Incidence of Surgical Site Infections (SSIs) and Antimicrobial Resistance their Pathogens in Ukraine
Authors: Salmanov A.G. , Vdovychenko Yu.P. , Nychytailo M.Yu. , Andriuschenko D.V. , Verner O.M. 
Published: May 2018

OBJECTIVE — to analyses the results of patients’ surgery, to determine the incidence rate of surgical site infections (SSIs) and to identify prevailing pathogens and their resistance to antibiotics in Ukrainian hospitals.
MATERIALS AND METHODS. The investigation included 9,408 patients who underwent surgeries during 2015 in 12 surgical hospitals in different Ukrainian regions. In order to determine the incidence rates of SSIs were used the standard definition that were developed by the CDС (USA). The investigation included the analysis of 1,248 strains from patients with clinical symptoms SSIs. 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 AND DISCUSSION. Data analysis demonstrated that 13.3 % (CI 95 %: 12.3—14.2 %) patients developed postoperative SSIs. Infection rates after various surgical procedures at surgical sites were observed. Shows the high infection rate in appendectomy (17.47 %), gastric, small and large bowel surgeries (18.23 %). The infection rate in orthopedic procedures (13.27 %), cholelithiasis (hepatobiliary) (14.93 %), uterus and adnexal structures (11.10 %), urinary tract and genitalia (9.37 %) and hernia (14.1 %) are comparatively lower. The infection rate in lower segment caesarean structure is 4.24 % and excision of dermoid cysts, lipomas 3.22 %. Staphylococcus aureus was identified as the most common causative agent of SSIs (27.6 %), followed by Escherichia coli (14.1 %), Enterococcus faecalis (13.5 %), and Pseudomonas aeruginosa (10.1 %). Frequency of Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter aerogenes, Enterococcus faecium, Streptococcus spp., Staphylococcus epidermidis and Proteus vulgaris was 7.1 %, 6.9 %, 6.1 %, 4.7 %, 4.6 %, 3.6 %, and 1.6 %, respectively. Antibiotic susceptibility testing showed that all strains of S. aureus resistant to penicillin. The most active antibiotics found were linezolid, tigecycline, and mupirocin, showing growth inhibition of 100 % strains tested, followed by nitrofurantoin, trimethoprim/ sulphamethoxazole, to fusidic acid, teicoplanin, fosfomycin, gentamycin, vancomycin. Susceptibility to tetracycline, rifampicin, erythromycin, and clindamycin was observed to be some lower. Methicillin-resistant S. aureus comprised 1 %, while Vancomycin-resistant S. aureus comprised 9.3 %. Resistance E. faecalis to ceftibuten, chloramphenicol, moxifloxacin, and teicoplanin was 100 % and to cefepime 96 %. The proportion of vancomycin-resistant enterococci was 6.9 %. 26.5 % of E. coli strains showed resistance to all tested antibiotics. The most potent antimicrobials were imipenem, tobramycin, meropenem, levofloxacin and amikacinum. The high rates of resistance were found to penicillum, lincomycin, clindamycin, ampicillin, clarithromycin, amoxicillin, and to cefuroxime. K. pneumoniae showed the lowest resistance to amikacin and imipenem, and was moderately sensitive to cefepime, gentamicin, ceftriaxone, tobramycin, piperacillin/ tazobactam, ciprofloxacin, tetracycline, ceftazidime, and aztreonam. 39.6 % of P. aeruginosa were resistant to all tested antibiotics. The most potent antimicrobials were meropenem, tobramycin, imipenem and levofloxacin. The high rates of resistance were found to penicillin, erythromycin, rifampicin, tetracycline, azithromycin, amoxicillin, cefalexin, ampicillin/sulbactam, clarithromycin, and to pefloxacin. P. aeruginosa were 100 % resistant to oxacillin, ceftibuten, tetracycline, and erythromycin.
CONCLUSIONS. SSIs remain an important cause of postoperative morbidity. 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.