The main pathogens of healthcare-associated infections in patients of neurosurgery intensive care unit and antimicrobial activity of the most used antibacterial drugs

Authors

  1. Main Military Clinical Hospital n.a. acad. N.N.Burdenko, Moskva, Russian Federation
  2. Burdenko Main Military Clinical Hospital, Moskva, Russian Federation
  3. Moscow State University of Food Production, Moskva, Russian Federation
  4. Haass Moscow Medical and Social Institute, Moscow, Russian Federation, Moskva
  5. Russian Scientific Center of Radiology, Moskva, Russian Federation

https://doi.org/10.35571/RMSJ.2019.2.004

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Abstract

Importance. Healthcare-associated infectionsare an important issue in the neurosurgery. The changes in the epidemiological structure of etiological agents, the increase of antimicrobial drug resistance may lead to the ineffectiveness of previously used patterns for the prevention and treatment of healthcare-associated infections. Objective.The aim of the research was to study the microbiological structure of leading etiological agents that cause healthcare-associated infectionsin patients of neurosurgery intensive care unitand to evaluate the effectiveness of the most used antibacterial drugs. Patients and Methods.A retrospective statistical analysis of the results of microbiological monitoring of pathogens of healthcare-associated infectionsin patients of neurosurgery intensive care unitin 2013-2017 was carried out. Results. The share of gram-negative microorganisms among all isolated microorganisms in the period 2013-2017 increased from 42.47% in 2013 to 54.10% and 50.68% in 2016 and 2017.K. pneumoniae, A. baumannii, P. aeruginosa were most often isolated among gram-negative pathogens, and S. aureus, E. faecalis, and S. Epidermidis- amonggram-positive pathogens; the total rate of these six microorganisms progressively increased from 58.91 % in 2013 to 80.51% in 2017. The rateof A. baumanniiincreased from 8.22% in 2013 to 15.58% in 2017 and the rate of K. pneumoniae- from 5.48% in 2013 to 14.29% in 2017, stable significant detectability of P. aeruginosatended to increase (from 9, 59% in 2013 to 11.69% in 2017). Enterococcus spp. was identified at a significantly high level, mainly E. faecalis and E. faeciumwere represented. E. faecalis dominated (10.96% in 2013, 12.35% in 2014, 10.24% in 2015, 8.70% in 2016, 6.49% in 2017) among the isolated Enterococcus spp. A dynamic decrease in the antimicrobial activity of most used antibacterial drugs was revealed. The greatest dynamic decrease in antimicrobial activity was observed in the aminoglycoside antibiotics - gentamicin and amikacin; amoxicillin / clavulanic acid and levofloxacin. The sensitivity to vancomycin and linezolidremained at levels close to 100%. Conclusions.Today recommendations for perioperative antibiotic prophylaxis with cefazolin remain relevant. When conducting empirical antibacterial therapy, it is justified to use a combination of vancomycin with the IIId generation cephalosporins until the results of a microbiological study are obtained. An increase in the rate of resistant microorganisms complicates antibacterial therapy, requires the usage of several antibacterial drugs and increase the importance of preventive actions.

Keywords

Healthcare-associated infections, Hospital acquiredinfections, Nosocomial infections, Intensive care infections, Cross-infections, Neurosurgery, Microbiological analysis, Microbial sensitivitytests, Anti-bacterial drugs, Anti-bacterial drug resistance, Anti-microbial activity

Для цитирования:

Крюков Е.В., Гизатуллин Ш.Х., Корабельников Д.И., Зиятдинов М.Н., Сидорова А.О., Колобаева Е.Г. Микробный пейзаж при инфекциях, связанных с оказанием медицинской помощи у нейрохирургических больных, и антимикробная активность антибактериальных препаратов. Российский медико-социальный журнал. 2019;1(2):40-56. https://doi.org/10.35571/RMSJ.2019.2.004

For citation:

Kryukov E., Gizatullin S., Korabelnikov D., Ziyatdinov M., Sidorova A., Kolobaeva E. The main pathogens of healthcare-associated infections in patients of neurosurgery intensive care unit and antimicrobial activity of the most used antibacterial drugs. Russian Medical and Social Journal. 2019;1(2):40-56. (In Russian) https://doi.org/10.35571/RMSJ.2019.2.004

