Multicentre Study of the Prevalence and Clinical Value of Hospital-Acquired Infections in Emergency Hospitals of Russia: ERGINI Study Team.

Background: Hospital-acquired infection (HAI) is a common problem in intensive care units (ICU) and other hospital units. The methodical system of surveillance of hospital-acquired infections (HAI) is not available in Russia and there is no reliable data about the prevalence or epidemiology of HAI. We aimed in this pioneer study to determine the prevalence, epidemiological and microbiological characteristics, risk factors, clinical value and outcomes of HAI in different units of emergency multifields hospitals of Russia.

Methods: This prospective multicentre 1-day prevalence study with 28-days follow-up was realized between January and May 2013. Thirty two emergency hospitals with more than 500-beds from 18 cities participated in this study. The study was conducted separately on 5 different days in ICU, therapeutic, surgical, urology and neurology units. All patients treated in the unit on the day of the study were examined for the presence of HAI according to CDC criterias. Risk factors of HAI, nosological and etiological structure, susceptibility of pathogens were also evaluated.

Results: Totally 3809 patients were included in the study during 5 days of investigation in ICU and therapeutic, surgical, urology and neurology units (respectively 449, 1281, 1431, 342 and 306 patients). The total number of registered HAI was 290 and the prevalence of HAI was 7.61% (95% CI 6.81%, 8.50%). The greatest rate of HAI was registered in ICU (26.28%) and neurological unit (13.73%); the rate was lower in therapeutic, surgical and urology units (4.76, 4.12 and 2.92%). The prevalence of HAI.was similar in adult and pediatric hospitals .(7.62 and 7.54%). The prevalence of community-acquired infections was 28.53%. The lower respiratory tract was the most common site of infection, accounting for 42.4%.of HAIs followed by the urinary tract (19.0%), skin and soft tissue (13.4%), abdomen (11.4%) and intravascular (4.8%). 311 pathogens were isolated: 58.8% of isolates were gram-negative, 32.8% gram-positive, and 8.4% Candida spp. The most common bacterial isolates were Klebsiella spp. (19.6%), E.coli (12.2%), S.aureus (11.3%), Acinetobacter spp. (10.9%), E.faecalis (7.4%) and P.aeruginosa (7.1%). The resistance rate of E.coli and Klebsiella spp. to 3rd generation of cephalosporins was 60.5 and 95.1%. Only 26.5% of Acinetobacter isolates and 59,1% of P.aeruginosa isolates were susceptible to imipenem. The MRSA rate was 48.6%; 17,4% of E.faecalis were resistant to ampicillin. The mortality rate was higher in patients with HAI (16.5%) than in patients without HAI (3.0%); the mean length of hospital stay was also higher in patients with HAI (24.6±11,4 vs. 16.2±15,3 days).

Conclusion: The prevalence of HAI in Russian hospitals is high. According to the prevalence data the estimating annual number of HAI in Russia is approximately 2,300,000 cases. The multi-drug resistant microorganisms were dominated among causative agents of HAI.