Epidemiology of endometriosis in Ukraine: results a multicenter study (2019-2021).

OBJECTIVE: Aim: To estimate the prevalence and incidence of endometriosis, and to evaluate risk factors associated with endometriosis in Ukraine. PATIENTS AND METHODS: Materials and Methods: The multicenter cohort study was performed partly as a cross-sectional study to estimate occurrence of endometriosis, partly as a case-control study to look for factors associated with endometriosis. The study was carried out during the period from January 1st, 2019 to December 31st, 2021.This study included adolescent girls and adult women from 15 Ukrainian regions. RESULTS: Results: Among 15,458 patients, 4,397 (28.4%) endometriosis were observed. Of all endometriosis cases, 48.5% were peritoneal/superf i cial endometriosis (SPE), 34.6% were ovarian endometriotic cyst/endometrioma (OMA), and 16.9% were deep inf i ltrating endometriosis (DIE). The prevalence of the three types of endometriosis was: SPE, 13.8%; OMA, 9.8%; and DIE, 4.8%. The factors associated with an increased risk for endometriosis include age 23-32 years, parity (small number of births), age of fi rst sexual intercourse <20 years, history of healthcare-associated infection after gynecological surgery (pelvic abscess or cellulitis, salpingitis and oophoritis), history of infertility, early menarche (before the age of 11), dysmenorrhea, dyspareunia, pelvic pain, intermenstrual bleeding, heavy uterine bleeding and dysmenorrhea, and heavy uterine bleeding. CONCLUSION: Conclusions: Endometriosis is a common gynecological disease in Ukraine and the relative frequency of dif f erent types of endometriosis: the most common were ovarian and peritoneal endometriosis. Healthcare services and public health strategies need to be strengthened to ensure timely endometriosis diagnosis in adolescent girls and adult women and treatment.

POSTOPERATIVE INFECTIONS AFTER GYNECOLOGICAL SURGERIES IN UKRAINE.

OBJECTIVE: Aim: To determine the current prevalence of surgical site infections (SSIs) after gynecological surgeries and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter prospective observational cohort study was conducted from January 2020 to December 2022 in nine hospitals from eight regions of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST. RESULTS: Results: A total 12.2% (420/3450) patients who undergoing gynecological surgeries were found to have SSIs. The difference in SSI rates between the three subgroups by route of surgery was not statistically significant, being 12.0% for the abdominal group,11.1% for the vaginal group, and 12.5% for the combined group. The most common causing pathogens of SSIs was Escherichia coli, Pseudomonas aeruginosa, Enterobacter spp., Streptococcus spp., and Klebsiella pneumoniae. Many Gram-negative pathogens isolated from SSI cases were found to be multidrug resistant. CONCLUSION: Conclusions: This study showed that SSIs remains the common complication after gynecological procedures in Ukraine. Best practices should be established and followed to reduce the risk of SSIs associated with gynecologic surgery. Optimizing the antibiotic prophylaxis and empirical antimicrobial therapy may reduce the burden of SSIs in gynecological surgeries, but prevention is the key element.

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.

CATHETER-ASSOCIATED URINARY TRACT INFECTIONS AFTER CAESAREAN SECTION IN UKRAINE: RESULTS A MULTICENTER STUDY (2020-2022).

OBJECTIVE: The aim: To obtain the first national estimates of the current prevalence rate of catheter-associated urinary tract infections (CAUTIs) after caesarean section (CSEC) and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: Prospective multicentre surveillance was conducted from January 2020 to December 2022 in 15 women hospitals of Ukraine. Definitions of CAUTIs were adapted from the CDC/NHSN. Antibiotic susceptibility was done by the disc diffusion test as recommended by European Committee on Antimicrobial Susceptibility Testing guidelines. RESULTS: Results: A total of 15,892 catheterized women undergoing primary CSEC and 13.6% CAUTI were identified. The most common uropathogen was Escherichia coli, Proteus mirabilis, and Enterococcus species followed by Providencia stuartii and Pseudomonas aeruginosa. Many uropathogens isolated from CAUTI cases were found to be multidrug resistant. CONCLUSION: Conclusions: This study showed that CAUTIs in catheterized women undergoing primary CSEC 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 CAUTIs in catheterized women undergoing primary CSEC, but prevention is the key element.

HEALTHCARE ASSOCIATED INFECTION AFTER LEGAL INDUCED ABORTIONS IN UKRAINE: RESULTS A MULTICENTER STUDY.

