Healthcare-associated infections and antimicrobial use in Ukrainian acute care hospitals involved in treatment of casualties of war: multi-centre cross-sectional study in 2024.

BACKGROUND

The true burden of healthcare-associated infections (HAIs) in Ukraine remains unknown. A pilot point prevalence survey (PPS) of HAIs and antimicrobial use (AMU) was undertaken in Ukrainian hospitals in 2021, but the data are limited and do not represent changes in the burden of HAIs associated with the invasion of the Russian Federation in 2022. As such, in 2024, a PPS on HAI and AMU was conducted in five healthcare facilities to understand the burden of HAIs in Ukraine.

METHODS

This research was designed as a multi-centre cross-sectional study. Four acute care tertiary level hospitals and one specialized institution participated in the study. Patients of all ages from surgical wards, intensive care units (ICUs) and medical wards were included. Data were collected on a single day for every ward, and the timeframe for the whole study was 1 month. HAI case definitions and the PPS procedure were based on the most recent documents of the European Centre for Disease Prevention and Control.

RESULTS

In total, 660 patients were included in the study. Eighty-three patients had 91 HAIs, and the prevalence of HAIs was 12.6% point prevalence (pp). Thirty-seven (40.7%) HAIs were present on admission, and 54 (59.3%) were acquired during the current hospitalization. The most common type of HAI was surgical site infection (50.5%), followed by pneumonia (12.1%), skin and soft tissue infection (9.9%), urinary tract infection (6.6%), bloodstream infection (5.5%) and systemic infection (5.5%). The highest prevalence of HAI (51.9% pp) was observed in ICUs, followed by 12.1% pp on surgical wards. The most common organisms were Acinetobacter spp. (22.4%) and Klebsiella spp. (22.4%). All HAI pathogens showed very high resistance (66-100%) to third-generation cephalosporins, glycopeptides and carbapenems. The highest use of antimicrobials was recorded in ICUs (88.9% pp).

CONCLUSIONS

This study found a significant prevalence of HAIs in Ukrainian hospitals, higher than the European average. The AMU rate was comparable with the European rate, but with disproportionally higher use in ICUs.