Nosocomial infections in surgical wards in Russian emergency hospitals: ERGINI study
Ckground. Hospital - acquired infection (HAI) is an actual important problem in medicine. The methodical system of surveillance of HAI is not available in Russia and there is no reliable data about the prevalence or epidemiology of HAI. The present paper deals with the analysis of the data on prevalence as well as clinical value, risk factors, etiology and outcomes of HAIs in surgical wards. The present study was the part of first Russian survey on the epidemiological and microbiological characteristics and outcomes of HAIs in different units of emergency multifields hospitals.Methods. This prospective multicentre 1 day prevalence study with 28 - days follow - up was conducted on February 21, 2013. Thirty emergency hospitals with more than 500 beds from 17 cities participated in this study. The survey was conducted in each hospital in the single surgical department - general or abdominal surgery. All patients treated in the unit on the day of the study were examined for the presence of HAI according to CDC criteria. Risk factors of HAI, nosological and etiological structure, susceptibility of pathogens were also evaluated.Results. Totally 1284 patients were included in the study during 1 day of investigation in surgical wards. The total number of registered HAI was 54 and the prevalence of HAI was 4,21% (95% CI 3,17%, 5,56%). The prevalence of community - acquired infections in surgery was 26,48%. The skin and soft tissue was the most common site of infection, accounting for 38,9% of HAIs in surgical wards followed by the abdomen (25,9%), lower respiratory tract (20,4%), bone and joint (13,0%) and intravascular (1,8%). The significant risk factors of HAI in surgical hospital were: age, prior antibiotics, prior hospital stay, invasive procedure, liver cirrhosis, renal failure, glucocorticoids and cancer chemotherapy. 83 pathogens were isolated: both gram - positive and gram - negative microorganisms were detected in 44,6%, in 10,8% - Candida spp . E. coli was most prevalent gram - negative pathogen (19,4%), E. faecalis (12,1%) and S. aureus (10,9%) were dominant gram - positive pathogens. The resistance rate of Klebsiella spp. , Proteus spp. and E. coli and to 3rd generation of cephalosporins was 80,0, 80,0 and 56,3%. Only 33,3% of Acinetobacter isolates and 50,0% of P. aeruginosa isolates were susceptible to imipenem. The MRSA rate was 44,4%. The mortality rate was higher in patients with HAI (9,3%) than in patients without HAI (1,4%); the mean length of hospital stay was also higher in patients with HAI (18,8 ± 9,2 vs. 9,6 ± 7,3 days). In the case of occurrence of HAI in surgical ward the relative risk of death is 6,70% (95% CI 2,57; 17,48).Conclusion. The HAIs in surgical wards have a significant medical and economic value. According to the obtained prevalence data the estimating annual number of HAIs in surgical wards of Russian hospitals is approximately 280,000 cases. The multidrug resistant microorganisms were dominated among causative agents of HAIs.ERGINI Study Group: Anderzhanova A.A. (Moscow), Basin E.E. (Krasnodar), Bagin V.A. (Yekaterinburg), Barkanova O.N. (Volgograd), Gavrilov M.M. (Moscow), Grishina N.A. (Vologda), Dmitrieva I.B. (Moscow), Erofeeva S.B. (Moscow), Zolotukhin K.N. (Ufa), Kameneva T.R. (Moscow), Kotelnikova T.E. (Voronezh), Meleshina Yu.A. (Moscow), Molostova T.N. (Moscow), Naser N.R. (Saint Petersburg), Nikiforova S.V. (Moscow), Nikolaeva T.A. (Togliatti), Novozilova E.A. (Moscow), Palyutin Sh.H. (Yaroslavl), Petrovskaya E.V. (Samara), Pribytkova O.V. (Chelyabinsk), Rog A.A. (Moscow), Rydnov V.A. (Yekaterinburg), Tokareva I.Ya. (Moscow), Shalyapina O.V. (Moscow), Slyapnikov S.A. (Saint Petersburg).