Presentations from NW Russian regions – gaps and challenges, opportunities and strengths: Pskov region

1. Pskov Region
Challenges
Key Tasks
Potential
Tamara Nyunyushkina, Pskov Regional Clinical Hospital,
epidemiologist; senior external expert at Pskov Regional
Committee for Healthcare

2. Challenges
• 1.Lack of access to bacteriological tests for the majority of
medical institutions.
• 2.Staff shortage: lack of bacteriologists
• 3. Insufficient training of clinicians in antimicrobial therapy.
• 4. Inefficient use of antibiotics.
• 5. Lack of clinical pharmacologists even in large inpatient
facilities.
• 6.Lack of hospital epidemiologists.
• 7.Development of resistance to antibiotics.

3. Major pathogens antibiotic resistance profiles 2018г.
• Acinetobacteria 111 isolates E.coli 226 isolates

4. Klebsiella 355 isolates Pseudomonas Aureginosa 125 isolates

5. Key Tasks
1. We are in need of a concept of state-of-the-art
microbiological service to be established in the region.
2. Recruitment and staffing.
3. Introduction of modern methods of microbiological
diagnostics (automatic analyzers, blood incubators, MALDI-
TOF mass spectrometry)
4. Provision of modern equipment.
5. Improving the quality of clinicians training in antibiotic
therapy
5. Staffing more hospital epidemiologists into inpatient
medical facilities

6. Potential
• 1. A new bacteriological laboratory is equipped in the new
prenatal center, but there is no personnel.
• 2. The Center for the Prevention of AIDS and Infectious
Diseases conducts PCR diagnostics of most infections and an
up-to-date bacteriological laboratory will be commissioned
there soon.
• 3.Training in "Laboratory work" and "Epidemiology“ residency
under target training assignments from the region.

7. Major Pathogens Antibiotic Resistance
in Purulent Septic Infections
Data from Pskov Regional Hospital

8. • WalkAway automatic analyzer is used to
identify isolated pathogens
• WHONET program is used for resistance data
analysis.

9. Сomparative analysis of epidemiologically relevant opportunistic
pathogenic bacteria: their proportion in all isolates recovered from
patients with PSI (% of all isolated opportunistic pathogenic bacteria)
Klebsiella Ps. Aureginosa Acinetobacteria

10. Of 355 Klebsiella Isolates
• - 90 (25%) – multiresistant to 6 main AB,
• - 14 (4%) – pandrug resistant to 26 AB.
• Such change in the etiological structure of PSI
causes new problems in antibiotic therapy and
jeopardizes infectious safety.

11. Etiological structure of the clinical and bacteriological analyses –
aggregate numbers for the hospital in 2018г. (%)
Total number of isolates:1378
26
16
1115
15
8
9
8
Inpatientdepartment
Klebsiella spp
E.Coli
Other Coliforms
Staphylococci
Enterococci
Acinetobacteria
Ps. aeroginosa
Fungi

12. Antibiotic resistance profiles of the key epidemiologically
significant pathogens, 2018
Acinetobacteria 111 isolates E.coli 226 isolates

13. Antibiotic resistance profiles of the key epidemiologically
significant pathogens, 2018
Klebsiella spp 355 isolates Ps. Aeroginosa 125 isolates

14. Klebsiella spp. resistance to antibiotics in PSI patients,
2017-2018 (% resistant isolates)
0
20
40
60
80
100
120
cefoperazone/sulbactamertapenem
am
picillin/sulbactamceftriaxone
m
eropenem
am
ikacincefazolinecefotaxim
e
levofloxacin
gentam
ycine
2017
2018

15. Acinetobacter spp. resistance to antibiotics in PSI
patients, 2017-2018 (% of resistant isolates)
0
20
40
60
80
100
120
cefoperazone/sulbactamertapenem
am
picillin/sulbactamceftriaxone
m
eropenem
am
ikacincefazolinecefotaxim
e
levofloxacin
gentam
ycine
2017
2018

16. E.coli resistance to antibiotics in PSI patients, 2017-
2018 (% of resistant isolates)
0
10
20
30
40
50
60
70
80
90
100
ceftazidim
e
am
picillin/sulbactamceftriaxonem
eropenem
am
ikacin
cefazolinecefotaxim
elevofloxacinceftazidim
egentam
ycine
im
ipenem
am
picillin
2017
2018

17. P.aeruginosa resistance to antibiotics in PSI
patients, 2017-2018 (% of resistant isolates)
0
20
40
60
80
100
120
ceftazidim
e
ceftriaxone
m
eropenem
am
ikacin
cefepim
e
cefoperazone
cefotaxim
e
levofloxacin
2017
2018

18. • 133 pathogen isolates were identified with
WalkAway; the following microorganisms were
discovered:
• ESBL producers:
• -K.pneumoniae - 21 isolates
• -E.coli - 9 isolates
• IB isolates (resistant to all betalactam antibiotics):
• P.aeruginosa - 7 isolates

19. Conclusions