Healthcare-Associated Infection in Neurosurgical Patients in Ukraine: Results of a Multicenter Study (2017-2019)

Abstract

The aim: To obtain the estimates of the current prevalence of healthcare-associated infection among neurosurgical patients and determine the antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data of HAIs among neurosurgical patients from 2017 to 2019 in 7 regional hospitals. Definitions of HAI were used from the CDC/ NHSN. Results: Of 9,711 neurosurgical patients, 1,031 (20.9%) HAIs were observed. The most frequently of HAI types were surgical site infection (53.2%), pneumonia (17.3%), urinary tract infection (15.1%) and bloodstream infection (14.4%). The overall prevalence of HAIs was 20.9% within three months and was 12.8% during one month surveillance period. Death during hospitalization was reported in 11.3% of HAI cases. Escherichia coli were most commonly reported, accounting for 24.3% of all organisms, followed by Staphylococcus aureus (15.9%), Enterococcus spp (14.6%), Pseudomonas aeruginosa (13.4%), and Klebsiella pneumoniae (9.8%). Meticillin resistance was 34.6% of S.aureus isolates. Vancomycin resistance was in 7.1% of isolated enterococci. Among the gram-negative bacteria, third-generation cephalosporins resistance was found in 48.5% of K.pneumoniae and in 34.3% of E. coli isolates. Carbapenem resistance was reported in 11.7% of all included Enterobacteriaceae, also highest in K.pneumoniae, and in 32.4% of P.aeruginosa isolates and in 67.2% of Acinetobacter spp. isolates. Conclusions: Healthcare-associated infections are a cause for mortality and morbidity among hospitalized neurosurgical patients. This is due to increase emergence of antimicrobial-resistant pathogens. Routinely collected surveillance data are of great value as a basis for studying the consequences of HAIs.