References

  1. Donaldson L. World Alliance for Patient Safety. Forward Programme. WHO; 2004.
  2. Pokrovsky VI, Akimkin VG, Briko NI, Brusina YB, Blagonravova AS, Zuyeva LP, Kovalishena OV, Stasenko VL, Tutel’yan AV, Fel’dblyum IV, Shkarin VV. Terminologicheskiye aspekty infektsiy, svyazannykh s okazaniyem meditsinskoy pomoshchi [Terminological Aspects of Healthcare-Associated Infections]. Zhurnal mikrobiologii, epidemiologii i immunobiologii [J of Microbiology, Epidemiology and Immunobiology]. 2011;(5):122-125. (In Russ.).
  3. WHO/HSE/EPR/2009.1.Core components for infection prevention and control programmes. Report of the Second Meeting Informal Network on Infection Prevention and Control in Health Care. Geneva, Switzerland; 26-27 June 2008.
  4. McKibben L, Horan T, Tokars JI, Fowler G, Cardo DM, Pearson ML, Brennan PJ, Heathcare Infection Control Practices Advisory Committee. Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Am J Infect Control. 2005;33(4):217-226. doi https://doi.org/10.1016/j.ajic.2005.04.001.
  5. Brusina EB, Zuyeva LP, Kovalishena O V., Stasenko VL, Feldblium I V., Briko NI, Akimkin VG. Healthcare-Associated Infections: Modern Doctrine of Prophylaxis. Part II. Basic Concept. Epidemiol Vaccine Prev. 2019;17(6):4-10. (In Russ.). doi https://doi.org/10.31631/2073-3046-2018-17-4-10.
  6. Orlova OA. Comparative Characteristics of the Incidence of Healthcare-Associated Infections in the Chelyabinsk region and in the Russian Federation in Total. Epidemiol Vaccine Prev. 2015;14(5):56-61. (In Russ.). doi https://doi.org/10.31631/2073-3046-2015-14-5-56-61.
  7. European Centre for Disease Prevention and Control. Surveillance of Surgical Site Infections and Prevention Indicators in European Hospitals - HAI-Net SSI Protocol, Version 2.2. Stockholm: ECDC; 2017. doi https://doi.org/10.2900/260119.
  8. O sostoyanii sanitarno-epidemiologicheskogo blagopoluchiya naseleniya v Rossiiskoi Federatsii v 2018 godu. Gosudarstvennyy doklad [About a condition of sanitary and epidemiologic wellbeing of the population in the Russian Federation in 2018: State report]. Moscow: Rospotrebnadzor; 2019. (In Russ.).
  9. Prisakar VI, Zapukhlykh GV, Leu EL. Epidemiologicheskiye osobennosti vnutribol’nichnykh neyrokhirurgicheskikh infektsiy [Epidemiological features of hospital acquired infections in neurosurgical patients]. Meditsinskii al’manakh. 2009;7(2):63-68. (In Russ).
  10. Abdul-Jabbar A, Takemoto S, Weber MH, Hu SS, Mummaneni P V., Deviren V, Ames CP, Chou D, Weinstein PR, Burch S, Berven SH. Surgical Site Infection in Spinal Surgery. Spine (Phila Pa 1976). 2012;37(15):1340-1345. doi https://doi.org/10.1097/BRS.0b013e318246a53a.
  11. Scheithauer S, Burgel U, Ryang Y-M, Haase G, Schiefer J, Koch S, Hafner H, Lemmen S. Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2009;80(12):1381-1385. doi https://doi.org/10.1136/jnnp.2008.165357.
  12. Yamada K, Abe H, Higashikawa A, Tonosu J, Kuniya T, Nakajima K, Fujii H, Niwa K, Shinozaki T, Watanabe K, Sakae T, Okazaki H. Evidence-based Care Bundles for Preventing Surgical Site Infections in Spinal Instrumentation Surgery. Spine (Phila Pa 1976). 2018;43(24):1765-1773. doi https://doi.org/10.1097/BRS.0000000000002709.
  13. Tay L, Ong PL, Lang L. Nosocomial infections in a neurosurgery department. Ann Acad Med Singapore. 1987;16(4):565-570. http://www.ncbi.nlm.nih.gov/pubmed/3445999.
  14. Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y, Higuera F, Cuellar LE, Arikan OA, Abouqal R, Leblebicioglu H, International Nosocomial Infection Control Consortium. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006;145(8):582-591. doi https://doi.org/10.7326/0003-4819-145-8-200610170-00007.
  15. Commichau C, Scarmeas N, Mayer SA. Risk factors for fever in the neurologic intensive care unit. Neurology. 2003;60(5):837-841. doi https://doi.org/10.1212/01.wnl.0000047344.28843.eb.
  16. Kilpatrick MM, Lowry DW, Firlik AD, Yonas H, Marion DW. Hyperthermia in the neurosurgical intensive care unit. Neurosurgery. 2000;47(4):850-855; discussion 855-6. doi https://doi.org/10.1097/00006123-200010000-00011.
  17. Laborde G, Grosskopf U, Schmieder K, Harders A, Klimek L, Hardenack M, Gilsbach JM. [Nosocomial infections in a neurosurgical intensive care unit]. Anaesthesist. 1993;42(10):724-731. http://www.ncbi.nlm.nih.gov/pubmed/8250207.
  18. Abulhasan YB, Rachel SP, Châtillon-Angle M-O, Alabdulraheem N, Schiller I, Dendukuri N, Angle MR, Frenette C. Healthcare-associated infections in the neurological intensive care unit: Results of a 6-year surveillance study at a major tertiary care center. Am J Infect Control. 2018;46(6):656-662. doi https://doi.org/10.1016/j.ajic.2017.12.001.
  19. O’Shea M, Crandon I, Harding H, Donaldson G, Bruce C, Ehikhametalor K. Infections in neurosurgical patients admitted to the intensive care unit at the University Hospital of the West Indies. West Indian Med J. 2004;53(3):159-163. http://www.ncbi.nlm.nih.gov/pubmed/15352744.