OBJECTIVE: The aim: To determine trend of legal induced surgical abortion and to assess the frequency of infection complications after termination of pregnancy in Ukraine. PATIENTS AND METHODS: Materials and methods: We conducted a prospective multicentre cohort study was based on surveillance data of healthcare-associated infection (HAI) after legal induced surgical abortion in women's from January 2017 to 2019 in Ukraine. Definitions of HAI after induced abortion were used from the CDC/ NHSN. RESULTS: Results: The number of surgical abortions in Ukraine increased by 32.8%. A total of 25.9% HAIs were identified after surgical abortion. Of these HAIs, 25.9 were Endometritis, 21.8% Bacterial Vaginitis, 14.3% Parametritis, 13.1% Cervicitis, 9.9% Adnexa utery, 7.8% Salpingitis, 6.3% Chorioamnionitis, and 0.9% other reproductive tract infections. E.coli were most commonly reported, accounting for 25.9% of all organisms, followed by Enterococcus spp. (16.2%), Staphylococcus aureus (15.5%), P. aeruginosa (10.9%), and Enterobacter spp. (10.1%). Antimicrobial resistance in the isolates associated with HAIs showed, among the gram-positive bacteria, that 19.1% and 3.6% of coagulase-negative staphylococci isolates were b-lactam (oxacillin) - and glycopeptide-resistant, respectively. Meticillin resistance was reported in 23.2% of S aureus isolates. Vancomycin resistance was reported in 3.7% of isolated enterococci. Among the gram-negative bacteria, third-generation cephalosporins resistance was found in 33.1% of Klebsiella spp and in 24.1% of E.coli isolates. CONCLUSION: Conclusions: The results of this study revealed high rates of HAIs after surgical abortion and most causing pathogens were associated with resistant to antibiotic strains. This knowledge is essential to develop targeted strategies to surveillance and reduce the incidence of post-abortion infections.

PERINATAL INFECTIONS IN UKRAINE: RESULTS OF A MULTICENTER STUDY.

OBJECTIVE: The aim: To obtain the estimates of the сurrent incidence rate of perinatal infections, risk factors, as well as their associated impact on mortality and determine the antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a multicentre retrospective cohort study was based on surveillance data. This study included infants aged 0 to 6 days delivered in 2017-2019 at 11 Ukrainian regional perinatal centers. Definitions of perinatal infections and mortality were used from the CDC/WHO/UNICEF. RESULTS: Results: Of 18,348 liveborn infants, 472 (2.6%) perinatal infections were detected. The incidence of perinatal infection was 25.7 per 1000 live births. The most frequently identified types of infections were: bloodstream infections, 35.6 %, lower respiratory tract infections, 21.4%, Meningitis, 18.2%, Conjunctivitis, 11.9%, skin and soft tissue infections, 6.6%, Dacryocystitis, 3.8%, and urinary tract infections, 2.5%. Early mortality rates from perinatai infections was 51.1%, with an incidence of 13.1 deaths/1000 live births. Potential risk factors the development of perinatal infections and mortality were low birth weight, prematurity, low gestasional age, mode of delivery (manual aid), premature rupture of membranes, preterm premature rupture of membranes, prolonged rupture of membranes, turbid and meconeal amniotic fluid, infection of the mother during labor. resuscitation during delivery, invasive procedure, asphyxia. Main causative agents of perinatal infections were Escherichia coli, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, CoNS, Enterobacter cloacae, Pseudomonas aeruginosa. CONCLUSION: Conclusions: This study showing that the high incidence rate of perinatal bacterial infections, as well as their associated impact on mortality, and presents a significant burden to the Ukraine.

IMPACT OF INFECTIOUS DISEASES ON PUBERTAL TIMING IN UKRAINIAN GIRLS: RESULTS A MULTICENTER STUDY.

OBJECTIVE: The aim: To determine current age at the initiation of puberty for Ukrainian school-aged girls and infections impact to puberty. PATIENTS AND METHODS: Materias and methods: We performed a multicentre cohort study. The analyses are based on data that were collected and evaluated biannually on Ukrainian school girls aged 6-17 years from 5 regions of Ukraine. Pubertal development was classified according to the Marshall and Tanner criteria. RESULTS: Results: Overall, 2,784 girls have been included in the study. Mean age of onset of puberty in Ukrainian girls was 10.1±1.0 yrs. Age of onset of pubic hair was 11.0±1.0 yrs and that of axillary hair was 11.6±1.0 yrs. Mean age in girls of menarche was 12.2±0.9 yrs. There were no significant correlations between age at onset of puberty and body mass index, final height, total peak height velocity, duration of puberty, and peak height velocity. A total of 2,420 infectious diseases were diagnosted. Of these, 64.8% were viral and 35.2% bacterial infections, respectively. Ukrainian girls with infectious diseases (especially viral infections) had older age at pubertal onset and positive association of infections in childhood with late age of menarche. CONCLUSION: Conclusions: Infectious morbidity (especially viral infections) in girls may be associated with later puberty. The lowering of the number of infections in childhood could be an additional factor that contributes to earlier puberty. To reduce infectious diseases, more attention should be paid to the vaccination of children.