Healthcare-associated infections and antimicrobial use in Ukrainian acute care hospitals, involved into casualties of war treatment: multicenter cross-sectional study in 2024.

Background: True burden of healthcare associated infections (HAIs) in Ukraine remains unknown. The pilot point prevalence survey (PPS) of HAIs and antimicrobial use (AMU) was organized in Ukrainian hospitals in 2021 but data were limited and not fully represented changes in HAIs burden associated with full scale invasion of Russian Federation in 2022. PPS on HAI and AMU was conducted in 5 healthcare facilities to understand burden of HAI in Ukraine in 2024.

Methods: Our research was designed as multicenter cross-sectional study. Four acute care tertiary level hospitals and one specialized institution participated in the study. Patients of all ages from surgical wards, intensive care units (ICU) and medical wards were included. Data were collected on a single day for every ward, timeframe for the whole study was one month. HAI case definitions and PPS procedure were based on most recent European Center for disease control (ECDC) documents.

Results: 660 patients were included into the study. 83 patients had 91 HAIs, HAI prevalence was 12.6% pp. 37 (40.7%) of HAIs were present on admission and 54 (59.3%) were obtained during current hospitalization. The most frequent HAI was surgical site infection (50.5%), followed by pneumonia (12.1%), skin and soft tissue (9.9%), urinary tract (6.6%), bloodstream (5.5%) and systemic infections (5.5%). The highest prevalence of HAI (51.9% pp) was observed in ICUs, followed by 12.1% pp in surgical wards. Most common organisms were Acinetobacter (22.4%) and Klebsiella spp. (22.4%). All HAIs pathogens showed very high resistance levels (66-100%) to 3rd generation cephalosporins, glycopeptides and carbapenems. Highest use of antimicrobials was recorded in ICU (88.9% pp).

Conclusions: The study discovered significant prevalence of HAI's in Ukrainian hospitals, higher than European average. Antimicrobials use rate was comparable to European, but with disproportionally high use at ICU.