  20. Rubeli SL, D’Alonzo D, Mueller B, Bartlomé N, Fankhauser H, Bucheli E, Conen A, Fandino J, Fux CA. Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery. Neurosurg Focus. 2019;47(2):E3. doi https://doi.org/10.3171/2019.5.FOCUS19272.
  21. Jamjoom AAB, Joannides AJ, Poon MT-C, Chari A, Zaben M, Abdulla MAH, Roach J, Glancz LJ, Solth A, Duddy J, Brennan PM, Bayston R, Bulters DO, Mallucci CL, Jenkinson MD, Gray WP, Kandasamy J, Hutchinson PJ, Kolias AG, Ahmed AI. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry. 2018;89(2):120-126. doi https://doi.org/10.1136/jnnp-2017-316415.
  22. Yakovlev SV, Briko NI, Sidorenko SV. , et al. Programma SKAT (Strategiya Kontrolya Antimikrobnoi Terapii) pri okazanii statsionarnoi meditsinskoi pomoshchi: Rossiiskie klinicheskie rekomendatsii [SCAT (Antimicrobial Therapy Control Strategy) for inpatient care: Russian clinical guidelines]. In: Moscow. Izdatel’stvo «Pero»; 2018:156. (In Russ). doi https://doi.org/10.17513/np.318.
  23. Raffaldi I, Scolfaro C, Pinon M, Garazzino S, Dalmasso P, Calitri C, Peretta P, Ragazzi P, Gaglini PP, Pretti PF, Vitale P, Conio A, Tovo P-A. Surveillance Study of Healthcare-Associated Infections in a Pediatric Neurosurgery Unit in Italy. Pediatr Neurosurg. 2011;47(4):261-265. doi https://doi.org/10.1159/000335401.
  24. Chen Y, Zhang L, Qin T, Wang Z, Li Y, Gu B. Evaluation of neurosurgical implant infection rates and associated pathogens: evidence from 1118 postoperative infections. Neurosurg Focus. 2019;47(2):E6. doi https://doi.org/10.3171/2019.5.FOCUS18582.
  25. Stephens FL, Mossop CM, Bell RS, Tigno T, Rosner MK, Kumar A, Moores LE, Armonda RA. Cranioplasty complications following wartime decompressive craniectomy. Neurosurg Focus. 2010;28(5):E3. doi https://doi.org/10.3171/2010.2.FOCUS1026.
  26. Aslanov BI, Zuyeva LP, Kolosovskaya YN, Lyubimova AV, Khoroshilov VY, Dolgiy AA, Dar’ina MG, Tekhova IG. Printsipy organizatsii perioperatsionnoy antibiotikoprofilaktiki v uchrezhdeniyakh zdravookhraneniya. Federal’nyye klinicheskiye rekomendatsii [The principles of perioperative antibiotic prophylaxis in healthcare facilities. Federal clinical guidelines]. In: Moscow; 2014:42. (In Russ).
  27. Strachunskii LS, Belousov YB, Kozlov SN. , ed. Prakticheskoye rukovodstvo po antiinfektsionnoy khimioterapii [Practical guide to anti-infective chemotherapy]. Smolensk: NIIAKh SGMA; 2007. (In Russ.).
  28. Dettenkofer M, Ebner W, Hans F-J, Forster D, Babikir R, Zentner J, Pelz K, Daschner FD. Nosocomial Infections in a Neurosurgery Intensive Care Unit. Acta Neurochir (Wien). 1999;141(12):1303-1308. doi https://doi.org/10.1007/s007010050434.
  29. Aly NYA, Al-Mousa HH, Al Asar ESM. Nosocomial infections in a medical-surgical intensive care unit. Med Princ Pract. 2008;17(5):373-377. doi https://doi.org/10.1159/000141500.
  30. Orsi GB, Scorzolini L, Franchi C, Mondillo V, Rosa G, Venditti M. Hospital-acquired infection surveillance in a neurosurgical intensive care unit. J Hosp Infect. 2006;64(1):23-29. doi https://doi.org/10.1016/j.jhin.2006.02.022.
  31. Yakovlev SV, Suvorova MP, Beloborodov VB, Basin EE, Eliseev EV, Kovelenov SV, Portyagina US, Rog AA, Rudnov VA, Barkanova ON. Rasprostranennost i klinicheskoe znachenie nozokomialnyh infeksiy v lechebnyh uchrezhdeniyah Rossii: issledovanie ERGINI [Multicentre Study of the Prevalence and Clinical Value of Hospital-Acquired Infections in Emergency Hospitals of Russia: ERGINI Study]. Antibiotiki i Khimioterapiya [Antibiotics and Chemotherapy. 2016;(5-6):32-42. (In Russ.).
  32. Orlova OA, Akimkin VG, Chistova AV, Ephremova NP. Kliniko-epidemiologicheskaya kharakteristika infektsiy, svyazannykh s okazaniyem meditsinskoy pomoshchi, v khirurgicheskikh statsionarakh [Clinical and Epidemiological characteristics infections associated with medical care in Surgical Hospitals]. Epidemiol i Vaktsinoprofilaktika [Epidemiology Vaccination]. 2014;(3):36-44. (In Russ.).
  33. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, Scheld M, Spellberg B, Bartlett J. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(1):1-12. doi https://doi.org/10.1086/595011.
  34. Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2008;197(8):1079-1081. doi https://doi.org/10.1086/533452.
  35. Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, Bartlett JG, Edwards J, Infectious Diseases Society of America. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(2):155-164. doi https://doi.org/10.1086/524891.
  36. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8):470-485. doi https://doi.org/10.1016/S0196655304005425.
  37. WHO. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. 27 February 2017. https://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/. Accessed June 20, 2019.

