Dissemination of extensively drug-resistant NDM-producing Providencia stuartii in Europe linked to patients transferred from Ukraine, March 2022 to March 2023.

BackgroundThe war in Ukraine led to migration of Ukrainian people. Early 2022, several European national surveillance systems detected multidrug-resistant (MDR) bacteria related to Ukrainian patients.AimTo investigate the genomic epidemiology of New Delhi metallo-ß-lactamase (NDM)-producing Providencia stuartii from Ukrainian patients among European countries.MethodsWhole-genome sequencing of 66 isolates sampled in 2022-2023 in 10 European countries enabled whole-genome multilocus sequence typing (wgMLST), identification of resistance genes, replicons, and plasmid reconstructions. Five bla NDM-1-carrying-P. stuartii isolates underwent antimicrobial susceptibility testing (AST). Transferability to Escherichia coli of a bla NDM-1-carrying plasmid from a patient strain was assessed. Epidemiological characteristics of patients with NDM-producing P. stuartii were gathered by questionnaire.ResultswgMLST of the 66 isolates revealed two genetic clusters unrelated to Ukraine and three linked to Ukrainian patients. Of these three, two comprised bla NDM-1-carrying-P. stuartii and the third bla NDM-5-carrying-P. stuartii. The bla NDM-1 clusters (PstCluster-001, n = 22 isolates; PstCluster-002, n = 8 isolates) comprised strains from seven and four countries, respectively. The bla NDM-5 cluster (PstCluster-003) included 13 isolates from six countries. PstCluster-001 and PstCluster-002 isolates carried an MDR plasmid harbouring bla NDM-1, bla OXA-10, bla CMY-16, rmtC and armA, which was transferrable in vitro and, for some Ukrainian patients, shared by other Enterobacterales. AST revealed PstCluster-001 isolates to be extensively drug-resistant (XDR), but susceptible to cefiderocol and aztreonam-avibactam. Patients with data on age (n = 41) were 19-74 years old; of 49 with information on sex, 38 were male.ConclusionXDR P. stuartii were introduced into European countries, requiring increased awareness and precautions when treating patients from conflict-affected areas.

Healthcare-associated infections in postoperative patients with intracranial aneurysm in Ukraine.

OBJECTIVE: Aim: to investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) in postoperative patients with intracranial aneurysm in Ukraine. PATIENTS AND METHODS: Materials and Methods: Retrospective cohort study was conducted from January 2018 to December 2022 in four tertiary care hospitals of Ukraine. The diagnostic criteria were based on specific HAI site were adapted from the CDC/NHSN case definitions. RESULTS: Results: Of 1,084 postoperative patients with intracranial aneurysm, 128 (11.4%) HAIs were observed. The most common of HAI type was possible ventilatorassociated pneumonia (38.2%) followed by central line-associated bloodstream infections (33.8%), catheter -associated urinary tract infection (18.5%), and surgical site infection (9.6%). Inpatient mortality from HAI was 5.1%. Emergency admission, mechanical ventilation, taking antiplatelet aggregation drugs, albumin reduction, hyperglycaemia, hyponatremia, surgical procedure, operation time > 4 h, mechanical ventilation, urinary catheter, and central venous catheterization were risk factors associated with HAI in patients with intracranial aneurysm surgery. A total of 26% cases of HAIs by MDROs were notified over the study period. Klebsiella spp. - essentially K. pneumoniae - were the most frequent, followed by Enterobacter spp. and Escherichia coli. Carbapenemase production in Enterobacterales constituted the most frequent mechanism of resistance, while ESBL-production in Enterobacterales and meticillin-resistance in Staphylococcus aureus (MRSA) were detected in 65,7% 62,3% and 20% of cases, respectively. CONCLUSION: Conclusions: The present study showed that HAIs is a common complication in postoperative patients with intracranial aneurysm in Ukraine and multidrugresistant organisms the major pathogen causing infection.

