PREVALENCE OF AEROBIC VAGINITIS AFTER GYNECOLOGICAL SURGERIES AND ASSOCIATED ADVERSE PREGNANCY OUTCOME IN UKRAINE.

OBJECTIVE: Aim: To determine prevalence of Aerobic Vaginitis (AV) after gynecologic surgery, risk factors and antimicrobial resistance of responsible pathogens, and adverse pregnancy outcomes in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter retrospective cohort study was conducted from January 2020 to December 2022 in fifteen medical clinics from eight regions of Ukraine. Smears were analyzed using Donders' classification method and Dong's modified AV diagnosis for Gram stains. Definitions of HAIs were adapted from the CDC/NHSN. Antibiotic susceptibility testing of bacteria was determined by Kirby-Bauer disc diffusion test according to the protocol of the EUCAST. RESULTS: Results: Prevalence of AV among women's undergoing gynecologic surgery in Ukraine was 68.7%. Of the total AV cases, 70.3% were in non-pregnant and 29,7% in pregnant women. The most common pathogen of AV was Escherichia coli, followed by Enterococcus faecalis, Streptococcus agalactiae, Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Among the S. aureus strains, 11,6% of MRSA (Methicillin resistant S.aureus) were isolated whereas none of the CoNS were cefoxitin resistant. History of vaginal infection, history of post-operative infection and antibiotic use acted as an important risk factor of AV incidence rate. The presence of AV worsened pregnancy outcomes, by increasing the incidence of preterm birth, the premature rupture of membranes, miscarriage, neonatal jaundice, and neonatal infection. CONCLUSION: Conclusions: Aerobic Vaginitis after gynecological surgeries in Ukraine is a common medical problem in women that is associated with significant morbidity, adverse pregnancy outcome, and hence frequent medical visits.

URINARY TRACT INFECTIONS IN PREGNANT WOMEN IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2020-2022).

OBJECTIVE: The aim: To obtain the first national estimates of the current prevalence rate of urinary tract infections (UTIs) in pregnant women and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: Prospective multicentre cohort study was conducted from January 2020 to December 2022. The study population consisted of 36,876 pregnant women from 17 regions of Ukraine. Antibiotic susceptibility was done by the disc diffusion test as recommended by European Committee on Antimicrobial Susceptibility Testing guidelines. RESULTS: Results: A total 29.5% pregnant women were found to have UTIs. Among these cases, 36.5% Asymptomatic bacteriuria, 51.7% Cystitis and 11.8% Pyelonephritis were observed. Of all cases, 87.9% were defined as healthcare-acquired UTIs and 12.1% community-acquired UTIs. The most common uropathogen was Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Many uropathogens isolated from UTI cases were found to be multidrug resistant. CONCLUSION: Conclusions: UTIs in pregnant women in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics. Optimizing the management and empirical antimicrobial therapy may reduce the burden of UTIs in pregnant women, but prevention is the key element.

VULVOVAGINAL CANDIDIASIS AFTER GYNECOLOGICAL SURGERIES AND ADVERSE PREGNANCY OUTCOME IN UKRAINE: A MULTICENTRE STUDY.

OBJECTIVE: The aim: To investigate the epidemiology and microbiology of vulvovaginal candidiasis (VVC) after gynecological surgeries, and adverse pregnancy outcomes in Ukraine. PATIENTS AND METHODS: Materials and methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 and recruited pregnant and non-pregnant women aged 15-65 years who had sought medical help for vaginal dysbiosis the seven medical clinic from five regions of Ukraine. RESULTS: Results: Between 2020 and 2022, 2,341 women were followed in gynecological practices, and 1,056 (41.5%) women were diagnosed with VVC during the same period. Of the total VVC cases, 31.9% were in non-pregnant and 68.1% in pregnant women. The use of antibiotics (OR=3.48), use hormonal contracep¬tives (OR=2.75) and pregnancy (OR=1.13) were associated with an increase in the risk of VVC diagnosis. Diabetes mellitus (OR=0.44) were additional risk factors. The most common pathogen of VVC was C. albicans, Nakaseomyces glabratus (C. glabrata), followed by Pichia kudriavzevii (C. krusei), C. parapsilosis, C. tropicalis, C. kefyr, C. guillieromondii, C. lusitaniae, and C. rugosa. We found no significant difference in adverse pregnancy outcomes between Candida-positive and Candida-negative women. CONCLUSION: Conclusions: Vulvovaginal candidiasis after gynecological surgeries in Ukraine is a common medical problem in women that is associated with significant morbidity, and hence frequent medical visits. High prevalence rate of vulvovaginal candidiasis in the present study warrants, the importance of conducting continuous epidemiological surveys to measure changes in species distribution from C. albicans to non-albicans Candida species in Ukraine.

