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.
Relevance. Vaccination is being replaced by the primary and most effective means of protecting the world's population from a new coronavirus infection.Aim. Evaluation of the effectiveness of COVID-19 immunization in Saint-Petersburg.Materials and methods: We retrospectively studied the epidemiological data on the cumulative incidence of COVID-19 in St. Petersburg among adults vaccinated (1,558,030 people) and unvaccinated (2,863,050 people) for period from December 01, 2020 to November 30, 2021 on 12.01.2021. We analyzed the data presented in the Federal Register of Persons with COVID-19 and the Federal Register of Those Vaccinated against COVID-19.Results. The risk of COVID-19 infection among vaccinated is statistically significantly lower than among unvaccinated RR = 0.11 (95% CI 0.109–0.110; p < 0.001). Infected COVID-19 Vaccinated patients were less likely to need for emergency care/hospitalization RR = 0.30 (95% CI 0.29–0.30; p < 0.001). Also among the vaccinated mortality was lower RR = 0.35 (95% CI 0.33–0.37; p < 0.001).Conclusion: We have established reliable preventive effectiveness of the use of domestic vaccines by reducing morbidity, the frequency of development of forms of the disease requiring inpatient treatment; reducing mortality among vaccinated and, accordingly, reducing the burden on the healthcare system of St. Petersburg.
Ключевые слова: бактериальная резистентность, бремя болезни, клиникоэкономический анализ. Впервые в России была проведена оценка бремени бактериальной резистентности. Проведен ана лиз базы данных СанктПетербургского Медицинского информационноаналитического центра о результатах бактериологических исследований в многопрофильных стационарах. На основании полученных данных рассчитано количество пациентов с инфекциями, вызванными штаммами ме тициллинорезистентного S. aureus (MRSA); K. pneumoniae, нечувствительными к цефалоспоринам 3 поколения и карбапенемам; E. coli, нечувствительными к цефалоспоринам 3 поколения. Данные экстраполированы на все многопрофильные стационары Российской Федерации с учетом извест ных уровней резистентности. Общие затраты на лечение пациентов с инфекциями, вызванными тремя возбудителями в многопрофильных стационарах СанктПетербурга (СПб) за год составили 250 887 292 руб., в РФ-12 413 309 939 руб. При этом основные затраты связаны с проведе нием антимикробной терапии (90% в СПб, 88%-в РФ). Затраты, связанные с дополнительными койкоднями, временной нетрудоспособностью, мероприятиями инфекционного контроля, состав ляют 10% и 12% соответственно. Математическое моделирование показало, что эти затраты могут увеличиться минимум на 10% за счет смерти пациентов трудоспособного возраста.
The fight against a new coronavirus infection (SARS-CoV-2) has been ongoing for more than two years and has clearly been delayed, necessitating an epidemiological assessment of the status of the solution, successes and shortcomings in the control of the problem on both global and regional scales. An monitoring, epidemiological analysis of SARS-CoV-2 morbidity and mortality in WHO regions and selected territories by month and week for 2020–2021 and partly for 2022 was performed. It was found that the monthly trend of morbidity and mortality in their comparison across WHO regions and in individual countries repeats to some extent the weekly dynamics, but is not equal to it in the territories under comparison. It shows the wavelike epidemic process of the new coronavirus infection caused mainly by the emergence and circulation of new variants and subvariants of the pathogen among the population. An attempt was made to explain some features of the wavelike course of the epidemic process of COVID-19 depending on a number of other additional risk factors. Significant risk factors for the spread of the infection include a low level of social responsibility of the population not providing the necessary amount of measures (masking regime, non-compliance with social distance), uncontrolled travel regulation and, finally, a low level or complete absence of collective immunity to new mutation variants of the virus. Collective immunity formed as a result of disease transmissions and specific prophylaot pxis does protect completely against infection with new virus variants, but ensures a lighter course of the disease in cases of infection, reduced hospitalizations and deaths. Morbidity and mortality from COVID-19 in Russia, Moscow and St. Petersburg are also characterized by a wave-like course, however the indicators at the height of waves and in the intervals between them don’t decrease. The reason for this situation could be overdiagnosis, shortcomings in identifying the new variant of the virus. The delta variant, characterized by a more severe clinical course and unfavorable outcomes, is still circulating in some territories. Therefore, vaccination with coverage of 80 % of the population, including 60 % of the booster dose should ensure a decrease in the incidence and prevalence of all variants of the virus, the frequency of hospitalizations and deaths. Proceeding from the wave-like nature of the epidemic process in Russia and its metropolitan areas, all preventive measures should be strengthened not only at the peak of the epidemic, but also between waves in order to prevent infections and reduce morbidity and mortality. The need for measures is evidenced by the dynamics of increasing rates from the summer to the autumn-winter period of the year. However, analysis of weekly dynamics of morbidity should be taken as a basis for monitoring and accounting for changes in the epidemic process.
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