Epidemiology and antimicrobial resistance of Acinetobacter

Species of the Acinetobacter represent opportunistic bacteria with a growing clinical significance for Healthcare-associated infections (HAIs). In this literature review, we focus on the current role of Acinetobacter in infectious pathology and describe taxonomy, pathogenicity, and antibiotic resistance of these bacteria. Pathogenesis and regulation of virulence factors in Acinetobacter spp. are described in detail. The majority of acinetobacterial infections are associated with A. baumannii and occur predominantly in an immunocompromised host. Usually, acinetobacterial infections are characterized by local purulent inflammation; in severe cases, meningitis and sepsis may develop. Antibiotic resistance of Acinetobacter is a major clinical problem; therefore we give special attention to laboratory testing of resistance to antibiotics as well as identification of Acinetobacter.

Antimicrobial Resistance Nosocomial Strains of Enterobacter spp. in Ukrainian surgical Hospitals: results of multicenter study

Objective. To determine activity of antimicrobials against Enterobacter spp. isolated from patients hospitalized to surgical departments in different Ukrainian hospitals. Materials and methods. A total of 3991 Enterobacter spp. isolated from patients with surgical site infections in 24 surgical hospitals in 17 Ukrainian regions. The identification and antimicrobial susceptibility of Enterobacter spp. were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results. The most potent antimicrobials were imipenem, meropenem, cefixime and amikacinum. The high rates of resistance were found to penicillin (46,2%), ampicillin/sulbactam (42,9%), gentamicin (40,4%), ceftazidime (39,4%), ampicillin (38,2%), and cefuroxime (36,3%). Conclusions. (1) Resistance of nosocomial strains of Enterobacter spp. at in patient medical institutions, that are subject to research, is a serious therapeutic and epidemiologic issue. Imipenem, meropenem, cefixime and amikacinum have been the most active to nosocomial strains of Enterobacter spp. (2) Taking into account resent changes and resistance levels of nosocomial strains of Enterobacter spp., which take place in various regions, constant monitoring over resistance to antimicrobials at every in patient medical institution is required. Also, hospital record sheets of antibiotics should be elaborated based upon the local data received. (3) Antibiotics utilization policy in each surgical in patient institution should be determined based in accordance with the local data on resistance to antimicrobials. (4) System of epidemiologic surveillance over antimicrobial resistance should be established on the local, regional, and national level.

Antimicrobial Resistance is a Global Problem

Infectious agents resistance to antimicrobials remains a challenging open problem of health care around the world. As a result, treatment-induced infections pose a serious threat to public health in general. This problem has become so important that the overwhelming majority of countries consider it a threat to the national security. Resistance to antimicrobials threatens to offset the very fundamentals of modern medicine and the sustainability of the public health system effective global response to a permanent infectious diseases threat. Today, antimicrobial resistance issues can be tackled provided that one implements an effective One Health approach (the principle of human and animal health interrelation), assuming that there is a coordination between different sectors and subjects, including experts in medicine, veterinary medicine, agriculture, ecology, and well-informed consumers. To ensure effectiveness of treatment, action is urgently needed to counteract the further development and spread of antibiotic resistance, which is driven by antibiotic use in all sectors. Since this resistance has no ecological, sectoral or geographical borders, its appearance in one sector affects resistance in other sectors. National authorities, veterinarians, physicians, patients and farmers all have key roles in preserving the power of antibiotics. The prevention and containment of antibiotic resistance therefore requires addressing all risk factors for the development and spread of antibiotic resistance across the full spectrum of conditions, sectors, settings (from health care to use in food-animal production) and countries. This article explores the options for prevention and containment of antibiotic resistance in the food-chain through national coordination, including the regulation and reduction of antibiotic use in food animals, training and capacity building, surveillance of resistance trends and antibiotic usage, promotion of knowledge and research, and advocacy and communication to raise awareness of the issues. The article suggests possible ways for adopting a holistic, intersectoral, multifaceted approach to this growing problem.