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.

Endometritis after hysteroscopic procedures in Ukraine: results a multicenter study.

OBJECTIVE: Aim: To determine the current prevalence of endometritis after hysteroscopic procedures and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of endometritis 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: Among 13,872 patients with hysteroscopic procedures, 1027 (7.4%) endometritis were observed. Of these cases, 0.4% were detected after diagnostic hysteroscopy, and 7.0% were detected after operative hysteroscopy. Of all endometritis cases, 64.2% were detected after hospital discharge. The most commonly reported bacterial species were Escherichia coli (24.3%), followed by Enterobacter spp. (12.7%), Enterococcus spp. (8.3%), Pseudomonas aeruginosa (8.1%), Serratia marcescens (6.8%), Staphylococcus aureus (5.9%), Proteus mirabilis (5.8%), Klebsiella oxytoca (5.1%), Stenotrophomonas maltophilia (4.5%), Klebsiella pneumoniae (4.1%). A significant proportion of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group, and geographical region of Ukraine. CONCLUSION: Conclusions: Our data suggest a high prevalence of endometritis after hysteroscopic procedures. Risk for endometritis was higher after operative hysteroscopy compared with diagnostic hysteroscopy. Many most of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials. These data underscore the importance of tracking antimicrobial resistance of responsible pathogens of HAIs in hospitals.

Postpartum infections and antimicrobial resistance of responsible pathogens in Ukraine: results a multicenter study (2020-2022).

OBJECTIVE: Aim: To determine the current prevalence of postpartum infections and antimicrobial resistance and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of healthcare- associated postpartum infection 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: Among 21,968 women, 6,175 (28.1%) postpartum infections were observed. Of all postpartum infection cases, 83.1% were detected after hospital discharge. The postpartum infection rates were 17.3% after cesarean section and 10.8% after vaginal delivery. The most common postpartum infection types were endometritis (17.3%), followed by urinary tract Infection (3.5%), mastitis (3.4%), surgical site infection (excluding endometritis) (2.4%), and episiotomy site infection (1.5%). The predominant postpartum infection pathogens in Ukraine were: Escherichia coli (10.4%), Enterococcus spp. (9.6%), Staphylococcus aureus (6.7%), Pseudomonas aeruginosa (5.8%), Enterobacter spp. (5.8%). In our study pathogens of postpartum infection had differently levels of resistance to antibiotics. CONCLUSION: Conclusions: Our results indicate that postpartum infections requiring medical attention are common in Ukraine and that most postpartum infections occur after hospital discharge, so that use of routine inpatient surveillance methods alone will lead to underestimation of postpartum infection rates. Optimizing the antibiotic prophylaxis may reduce the burden of postpartum infection, but prevention is the key element.

Healthcare-associated infections after neurosurgical procedures in Ukraine: a multicentre study (2020-2022).

OBJECTIVE: Aim: To investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) after a neurosurgical procedure in Ukraine. PATIENTS AND METHODS: Materials and Methods: Prospective multicentre surveillance was conducted from January 2020 to December 2022 in 10 regional hospitals of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. RESULTS: Results: Of 8,623 neurosurgical patients, 1,579 (18.3%) HAIs were observed. The most frequently of HAI types were pneumonia (38.4%), surgical site infection (34.2%), urinary tract infection (18.1%) and bloodstream infection (9.3%). Death during hospitalization was reported in 11.3% of HAI cases. There was an association between HAIs after neurosurgical procedures and patients with diabetes mellitus, end-stage renal disease undergoing dialysis, and leukaemia. The strongest independent associations were observed for intubation, urinary catheters, and vascular catheters. Klebsiella pneumoniae were most commonly reported, accounting for 25.1% of all organisms, followed by Escherichia coli (17.6%), Staphylococcus aureus (9.9%), Pseudomonas aeruginosa (8.9%), Acinetobacter baumannii (8.5%), coagulase-negative staphylococci (6.8%), and Streptococcus spp. (5.5%). In total, 76.3% isolates from neurosurgical patients were MDROs. Antimicrobial resistance in Ukraine varies greatly by bacterial species, antimicrobial group, and region. CONCLUSION: Conclusions: Healthcare-associated infections are a cause for mortality and morbidity among neurosurgical patients. This is due to increase emergence of antimicrobial-resistant pathogens. Routinely collected surveillance data are of great value as a basis for studying the consequences of HAIs.

