Microbiological monitoring, being an integral component of epidemiological surveillance of healthcare associated infection (HAI), is one of the most important components in hospital patient safety. The purpose of monitoring is the etiological interpretation of pathogens, the identification of microbial hospital strains and development of strategies as well as tactics for combating them. In modern conditions development of healthcare and humanity as a whole, the most important problem is the steady increase in the number of HAI caused by antimicrobial drug-insensitive pathogens and decreased drug effectiveness used in therapy. The structure of infectious conditions in the hospital is specific and is determined by the profile and nature of the treatment, nosology and age of patients. The main pathogens in the etiological structure of HAI are Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumanii, Enterococcus faecalis and Enterococcus faecium. The study estimated the prevalence of bloodstream infections pathogens resistant to antimicrobial agents in healthcare facilities in St. Petersburg. We retrospectively analyzed data on the antimicrobial resistance for the six clinically significant HAI pathogens that were detected in the blood samples at the 50 hospitals of St. Petersburg during the years 2016–2019. It was found that the use of β-lactam antibiotics is not effective in the treatment of patients with bloodstream infections (BSI) caused by S. aureus (in 21.9% of BSI cases), E. coli (2.1%), Klebsiella spp. (39.6%), P. aeruginosa (40.5%), Acinetobacter spp. (66.7%), Enterococcus spp. (4.4%). This article shows that targeted microbiological monitoring of HAI caused by resistant pathogens should be considered as an effective organizational mechanism for timely detection and prevention of complications that are observed in medical care to patients at high risk for bloodstream infections. Identification of the features of the epidemic process for purulentseptic infections in medical organizations contributes to the improved preventive measures in order to improve the quality of medical care. Microbiological monitoring data are necessary for the development and implementation of measures to curb the further growth of antimicrobial resistance of infectious disease pathogens.

Relevance. The COVID-19 pandemic has led to significant overloads in the work of health systems in many countries, a shortage of beds and staff, which contributes to a decrease in adherence to measures to prevent and control nosocomial infections, which can significantly worsen the course of viral pneumonia. Aim. To assess the possibility of the formation of hospital strains of multidrugresistant microorganisms in hospitals repurposed to provide medical care to patients with COVID-19. Materials and methods. The study included patients with severe and moderate forms of COVID-19 (ICD codes U07.1, U07.2), who were admitted to two large hospitals repurposed for the treatment of this infection. The data of microbiological studies of the biomaterial associated with the respiratory tract (sputum, bronchoalveolar lavage, tracheal aspirates) obtained from 1101 patients from May to January 2021 were analyzed using a combination of molecular genetic methods (RAPD-PCR, detection of integrons and the carbapenemase gene bla NDM.), and molecular typing of carbapenem-resistant strains of Klebsiella pneumoniae and Acinetobacter baumannii was carried out. Results. It was found that carbapenem resistant gram-negative bacteria predominate in the structure of the nosocomial microbiota of the respiratory tract of patients with COVID-19 in both hospitals. Based on molecular typing made the wide distribution of several genetic lines of integron-positive carbapenem resistant Klebsiella pneumoniae and Acinetobacter baumannii was detected. Conclusions. The COVID-19 pandemic has exacerbated the spread and circulation of bacteria with multiple antibiotic resistance in hospitals. This study has demonstrated the possibility of the formation of hospital strains of nosocomial infections in COVID-19 hospitals, which justifies the need to improve infection control measures in the context of a new coronavirus infection pandemic.

