Healthcare associated infections in patients with combat wounds and antimicrobial resistance of the responsible pathogens in Ukraine: results of a multicenter study (2022-2024)

OBJECTIVE: Aim: Aim this study was to estimate the prevalence and incidence of HAI in patients with combat wounds, and determine phenotypic and genotypic aspects of antimicrobial resistance of the responsible pathogens in Ukraine. PATIENTS AND METHODS: Materials and Methods: A multicenter observational cohort study based on HAIs and antimicrobial resistance surveillance data in Ukraine. Between June 21, 2022 and December 31, 2024, patients (aged 20-74 years) with combat wounds were admitted to civilian hospitals which are located in Kharkiv, Dnipro, Kherson, Zaporizhzhia, Odessa, and Kyiv, Ukraine. The criteria for HAIs were adapted from the CDC/NHSN. Antimicrobial susceptibility test used Kirby - Bauer disc diffusion antibiotic test according to the EUCAST. RESULTS: Results: Among 7,324 patients with combat wound, 5,022 (68.6%) HAIs were observed. The most frequently reported HAI types were surgical site infections (27.3%), bone and joint infections (25.6%), skin and soft tissue infections (15.7%), bloodstream infections (9.7%), central nervous system infections (7.9%), and pneumonia (5.3%). In total, 88.9% isolates from patients with combat wounds were found to be MDROs. A significant number of the MDROs isolated from patients with HAIs had β-lactamase genes, including extended-spectrum β-lactamase (ESBL) (53.1%), OXA-type (32.9%), AmpC-type (35.7%), KPC-type (31.8%), and metallo-β-lactamases (51.4%) including IMP-type (18.5%), VIM-type (29.6%), and NDM-1 (34.7%). CONCLUSION: Conclusions: This study found a high prevalence of HAI in patients with combat wounds caused by MDROs, varying depending on the bacterial species, and antimicrobial group. The majority of MDRO isolates from patients with HAI carried β-lactamase genes.