Microbiology of Healthcare-Associated Infections: Results of a Fourth National Point Prevalence Survey in Serbia.

Millions of patients acquire healthcare-associated infections (HAIs) every year, putting them at risk for serious complications and prolonged hospitalization. Point prevalence surveys (PPS), guided by the European Centre for Disease Prevention and Control framework, are one of the primary methods by which countries in the European Union conduct surveillance of HAIs. Serbia, though not in the EU, implemented this approach in its national PPS. The microbiological and antimicrobial resistance (AMR) analyses comprised patients in 61 out of 65 hospitals included in the fourth PPS conducted in November 2017. A total of 515/12,380 (4.2%) of the adult patients included in the PPS had at least one HAI, with intensive care units carrying the highest prevalence of 15.9%. Urinary tract and surgical site infections were the most frequently identified types of HAIs (23.9% and 23.0%, respectively). Enterobacterales comprised almost half (47.0%) of all causative agents, most notably Klebsiella spp. (16.7%). AMR was very high for most pathogens-80.5% of nonfermentative Gram-negative bacilli were resistant to carbapenems whereas 62.9% of Enterobacterales were resistant to third generation cephalosporins. The calculated AMR index of 61% is one of the highest in Europe. Further efforts are needed to reduce the burden of HAIs in Serbia that carry very high resistance rates to antibiotics currently used in clinical practice.

A nationwide assessment of the burden of healthcare-associated infections and antimicrobial use among surgical patients: results from Serbian point prevalence survey, 2017.

BACKGROUND: As the only non-European Union (EU) country, Serbia participated in a second point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use (AMU) organized by the European Centre for Disease Prevention and Control (ECDC) in the EU countries. Here, we aimed to estimate the prevalence of HAI and AMU in patients who had recently undergone a surgery and to compare risk profile, HAI rates, and AMU among surgical patients and non-surgical patients. METHODS: A national PPS was performed in 65 Serbian acute-care hospitals, in November 2017. In this paper, the data of 61 hospitals for adult acute-care were analyzed. To ensure the comparability of study design we used the Serbian translation of ECDC case definitions and ECDC PPS protocol. The trained infection control staff, led by a hospital coordinator, reviewed medical records to identify HAI active at the time of the survey and AMU. Only inpatients admitted to the ward before 8 a.m. on the day if the survey were included. RESULTS: A total of 12,478 patients from 61 hospitals for adult acute-care were eligible for inclusion in this study. Significantly higher proportions of surgical patients were female, belonged to the 60-to-79 age group, and were less severely ill. Also, extrinsic factors (invasive devices, hospitalization at the ICU, and prior antibiotics therapy) were more frequent in surgical patients. Prevalence of HAIs was higher among surgical patients (261/3626; 7.2%) than among non-surgical patients (258/8852; 2.9%) (p < 0.0001). The highest prevalence of all HAIs was noted in patients who had kidney transplantation (4/11; 36.4%), while SSIs were the most prevalent among patients who had peripheral vascular bypass surgery (3/15; 20.0%). Non-surgical patients received treatment for community-acquired infections in significantly higher proportion (2664/8852; 64.3) (p < 0.001). Surgical prophylaxis for more than 1 day was applied in 71.4% of surgical patients. CONCLUSION: We have provided an insight into the burden of HAIs and AMU among Serbia acute-care hospitals, and highlighted several priority areas and targets for quality improvement.

A Prospective Cohort Study on Injuries Among Intensely Physically Active High School Students.

BACKGROUND: The leading cause of nonfatal injuries in age group 14-19 is sports injuries. Purpose of the study was to determine the association between intense physical activity and injury and to identify the circumstances and environment in which injuries are most likely to occur. METHODS: A prospective cohort study included 698 high school students 15-19 years old, divided into those exposed and those unexposed to intense physical activity. The international standard questionnaire about physical activity (International Physical Activity Questionnaire-IPAQ) and the metabolic equivalent task (MET) scores were used. RESULTS: The risk of injuries was 7 times higher (relative risk [RR]: 7.041; 95% confidence interval [CI]: 6.071, 8.187) and the risk of injuries requiring treatment in health facilities was 15 times higher (RR: 14.717; 95% CI: 10.652, 20.592) in the intensely physically active adolescents. The risk of gaining sports injuries was 11 times higher in the exposed group (RR: 11.212; 95% CI: 9.013, 14.074), with a significantly higher incidence rate (Inc.) among men (82.9 per 100). Most injuries occurred in football (Inc. 4.4 per 1000 hours), volleyball (Inc. 3.9 per 1000 hours), and boxing/kickboxing (Inc. 3.7 per 1000 hours). CONCLUSIONS: Intensely physically active high school students have a much higher risk of injury, which usually occurs during training or a match.