HAI pathogens that were detected in the blood samples at the 50 hospitals of St. Petersburg during the years 2016–2019. It was found that the use of β-lactam antibiotics is not effective in the treatment of patients with bloodstream infections (BSI) caused by S. aureus (in 21.9% of BSI cases), E. coli (2.1%), Klebsiella spp. (39.6%), P. aeruginosa (40.5%), Acinetobacter spp. (66.7%), Enterococcus spp. (4.4%). This article shows that targeted microbiological monitoring of HAI caused by resistant pathogens should be considered as an effective organizational mechanism for timely detection and prevention of complications that are observed in medical care to patients at high risk for bloodstream infections. Identification of the features of the epidemic process for purulentseptic infections in medical organizations contributes to the improved preventive measures in order to improve the quality of medical care. Microbiological monitoring data are necessary for the development and implementation of measures to curb the further growth of antimicrobial resistance of infectious disease pathogens.
Relevance. Enterococcus are ubiquitous, and can cause various infections, up to endocarditis. Vancomycin-resistant enterococcus (VRE) infections are difficult and expensive to treat. According to the AMRmap (Online Platform for Analysis of Antimicrobial Resistance Data in Russia) data for 2017–2020, VRE cases were reported in all federal districts of the Russian Federation, with one of the highest VRE rates in St. Petersburg (4.27%, 95% confidence interval [95% CI] 2.1–8.6)). But further, larger studies in each region are required. Aims. The study is to identify the epidemiological features of infections/colonization caused by VRE in Saint-Petersburg hospitals in 2017–2020. Materials and methods. A retrospective analysis of the prevalence of VRE isolated from hospital patients (51 hospitals of various profiles) in St. Petersburg for the period from 2017 to 2020 was performed. Results. During the study period, VRE rate was 5.3% (95% CI 5.1–5.6). The highest proportion (11.6%, 95% CI 10.4–13)) and incidence (0.6 per 1000 patients) of VRE was observed in children hospitals, the lowest – in maternity homes 0.5% (95% CI 0.3– 0.7). Throughout the analysis period VRE were detected in clinical specimens of patients from most of the departments. In adult hospitals, the proportion of VREs was significantly higher in oncohematology 14.6% (95% CI 9.6–21.7), neurology 10.8% (95% CI 7.4–15.6), and intensive care units 10.1% (95% CI 9.4–11.0). In 2020, there was a dramatic increase in VREs in neurology, cardiology, and infection departments in adult hospitals. Neonatology and intensive care units in children hospitals had the highest proportion of VRE, 40.7% (95% CI 34–48.3) and 29.8% (95% CI 21.04–40.3), respectively. In departments of other profiles, this rate varied from year to year, which may be related with clusters in hospitals and departments. Sporadic cases were detected in both neonatal and obstetric departments of maternity homes. The most common clinical specimen with isolated VRE was urine; this was characteristic of departments of almost all profiles and for children intensive care patients also VRE was isolated in gastric fluid and feces often. Conclusions. The proportion of VRE isolated from clinical specimens from patients in St. Petersburg hospitals is at an average level compared to other regions of the Russian Federation and other countries. The highest prevalence of VRE was noted in pediatric hospitals. Risk groups are patients of neonatology and intensive care departments in children's hospitals and oncohematology, neurology and intensive care departments in adult hospitals. VRE are most commonly found in the urine of patients. Screening for VRE among patients in at-risk units and contact precautions should be taken to VRE-infected/colonized patients.
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