PREVALENCE AND RISK FACTORS OF INFERTILITY IN UKRAINE: RESULTS A MULTICENTER STUDY (2019-2021).

OBJECTIVE: The aim: To assess the current prevalence and identify the risk factors for infertility among couples of reproductive age in Ukraine. PATIENTS AND METHODS: Materials and methods: We conducted a retrospective multicentre cohort study was based on reproductive health surveillance data among married populations from January 1st, 2019 to December 31st, 2021 in Ukraine. Definitions of infertility were used from the WHO. RESULTS: Results: Among all the 6,885 participants in this study, the prevalence of infertility was 25.4%. The prevalence of primary infertility was 5.8%, and the prevalence of secondary infertility was 19.6%. The levels of infertility in the regions of Ukraine had significant differences. It was found that among those women who had primary infertility, more were from rural than urban, while for secondary infertility women the situation was reversed. Infertility was associated with age, history of gynecological surgery, decreased ovarian reserve, age of marriage, long-term air-conditioning environment, and history of endometriosis. There were differences among factors associated with infertility, primary infertility and secondary infertility. The factors associated with primary infertility were age of marriage, age of first sexual intercourse, long-term air-conditioning environment, decreased ovarian reserve and age. A factors associated with secondary infertility were history of gynecological surgery and decreased ovarian reserve. CONCLUSION: Conclusions: The results of this study revealed high level the prevalence rate of infertility among couples of reproductive age in Ukraine is high. This applies to both primary and secondary infertility of married women. The most women who had experienced infertility have not sought medical or professional help for the problem.

SURGICAL SITE INFECTION AFTER LAPAROSCOPIC HYSTERECTOMY FOR BENIGN GYNECOLOGICAL DISEASE IN UKRAINE.

OBJECTIVE: The aim: To obtain the first estimates of the current incidence, and risk factors for Surgical Site Infection (SSI) after laparoscopic hysterectomy, and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a multicenter prospective cohort study was patient-based on surveillance data for SSIs were according to CDC/NHSN methodology. This study included women's undergoing a laparoscopic hysterectomy in 8 hospitals from different regions of Ukraine from January 2018 to December 2020. RESULTS: Results: A total of 1184 women underwent a laparoscopic hysterectomy and 14.9% SSI were identified within 30 days of the operation. Majority of SSI were deep/organ-space. The deep/organ-space SSI incidence rate was 9.2% in total laparoscopic hysterectomy, 15.2% in laparoscopic-assisted vaginal hysterectomy, and 17% in laparoscopic supracervical hysterectomy. The predominant SSI types were Pelvic abscess or cellulitis (19.1%), Salpingitis (16%), Oophoritis (15.3%), Adnexa utery (14.5%), Vaginal cuff infections (13.7%), Endometritis (11.1%), and Chorioamnionitis (9.9%). 93.8% of SSIs were detected post discharge. The most commonly identified pathogen were Escherichia coli (21.6%), Enterobacter spp. (13.1%), followed by Klebsiella spp. (8,1%), Streptococcus spp. (7%), and Pseudomonas aeruginosa (7%). The overall proportion of extended spectrum beta-lactamase production (ESBL) among Enterobacteriaceae was 17.1% and of methicillin-resistance in S. aureus (MRSA)15.8%. Resistance to third-generation cephalosporins was observed in 13.7% E.coli and 8.5% Klebsiella spp. isolates. Carbapenem resistance was in 9.7% of P.aeruginosa strains. CONCLUSION: Conclusions: Our study identified high incidence rates of SSI within 30 days surveillance of the laparoscopic hysterectomy in Ukraine, and many cases were caused by pathogens that are resistant to antibiotics.