About the authors

  • Evgeniy Kryukov, Main Military Clinical Hospital n.a. acad. N.N.Burdenko, Moskva, Russian Federation

    Main Military Clinical Hospital n.a. acad. N.N.Burdenko — nachal'nik Glavnogo voennogo klinicheskogo gospitalya

  • Shamil' Gizatullin, Burdenko Main Military Clinical Hospital, Moskva, Russian Federation, Moscow State University of Food Production, Moskva, Russian Federation

    Burdenko Main Military Clinical Hospital — Neurosurgery Dept, Head of the Dept

    Moscow State University of Food Production — Surgery Dept, Medical Institute of Continuing Education, Professor

  • Daniil Korabelnikov, Haass Moscow Medical and Social Institute, Moscow, Russian Federation, Moskva, Haass Moscow Medical and Social Institute, Moscow, Russian Federation, Moskva, Haass Moscow Medical and Social Institute, Moscow, Russian Federation, Moskva

    Haass Moscow Medical and Social Institute, Moscow, Russian Federation — Rector

    Haass Moscow Medical and Social Institute, Moscow, Russian Federation — Dept of Preventive Medicine, Head,MD

    Haass Moscow Medical and Social Institute, Moscow, Russian Federation — Dept of Internal Diseases, Professor

  • Marat Ziyatdinov, Russian Scientific Center of Radiology, Moskva, Russian Federation

    Russian Scientific Center of Radiology — Epidemiologist

  • Anastasia Sidorova, Burdenko Main Military Clinical Hospital, Moskva, Russian Federation, Moscow State University of Food Production, Moskva, Russian Federation

    Burdenko Main Military Clinical Hospital — Neurosurgery Dept, M.D., Neurosurgeon

  • Ekaterina Kolobaeva, Burdenko Main Military Clinical Hospital, Moskva, Russian Federation

    Burdenko Main Military Clinical Hospital — ICU of Neurosurgery Dept, M.D.,Head of the Unit

How to Cite

The main pathogens of healthcare-associated infections in patients of neurosurgery intensive care unit and antimicrobial activity of the most used antibacterial drugs. (2019). Russian Medical and Social Journal, 1(2), 40-56. https://doi.org/10.35571/RMSJ.2019.2.004
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