Nosocomial pneumonie in intensive care units: problems and solutions

Nosocomial pneumonia (NP) is a serious problem in healthcare in the world and remains the same, despite the application of new therapies and prevention. Among the infections associated with the provision of healthcare, the state of emergency takes the second - the third place in terms of prevalence and second place in terms of mortality. NP significantly impairs the prognosis of the underlying disease, increases the length of stay of the patient in the hospital and the cost of treatment. Insufficient resolution of issues of prophylaxis, early diagnosis and treatment is the reason that a significant proportion of cases of NP are diagnosed only by the results of autopsy. In recent years, there has been an increase in the number of cases of NP caused by antibiotic-resistant microorganisms, which complicates the implementation of effective empirical antibiotic therapy and disease prevention. The authors propose recommendations that take into account the modern scientific developments of many domestic and foreign researchers on NP issues. The issues of epidemiology, etiology, pathogenesis, clinical classification of the disease are elucidated in detail. Particular attention is paid to surveillance of emergency rooms in intensive care units (ICU).

Comparative analysis of the effectiveness of simultaneous laparoscopic operations in acute appendicitis accompanied by various gynecological pathologies

Introduction. According to the World Health Organization 20 to 30% of gynecological pathologies in women are assosiatedwith surgical pathology and these challenge surgeons and gynecologists to correct these pathologiessimultaneously. The study aimed to evaluation of effectiveness of simultaneous laparoscopic operations in acute appendicitis accompanied by various gynecological pathologies Material and Methods. Total 88 patients were involved in the study. Of these, 55 patients underwent laparoscopic surgery - appendectomy (A control subgroup) and 33 simultan surgeries (core B subgroups). Diagnosis of acute abdomenal in gynecological patients, including diagnostic laparoscopy, was performed on the basis of algorithm. Comparison of arterial pressure, heart rate, intensity of pain and patients' activation period was studied in control and main subgroups during surgery and postoperative period. Results. Comparative analysis has showed that the statistical difference between these parameters in patients with isolated appendectomy and simultaneous surgery is almost inaccurate and simultaneous operation may be adequate, despite the complex effects of some negative factors of laparoscopy.

ANTIMICROBIAL RESISTANCE IN SEXUALLY TRANSMITTED INFECTIONS

Sexually Transmitted Infections (STIs), including gonorrhea, are an actual problem that continues to bother doctors and health care providers. After all, the consequences of urogenital infections are harm to the sexual and reproductive health of the population, to future generations. The level of registration of individual STIs continues to increase, which puts before the health care system and society as a whole the urgent task of preventing the harmful effects of this pathology on public health. In recent years, according to research, the epidemiological characteristics of STIs have changed dramatically. These changes are associated with the expansion of the age and social composition of STI patients. There are changes in the etiology of STIs and the antimicrobial resistance of their pathogens. There are new mechanisms of resistance of STI agents in the most important antibiotics and chemotherapeutic drugs. There is every reason to believe that the problem of antibiotic-resistant strains will continue to exist, which hampers the effectiveness of treatment regimens. Efforts at many levels are important to effectively address this problem, particularly in the areas of new drug development, alternative treatment regimens, and further research on testing antimicrobial resistance.

Ukrainian Strategy and Action Plan for the Prevention of Healthcare Association Infections (HAIs) and Antimicrobial Resistance