Aim: to assess the relationship between colonization of the oral cavity with S. mutans and different genotypic characteristics and the degree of tooth decay in children.Materials and methods. 274 children aged 5 to 17 years (153 girls and 121 boys) who received a preventive dental checkup were included in the study. The dental caries experience was assessed by the DMFT index (number of decayed, missing due to caries, and filled teeth), according to WHO recommendations. The plaque was collected with sterile wooden toothpicks from the buccal gingival margin or from fissures of the first molars and placed in 1.5 mL Eppendorf tubes, and then plated on Mitis Salivarius Agar medium (HiMedia, India). 481 strains of S. mutans were selected for further study. DNA was extracted by an express method. Amplification was performed in the CFX-96 thermal cycler (Bio-Rad, USA). Serotyping was performed by multiplex PCR. PCR products were analyzed by gel electrophoresis in 1.5% agarose gel with ethidium bromide (10 mg/mL) manufactured by Helicon, Moscow, and visualized in UV light in transilluminator UVT1 by Biokom. Genotyping was performed according to the methodology (Saarela et al., 1996) with the oligonucleotide primer OPA-02 (5’-TGCCGAGCTG-3’). Strains of S. mutans were studied for the presence of the following genes: gtfB, spaP, cnm, fruA, gtfB, htrA, comE, mutA x(I), mutA (II), mutA (III), nlmAB (IV), adcA, Smu.399, Smu.583, Smu.761, Smu.940c, Smu.1449, Smu.2130.Results. S. mutans was isolated from all the examined children. Dental decay was detected in 82.4% of the children. Among the strains studied, all 4 serotypes were found: in children with a DMFT = 0 only serotypes k and f were detected; the predominant serotype in children with tooth decay was serotype c (74.7%). 19 genotypes of S. mutans were identified. In children without caries (DMFT = 0), S. mutans did not contain the genes spaP, comE, adcA, Smu.2130, Smu.1449, gtfB, htrA. With the increase in the DMFT index, the frequency of their detection increased. 9 genotypes of S. mutans had all 7 virulence factors. In 94.9% of children colonized by these “virulent” genotypes, high DMFT index scores were observed.Conclusion. The data obtained indicate that only a limited number of specific strains have a cariogenic potential. Strains of S. mutans belonging to serotypes e and c with a combination of virulence genes spaP, gtfB, comE, adcA, Smu.2130, Smu.1449, and htrA were isolated from children with tooth decay. Strains without these factors did not cause any damage to the teeth. The degree of tooth decay increases with colonization by several genotypes with the combination of virulence factors described above.

Relevance . Cardiac surgery is a direction that is currently being actively developed. The number of operations performed on an openheart is growing annually, and the number of postoperative complications, including infectious ones, is correspondingly increasing. The purpose of the work is to identify the frequency of surgical site infections (SSI) in open-heart surgery, to study the leading risk factors, to identify possible sources of infection. Materials and methods . Basic information was obtained from medical records, as well as using the medical information system, which allows to track the patient's repeated hospitalization in the hospital, and the laboratory information system. Additional forms have been developed to account for intraoperative risk factors. The follow-up period was 3 years (2016-2018). A total of 433 surgical interventions and their outcomes were analyzed, the duration of follow-up f o r patients was 1 year from the time of surgery. Identified 19 cases of SSI. Results and discussion . The frequency of SSI in open-heart surgery was 4.4 per 100 operations (2.6-6.7). Up to 74% of all SSI occurred in the period up to 30 days from the moment of surgery. The relative risk index was calculated for such factors as the length of stay in the intensive care unit in the postoperative period, the timing of drainage of the postoperative wound, and diabetes mellitus. It has been established that for cardiosurgical operations on the 1st class of wounds, diabetes mellitus is a significant risk factor for SSI. The analysis pathogens in patients with acute respiratory infections and the microbiological landscape of the departments made it possible to establish cases of possible infection of patients in the hospital, and in some cases put forward an assumption of endogenous infection. Conclusions . An epidemiological investigation, the development, and implementation of anti-epidemic measures require a complete consideration of possible risk factors, the participation of cardiac surgeons in identifying, and analyzing each case of SSI, and the mandatory exchange of information about the outcome of the disease between medical organizations that are involved in the management of a cardiac surgical patient in the postoperative period.

Objective. To estimate composite indicators of systemic antibiotic consumption in the hospital segment of Saint-Petersburg in 2014–2018. Materials and Methods. Information on the volume and structure of AMP consumption in the hospital segment of St. Petersburg in 2014–2018 was obtained from AlfaRm Databases. The amount of purchased AMP was recalculated in the number of average daily maintenance doses (Defined Daily Dose, DDDs), as well as DDDs per 100 bed-days (DDDh) for each international nonproprietary name of AMP. Data on the bed-days spent in the period 2014–2018, as well as the epidemiological situation in hospitals of St. Petersburg in the period 2016–2018 were obtained from the databases of St. Petersburg state medical institution MIAC. Based on data on AMP consumption and the epidemiological situation in hospitals in St. Petersburg, the indicator of a comprehensive assessment of AMP consumption – the drug resistance index (DRI) was calculated. Results. During the study, there was a decrease in the absolute consumption of AMP from 17.6 to 9.2 million DDDs, with a decrease in DDDh from 125 to 66, accompanied by a decrease in the total cost of purchasing AMP from 74 to 67 million rubles per year. Fluoroquinolones, other AMP and cephalosporins remained the main classes of AMP for systemic use throughout the observation period. At the same time, the relative amounts of resistant strains of the ESKAPE group of bacteria, as well as DRI, remained virtually unchanged. Conclusions. Pharmacoepidemiological monitoring data provide a picture of current trends in the use of AMP and can serve as a guide for the treatment of patients, identifying risk groups, informing policy makers and used to assess the effectiveness of measures taken.