Epidemiology of healthcare-associated endometritis after surgical abortion in Ukraine: results a multicenter study.

OBJECTIVE: Aim: To determine the current prevalence of healthcare-associated endometritis after surgical abortion and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and Methods: We performed a prospective, multicentre cohort study was based on surveillance data of healthcare-associated endometritis after legal induced surgical abortion. Women who underwent induced surgical abortion at gynecological departments of 16 regional hospitals between 2020 and 2022 are included in the study. Definitions of endometritis were adapted from the CDC/NHSN. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST. RESULTS: Results: Among 18,328 women who underwent surgical abortion, 5,023 (27.4%) endometritis were observed. Of all post-abortion endometritis cases, 95.3% were detected after hospital discharge. The prevalence of endometritis in different types surgical abortion was: after vacuum aspiration at < 14 weeks, 23.8%, and after dilatation and evacuation at ≥ 14 weeks, 32%. The most responsible pathogens of post-abortion endometritis are Escherichia coli (24.1%), Enterococcus spp. (14.3%), Enterobacter spp. (12,8%), Pseudomonas aeruginosa (8.3%), Proteus mirabilis (6.6%), Serratia marcescens (6.2%), Staphylococcus aureus (5.9%), and Stenotrophomonas maltophilia (5.7%). A significant proportion these pathogens developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group. CONCLUSION: Conclusions: Results this study suggest a high prevalence of endometritis after surgical abortion in Ukraine. A significant proportion of women were affected by endometritis caused by bacteria developed resistance to several antimicrobials. Optimizing the antibiotic prophylaxis may reduce the burden of endometritis after surgical abortion, but prevention is the key element.

Factors associated with female infertility in Ukraine: results a multicenter study.

OBJECTIVE: Aim: To determine the current prevalence of female infertility and characterize and identify risk factors associated with infertility in Ukraine. PATIENTS AND METHODS: Materials and Methods: Multicenter prospective cohort study was conducted from January 2021 to December 2023 in twelve medical centers from nine regions of Ukraine. Definitions of infertility were adapted from the World Health Organization. According to the data collected from questionnaire, participants were divided into infertile and fertile groups and analyzed associated factors. RESULTS: Results: Among all the 7,618 participants in this study, the prevalence of female infertility was 24.3%. The prevalence of primary infertility was 5.9%, and the prevalence of secondary infertility was 18.4%. In logistic multivariate regression analyses, female infertility was associated with age of women (p<0.001), age of first sexual intercourse (p<0.001), history of gynecological surgery (p<0.001), marital status (p<0.001), age of marriage (p<0.001), decreased ovarian reserve (DOR) (p=0.006), family history of infertility (p<0.001), history of cervicitis (p=0.007), history of surgical abortion (p<0.001), history of endometritis (p=0.027), bacterial vaginosis (p=0.023), and aerobic vaginitis (< 0.001). CONCLUSION: Conclusions: Our data suggest a high prevalence of female infertility in Ukraine. The prevalence of secondary infertility was higher than primary infertility. Age of women, age of first sexual intercourse, history of gynecological surgery, marital status, age of marriage, DOR, family history of infertility, history of cervicitis, history of surgical abortion, history of endometritis, bacterial vaginosis, and aerobic vaginitis were associated with infertility.

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.

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.

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.

