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EPISIOTOMY INFECTIONS IN THE PUERPERIUM AND ANTIMICROBIAL RESISTANCE OF RESPONSIBLE PATHOGENS IN UKRAINE.

OBJECTIVE
The aim: To obtain the first estimates of the current prevalence rate of episiotomy infections in the puerperium and antimicrobial resistance of responsible pathogens in Ukraine.


PATIENTS AND METHODS
Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population consisted of all women who had a vaginal delivery in 7 Regional Women's Hospitals of Ukraine. Definitions of episiotomy infections were used from the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC/NHSN).


RESULTS
Results: Total 35.6% women after vaginal delivery had episiotomy done. The prevalence rate of episiotomy infections was 17.7%. The predominant pathogens were: Escherichia coli (49.2%), Enterobacter spp. (11.1%), Streptococcus spp. (9.1%), Enterococcus faecalis (6.5%), Klebsiella spp. (8.1%), followed by Pseudomonas aeruginosa (4.7%), Staphylococcus aureus (4.2%), Proteus spp.(2.9%) and Staphylococcus epidermidis (2.8%). The overall proportion of methicillin-resistance was observed in 17.3% of Staphylococcus aureus (MRSA). Vancomycin resistance was observed in 6.8% of isolated enterococci. Carbapenem resistance was identified in 8% of P.aeruginosa isolates. Resistance to third-generation cephalosporins was observed in 15.2% Klebsiella spp. and E.coli 16.4% isolates. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 26.4%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (31.4%, vs 12.5%).


CONCLUSION
Conclusions:Episiotomy infections in the puerperium are common in Ukraine and most of these infections caused by antibiotic-resistant bacteria. Optimizing the management and empirical antimicrobial therapy may reduce the burden of episiotomy infections, but prevention is the key element.