The Ukrainian Strategy and Action Plan for the Prevention of Healthcare Association Infections (HAIs) and An- timicrobial Resistance defines the purpose, principles and main directions of the improvement of the National system for control and prevention of HAI and AMR pathogens of these infections, mechanisms of its functioning, as well as expected socio-economic impact. Action plan underscores the need for an effective «One Health» approach involving coordination among numer- ous international sectors and actors, including human and veterinary medicine, agriculture, environment, and well-informed consumers. The Action Plan recognizes and addresses both the variable resources nations have to combat antimicrobial resistance. The main objectives of the Ukrainian Action Plan is to improve the regulatory, legal and methodological support system of prevention of Healthcare-associated Infections (HAI), laboratory diagnosis and monitoring of AMR pathogens infections, training system for medical personnel in these fields. We are talking about the introduction of modern approaches and optimization of controls and prevention of HAI, preventing of transmission of multi re- sistance pathogens in healthcare institutions, improving the effectiveness of disinfection and sterilization measures. It is planned to create a unified system of laws and regulations that will ensure effective control and prevention of HAI and AMR, and investigation of outbreaks when they occur and ensuring of adequate compensation to victims; to prepare a standard on infection control with the compliance of mandatory requirements aimed at preventing HAI and AMR in healthcare institutions based on their profile; to create in healthcare institutions the methods of epidemiological diagnostic, based on standard criteria for determining of nosocomial infection cases by anatomic localization of infection. In addition, it is necessary to optimize the list of indications for microbiological and clinical research material and objects of hospital environment, rules of sampling and shipping of samples of biological material in the laboratory. And to develop target prevention programs for HAI and AMR at the national (country), regional and municipal levels. To implement modern technologies on infection control and monitoring of AMR in health care institutions. As a result of the Ukrainian Action Plan is expected to reduce the number of infections caused by resistant strains of microorganism’s mortality, disability and complications from infections associated with medical care, increase the employment potential of the nation by reducing temporary and permanent loss of working ability as a result of population diseases. Also, it is necessary to increase safety of patients and staff while providing medical care.

SURVEILLANCE OF HEALTHCARE-ASSOCIATED INFECTIONS IN UKRAINIAN INTENSIVE CARE UNITS: PROBLEMS AND SOLUTIONS

In article modern principles of surveillance of healthcare-associated infections in branches of a Ukrainian intensive care units are submitted. The risk factors influencing occurrence of such infections, ways of prevention of their occurrence and improvement are considered.

ONE HEALTH: ENVIRONMENTAL CONTAMINATION BY ANTIMICROBIALS

Over the past few decades, a high number of pharmaceuticals have been detected in surface, ground and drinking waters. This contamination comes from domestic sewage, livestock, hospitals and chemical- pharmaceutical industries. Typical examples of these pollutants are the antimicrobials – powerful antibiotics used in human and veterinary medicine. The presence of antimicrobials in the environment can pose a serious threat to the ecosystem and to human health due to their high consumption globally. Even at low environmental concentrations, antibiotics stimulate bacterial resistance. The consequences of the presence of fluoroquinolones in the environment are not fully understood, but are known to be toxic to plants and aquatic organisms. Approximately 85% of the antimicrobials present in influents can be removed by conventional wastewater treatment plants, but the removed fraction is frequently accumulated in the sludge, which is sometimes used as fertilizer, representing an additional input route into the environment. The removal of antimicrobials by biological treatment is ineffective, and it is believed that only advanced oxidation technologies are able to destroy these emerging pollutants.

ANTIMICROBIAL RESISTANCE OF PATHOGENS OF HEALTHCARE-ASSOCIATED INFECTIONS IN SURGERY AND INTENSIVE CARE UNITS

OBJECTIVE. To determine resistance to antibiotics of the pathogens of healthcare-associated infections (HAIs) in surgery and intensive care units in Kyiv hospitals. MATERIALS AND METHODS. The investigation included the analysis of 6159 strains from patients with clinical symptoms HAIs. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer Vitek 2 Compact (BioMerieux, France). Susceptibility to antibiotics was determined using AST cards (BioMerieux, France). Some antimicrobial susceptibility test used Kirby – Bauer antibiotic testing. Interpretative criteria were those suggested by the CLSI (USA). RESULTS. The leading agents are E.coli, S.aureus, S.epidermidis, P.aeruginosa, Enterobacter in surgical departments, and Klebsiella, Acinetobacter spp., P.aeruginosa and Enterobacter in departments of intensive care. Multiple resistant hospital cultures are shared in surgical as well as in the departments of intensive care. Its susceptibility to antibiotics was given. CONCLUSIONS. HAIs remain an important cause of morbidity in surgery and intensive care units. Antimicrobial resistance among these and other clinically important pathogens is an increasing problem. The clinical should choose antimicrobial drug in accordance with the local bacterial resistance characteristics for reduce the production of drug resistance and improve the effect of anti-infection treatment possibly.