PREGNANCY AND BIRTH OUTCOMES IN FEMALE WITH AND WITHOUT ASSISTED REPRODUCTIVE TECHNOLOGY IN UKRAINE.

OBJECTIVE: The aim: To assess and compare the risk of maternal/perinatal complications and adverse outcomes in pregnancy and childbirth conceived by ART with those conceived naturally in Ukraine. PATIENTS AND METHODS: Materials and Methods: We conducted a retrospective multicenter cohort study from January 1st, 2019 to December 31st, 2021. This study included pregnant women who delivered at 14 Women's Hospitals from 8 regions of Ukraine. RESULTS: Results: A total of 21,162 pregnancies were included. Of these, there were 19,801 natural pregnancies and 1,361 pregnancies after ART. The proportion of ART. pregnancies has increased every year in during study period, peaking in 2021 (6.7%). Data analysis showed that the risks of gestational diabetes, preeclampsia, moderate or severe anemia, liver-related diseases, thyroid-related diseases, preterm birth, placenta previa, postpartum hemorrhage, and cesarean section were significantly increased in ART pregnancy. For neonatal outcomes, women conceived by ART were more likely to have twins. The effects of ART on the risk of premature rupture of membrane, cord entanglement, intrapartum fever, and cesarean section were more pronounced in singletons pregnancies. CONCLUSION: Conclusions: Women conceived by ART were at increased risks of several adverse pregnancy outcomes compared with women conceived naturally. Therefore, prenatal and intrapartum monitoring should be strengthened, and neonatal outcomes should be closely observed for ART pregnancy.

HYPERPLASIA OF THE FEMALE REPRODUCTIVE ORGANS IN UKRAINE.

OBJECTIVE: The aim: To determine the role of infectious diseases as the cause of the Cervical, Ovarian and Breast hyperplasia in Ukraine. PATIENTS AND METHODS: Materials and methods: We conducted a retrospective multicenter cohort study from January 1st, 2020 to December 31st, 2022. This study included patients aged 20-59 years with a diagnosis of hyperproliferative pathology of the women reproductive organs without atypia, who sought medical care for hyperplastic processes admitted to the 12 hospitals from 9 regions of Ukraine. RESULTS: Results: We had examined 4,713 women; out of which 81.1% met the clinical definition of female reproductive organs hyperplasia. Of all hyperplasia cases, most frequently recorded types were breast hyperplasia (41,7%), followed by cervical hyperplasia (31,1%) and ovarian hyperplasia (27,2%). History of Cervicitis (p<0.001), Vaginal cuff infection (p<0.001), Oophoritis (p<0.001), and Mastitis (p<0.001) were identified as independent risk factors of Cervical, Ovarian and Breast hyperplasia. CONCLUSION: Conclusions: This study showed that surgical site infections after obstetric and gynecological operations are is the cause of Cervical, Ovarian and Breast hyperplasia. Therefore, early detection and treatment SSIs can reduce the risk of hyperplasia these organs.

HEALTHCARE-ASSOCIATED BACTERIAL VAGINOSIS AFTER GYNECOLOGICAL SURGERIES AND ASSOCIATED ADVERSE PREGNANCY OUTCOME IN UKRAINE.

OBJECTIVE: The aim: To determine the prevalence of healthcare-associated bacterial vaginosis after gynecological surgeries and associated adverse pregnancy outcomes in Ukraine. PATIENTS AND METHODS: Materials and methods: Multicenter retrospective cohort study was conducted from January 2019 to December 2021 in eleven medical centers from eight regions of Ukraine. Vaginal cultures were obtained preoperatively from 3,502 women undergoing gynecologic surgery. Diagnosis of Bacterial Vaginosis is based on the Nugent and Amsel criteria. RESULTS: Results: Healthcare-associated bacterial vaginosis (HA BV) was diagnosed in 1,498 of 3,502 women, giving a prevalence rate of 42.8%. HA BV was significantly associated with preterm birth (risk ratio [RR], 2.68; 95% confidence interval [CI], 1.44-4.98), miscarriage (RR, 6.11; 95% CI, 3.22-14.11), low birth weight (RR, 3.20; 95% CI, 1.29-7.94), and premature rupture of membranes (RR, 6.75; 95% CI, 3.11-14.67). CONCLUSION: Conclusions: The HA BV after gynecological surgeries prevalence is high in Ukraine, with a concomitant adverse pregnancy outcome, including preterm birth, low birth weight, premature rupture of membranes, and miscarriage. A significant number of cases of bacterial vaginosis are associated with long-term use of antibiotics to treat post-operative infections.

