O. Korniychuk, R. Shykula, Yu. Khorkavyi, Yu. Konechnyi
Danylo Halytsky Lviv National Medical University
Introduction. Healthcare-associated infections (HAIs) are a pressing problem in the health care system. Respiratory tract infections (RTI) are the second most common group of HAIs. One of the determining factors in the development of nosocomial pneumonia, which is predominantly bacterial in origin, is the properties and level of virulence of microbial factors. Early nosocomial pneumonia occurs when the upper respiratory tract microbiota infects the respiratory tract. Late nosocomial pneumonia is caused by nosocomial strains of microorganisms, characterized by multidrug resistance to antibiotics and disinfectants high levels of virulence, which include P. aeruginosa, Acinetobacter spp., Enterobacteriaceae family, MRSA. Unfortunately, in Ukraine, the structure and prevalence of HAIs and the antimicrobial resistance of pathogens are extremely poorly studied.
The aim of the study. Therefore, the study investigates the species spectrum and antimicrobial resistance of the main causative agents of respiratory tract infections.
Materials and methods. A study of microbial factors of nosocomial respiratory tract infections in 4 hospitals in Lviv. 205 patients of intensive care units diagnosed with RTI (36.6 %) were examined. Statistical analysis of the results was performed using the standard package of the program “Microsoft Excel 2010”. Microbiological diagnostics were performed following current regulations in the specialty “Bacteriology and Virology” and “Guidelines for Clinical Microbiology” of the 12th revision of the American Association for Microbiology. Microbiological diagnostics is performed in the research laboratory of the Department of Microbiology of Danylo Halytsky Lviv National Medical University.
Results. The species profile of the detected pathogens of RTI indicates that among 14 representatives of different taxa, the gram-positive microbiota predominates, but the quantitative level of seeding per gram-negative microbiota accounts for 70.17 %.
Among the isolates – factors of HAIs, multidrug-resistant (MDR) share accounted for 62.8 %. 3 strains are classified as pan drug resistant (PDR): 2 – P. putida and 1 – P. aeruginosa.
Of the gram-positive microbiota, Enterococcus spp., represented mainly by E. faecalis and E. faecium, was most often detected in clinical material. E. faecalis was most often detected in the clinical material of the gram-positive microbiota. E. faecalis isolates were characterized by pronounced resistance to penicillins (including oxacillin), cephalosporins, fluoroquinolones, erythromycin and azithromycin, clindamycin with preserved sensitivity to vancomycin and linezolid.
Pseudomonas aeruginosa isolates showed absolute sensitivity to colistin. Among other antibiotics, the most effective in terms of the number of sensitive strains were carbapenems – imipenem (57.5 %) and meronem (55.0 %). Only 37.5 % of the cultures were sensitive to tobramycin and tegicillin, an inhibitor of the protected cephalosporin antibiotic, sulfperazone.
The genus Staphylococcus was among the causative agents of pneumonia other than Staph. aureus subsp. aureus, will Staph. haemolyticus, Staph. lugdunensis. Moreover, only one strain of methicillin-resistant Staphylococcus was detected. Most cases of RTI (57.4%) of patients in intensive care units occurred within 48 hours after the installation of a tracheostomy or intubation tube.
Conclusions. According to the results of microbiological diagnostics, it has been established that the main etiological factors of nosocomial pneumonia associated with medical care are opportunistic microorganisms – Pseudomonas aeruginosa and enterococci. 62.8 % of strains were MDR. Furthermore, the results of monitoring the antibiotic resistance of hospital strains of microorganisms show their differences in different institutions of Lviv and the connection exclusively with the hospital environment. Therefore, optimization of antimicrobial treatment of nosocomial pneumonia is possible only based on the broader use of microbiological research results, constant monitoring of the microbiological status of patients in intensive care units, hospitality (distribution and properties of pathogens in hospitals).
- Denisyuk VI, Denisyuk OV. Pneumonia: modern standards of diagnosis and treatment. Ukrainian Medical Journal. 2010;3:75-80 (Ukrainian)
- State Institution “Public Health Center of the Ministry of Health of Ukraine”. Criteria for the identification of infectious diseases related to medical care. Available from: https://phc.org.ua/kontrol-zakhvoryuvan/infekciyniy-kontrol-u-zakladakh-oz/dlya-fakhivciv (Ukrainian)
- MNIAC med. statistics. Bacteriology and virology: normative production-practical edition. Part 1. K.: IEC “Medinform”; 2014. 460 p. (Ukrainian)
- Ministry of Health of Ukraine. Guideline 00013. Nosocomial multidrug-resistant strains of bacteria 2017. Available from: https://guidelines.moz.gov.ua/login?next=%2Fdocuments%2F2918%3Fid%3Deb (Ukrainian)
- Optimization of management of patients with nosocomial pneumonia. Health of Ukraine. 2019 PP-PFE-UKR-0106, 2021 (Ukrainian)
- Salmanov AG, Dubrov SO, Kharchenko LA. Nosocomial infections, antibiotic resistance, antibiotic crisis: is there a way out? Thematic issue “Surgery, Orthopedics, Traumatology” № 2(24), May 2016 (Ukrainian)
- Feshchenko YI, Golubovskaya OA, Goncharov KA. Nosocomial pneumonia in adults: etiology, pathogenesis, classification, diagnosis, antibacterial therapy (draft clinical guidelines). Ukrainian Pulmonology Journal. 2013;2:57-66 (Ukrainian)
- Carroll KC, Pfaller MA, Landry M, McAdam A, Patel R, Richter S et al. Manual of Clinical Microbiology, 12th Edition. 2019. 2832 p.
- Chastre J, Fagon J-Y. Ventilator-associated Pneumonia. Am J Respir Crit Care Med [Internet]. 2002;165(7):867-903. Available from: http://www.atsjournals.org/doi/abs/10.1164/ajrccm.165.7.2105078
- Chughtai M, Gwam CU, Mohamed N, Khlopas A, Newman JM, Khan R et al. The epidemiology and risk factors for postoperative pneumonia. J Clin Med Res. 2017;9(6):466-475.
- Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections – an overview. Infect Drug Resist. 2018;11:2321-2333.
- Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015;373(5):415-427.
- Konechnyi Y, Panas M, Tymchuk I, Havur O, Borysiuk O, Hubytska I, Zhurakhivska L, Konechna R, Korniychuk O. Epidemiological and microbiological aspects of healthcare-associated infections in Ukraine during the 2009-2019 period. Przegl Epidemiol. 2021;75(1):86-95.
- Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S et al. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med. 2018;37(1):83-98.
- Pradhan NP, Bhat SM, Ghadage DP. Nosocomial infections in the medical ICU: a retrospective study highlighting their prevalence, microbiological profile and impact on ICU stay and mortality. J Assoc Physicians India. 2014;62(10):18-21.