乌克兰医疗相关性宫颈炎的流行情况及相关病原体的抗生素耐药性：一项多中心研究的结果（2019-2021 年）。

PREVALENCE OF HEALTHCARE-ASSOCIATED CERVICITIS AND ANTIMICROBIAL RESISTANCE OF THE RESPONSIBLE PATHOGENS IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2019-2021).

机构信息

SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE.

NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE.

出版信息

Wiad Lek. 2022;75(9 pt 2):2189-2197. doi: 10.36740/WLek202209202.

DOI:10.36740/WLek202209202

PMID:36378693

Abstract

OBJECTIVE

The aim: To obtain the first estimates of the current prevalence of healthcare-associated cervicitis (HACs) and antimicrobial resistance of responsible pathogens in Ukraine.

PATIENTS AND METHODS

Materials and methods: We conducted a retrospective multicentre cohort study was based on surveillance data from January 1st, 2019 to December 31st, 2021 in Ukraine. Antibiotic susceptibility testing was determined by Kirby-Bauer disc diffusion test according to the protocol of the European Committee on Antimicrobial Susceptibility Testing.

RESULTS

Results: Of the 6,885 participants in this study, 1746 women (25.5%) met the clinical definition of cervicitis. Prevalence of HACs and cervcits caused sexually transmitted pathogens were 12.7% and 8.3%, respectively. The incidence of HACs among women with a history of gynecological procedures was 25.4%. The main causes of HACs were legal induced abortions (28.8%), vaginal hysterectomy (23.9%), and postpartum instrumental examination (12.8%). The predominant pathogens of HACs were: Escherichia coli, Enterobacter spp., Klebsiella spp., Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis. Methicillin-resistance was observed in 20.8% of S. aureus (MRSA). Vancomycin resistance was observed in 7.4% of isolated enterococci (VRE). Resistance to third-generation cephalosporins was observed in 13.1% Klebsiella spp. and E.coli 17.5% isolates. Carbapenem resistance was identified in 11.6% of P.aeruginosa isolates. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (33.5%, vs 8.7%). The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 34.6%.

CONCLUSION

Conclusions: This study showed that the prevalence of healthcare-associated cervicitis in Ukraine is high, and many cases were caused by antibiotic-resistant pathogens.

摘要

目的

旨在获取乌克兰当前医源性宫颈炎（HAC）的患病率以及相关病原体的抗生素耐药率的首份估计值。

患者和方法

我们开展了一项回顾性多中心队列研究，其数据基于 2019 年 1 月 1 日至 2021 年 12 月 31 日期间在乌克兰的监测结果。药敏试验采用欧洲抗菌药物敏感性试验委员会（EUCAST）推荐的纸片扩散法进行。

结果

本研究共纳入 6885 名参与者，其中 1746 名女性（25.5%）符合宫颈炎的临床诊断标准。医源性宫颈炎和性传播病原体导致的宫颈炎的患病率分别为 12.7%和 8.3%。有妇科手术史的女性中，医源性宫颈炎的发病率为 25.4%。医源性宫颈炎的主要病因是合法引产（28.8%）、阴道子宫切除术（23.9%）和产后器械检查（12.8%）。医源性宫颈炎的主要病原体包括：大肠埃希菌、肠杆菌属、克雷伯菌属、金黄色葡萄球菌、铜绿假单胞菌、粪肠球菌。金黄色葡萄球菌中耐甲氧西林的比例为 20.8%（MRSA）。分离出的肠球菌中有 7.4%为万古霉素耐药（VRE）。产超广谱β-内酰胺酶（ESBL）的克雷伯菌属和大肠埃希菌的耐药率分别为 13.1%和 17.5%。11.6%的铜绿假单胞菌对碳青霉烯类耐药。大肠埃希菌产 ESBL 的比例明显高于肺炎克雷伯菌（33.5% vs 8.7%）。肠杆菌科产 ESBL 的总体比例为 34.6%。