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.

CERVICITIS AS A CAUSE OF PRETERM BIRTH IN WOMEN.

OBJECTIVE: The aim: To evaluate the prevalence of preterm birth and to determine the role of cervicitis as a cause of preterm birth in women in Ukraine. PATIENTS AND METHODS: Materials and methods: We conducted a retrospective multicentre cohort study from January 1st, 2019 to December 31st, 2021. This study included pregnant women aged 17-50 years admitted to the labor ward at the 13 hospitals from 10 regions of Ukraine. RESULTS: Results: Of the 8151 participants, the prevalence of preterm birth was 2226 (27.3%, [95% CI 26.8 - 27.8]) whereas 5925 (72.7% [95% CI 72.2-73.2]) delivered at term. Preterm birth associated with cervicitis was 76.3% (4,388/2666). History of cervicitis, maternal age, previous preterm labor or premature birth, and pregnancy with twins, triplets or other multiples were identified as independent risk factors of preterm birth. CONCLUSION: Conclusions: Preterm birth in Ukraine is widespread, the number of which tends to increase. Infection and inflammation of the cervix seem to play a significant role for preterm birth. Early detection and treatment of cervicitis can reduce the risk of preterm birth. Women who have a history of poor pregnancy outcomes are at greater risk of poor outcomes in following pregnancies. Health providers should be aware of this risk when treating patients with a history of poor pregnancy outcomes.

MOLECULAR EPIDEMIOLOGY OF THE TRANSMISSION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN KYIV ACUTE CARE HOSPITALS, UKRAINE.

OBJECTIVE: The aim: To evaluate the potential of transmission of methicillin-resistance Staphylococcus aureus (MRSA) in Ukrainian acute care hospitals. PATIENTS AND METHODS: Materials and methods: We performed a multicenter cross-sectional study. Definitions of HAI were used from the CDC/ NHSN. The susceptibility to antibiotics was determined by disk diffusion method according to the EUCAST. The cefoxitin-resistant isolates S.aureus were analyzed for the presence of the mecA gene and femA endogenous control gene using PCR. The virulence factor encoding genes (lukS-PV and lukF-PV) were detected by PCR. RESULTS: Results: Of 2,421 patients with HAIs caused S.aureus included in the study, 28.7% patients had MRSA. Prevalence of nasal carriage rate of MRSA among healthcare workers (HCWs) was 33.3%. MRSA contamination of hands and uniforms/gowns of HCW were 32.2% and 29.7%, respectively. MRSA contamination in the inanimate environment surfaces in near- and extended patients areas were 26.9%. The predominant MRSA contamination in hospital environment surfaces were: room inner door knob (32.8%), bed rails (28.9%), room light switch (28.9%), chair (27.9%), bedside table handle (20.6%), bedside table (20.5%), and tray table (13.7%). The PVL gene was present in 38.7% of MRSA strains, isolated from patients with HAIs and in 55.7% of MRSA, isolated from environment surfaces in patient area. In addition, the PVL genes were detected in over 56.3% of MRSA isolated from HCWs carrier. CONCLUSION: Conclusions: The majority of MRSA is acquired during hospitalization. Environmental surfaces may serve as potential reservoirs for nosocomial MRSA and facilitate transmissions via contact.

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.