Healthcare-associated infections in patients with acute cerebrovascular accident

Aim. To study the manifestations of the epidemic process of healthcare-associated infections in patients with acute cerebrovascular accident. Materials and methods. A descriptive, continuous, retrospective, single-center analytical study was performed to assess the frequency and intensity of the HAI epidemic process in patients with ACA (n = 1015) For the period from 2019 to 2025, in order to establish the dominant microflora and analyze the resistance of pathogens of HAIs of different localization to antibiotics, microbiological studies were carried out using the classical bacteriological method of more than 1300 isolates of microorganisms isolated from different biological materials (sputum, blood, urine, cerebrospinal fluid, etc.) of patients receiving inpatient treatment. For 21 Klebsiella pneumoniae isolates, hypervirulence marker genes were analyzed: the aerobactin gene − iucA, the mucoid phenotype regulator gene − rmpA2, as well as resistance genes − the main carbapenemases (OXA-48). All HAI cases are classified according to standard epidemiological case definitions. Results. The incidence density of HAI averaged 20,52 [20,40−20,64] cases and 29,89 [29,86−29,92] episodes per 1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP) 52,53 [52,52−52,54] per 1,000 days of mechanical ventilation, central line bloodstream infection (CLABSI) 2,55 [2,52−2,58] per 1,000 days of catheterization, catheter-associated urinary tract infections (CAUTI) 18,84 [18,81−18,87] per 1,000 days of cathetero-infections, incidence of surgical site infection (SSI) was 87,92 [87,79−88,05] per 1000 operations. The structure of HAI pathogens was dominated by Klebsiella pneumoniae, Acinetobacter baumannii, Candida albicans, whose specific gravity was 28,15 %, 20,08 % and 13.81 %, respectively. Extensively drug-resistant (XDR) was exhibited by 82,09 % of Klebsiella pneumoniae isolates and 52,67 % of Acinetobacter baumannii strains. There are data on a high prevalence of hypervirulence marker genes of Klebsiella pneumoniae (HvKp) isolates, namely, the aerobactin iucA gene (95.24 %), the mucoid phenotype regulator gene rmpA2 (100 %), isolates having a hypermucoid (positive stringing test) Hm phenotype (38.09 %) and carbapenem antibiotic resistance gene − carbapenemase OXA-48 gene (80.95 %). Conclusion. The epidemic process of HAI in patients with ACA is characterized by a high frequency and intensity of manifestations. In the etiological structure, Klebsiella pneumoniae, Acinetobacter baumannii and Candida albicans were of maximum importance. 82,09 % of Klebsiella pneumoniae and 52,67 % of Acinetobacter baumannii strains had extreme resistance properties (XDR). Isolates of Klebsiella pneumoniae simultaneously carrying hypervirulence marker genes and carbapenemase genes exhibiting a hypermucoid phenotype are described.

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