Antibiotic resistance threatens the effective prevention and treatment of healthcare associated infections which are the most frequent adverse event in health-care settings worldwide. There is an urgent need to investigate alterative preventive and treatment options while there are still a few antibiotics left. Bacteriophage (phage) therapy has been championed as a promising alternative to antibiotics.The aim of this study was to evaluate the efficacy of a therapeutic bacteriophages to control of Staphylococcus aureus and Klebsiella pneumonia outbreaks in newborn intensive care units.Materials and methods. Commercial bacteriophage cocktails targeting these paphogens was orally and locally given over 5 days to patients of neonatal intensive care units in Saint-Petersburg, Russia.Results. Bacteriophages were used as antimicrobial agents for control of three S.aureus outbreaks and one K.pneumonia outbreak. S.aureus infection incidence during the three outbreaks were 22.2%, 54.5% and 50.0% accordingly, and K.pneumoniae outbreak – 19.0%. After application of the phage cocktails among newborns, the incidence of infections caused by S.aureus and K. pneumoniae decreased to zero. All treatments were well tolerated. No adverse events were reported.Conclusion. Presented results clearly demonstrate high efficiency of bacteriophages. Phages have several features that make them potentially attractive antibacterial agents. Bacteriopahges are highly specific and very effective in destroying targeted bacteria, have only minimally impact on health-protecting normal flora bacteria, safe and rapidly modifiable to combat the emergence of newly arising bacterial threats.

The burden of bacterial resistance was assessed for the first time in Russia. The analysis was based on the results of bacteriological studies in multi-field hospitals provided by the St. Petersburg Medical Information and analytical Center. The number of patients with infections caused by strains of methicillin-resistant S. aureus (MRSA); K. pneumoniae, are not sensitive to 3rd generation cephalosporins and carbapenems; E. coli, are not sensitive to 3rd generation cephalosporins was calculated on the basis of the obtained data. The data are extrapolated to all multi-profile hospitals of the Russian Federation with regard to known levels of resistance. The total cost of treatment of patients with infections caused by three pathogens in multi-field hospitals in St. Petersburg for the year amounted to 250 887 292 rubles, in Russia – 12 413 309 939 rubles. The main costs are associated with antimicrobial therapy (90% in St. Petersburg, 88 – in Russia). The costs associated with additional beds, temporary disability, epidemiological control measures are 10% and 12%, respectively. Mathematical modeling has shown that these costs can increase by at least 10% due to the death of patients of working age.

Serratia marcescens is a frequent cause of health care-associated infections and has led to multiple outbreaks. Here, we report the draft genome of a multidrug-resistant S. marcescens strain 189 which was isolated in 2012 as a predominant clone in a neonatal hospital in Kemerovo.

The article discusses the methodological foundations of epidemiological diagnostics - the basis for risk-oriented approach to the prevention of healthcare-associated infections (HAI). It outlines goals, objectives, basic terms and sequence of steps in the organization and conduct of epidemiological diagnostics. The importance of epidemiological surveillance of HAI is underlined. The article describes the main principles of descriptive and analytical studies in the structure of epidemiological diagnostics of HAI.

Influenza and ARVI - the main nosological form in structure of all infectious diseases. Influenza is especially dangerous to pregnant women. Purpose: to estimate commitment of pregnant women and health workers to vaccination against influenza. Materials and methods: form No. 5, form of the statistical account No. 1 - influenza the section 1, information from the official site of Federal State Budgetary Institution Scientific Research Institute of influenza of the Ministry of Health of the Russian Federation; materials of various conferences and the congresses on a influenza problem, information and analytical reference of the Ministry of Health of the Russian Federation. There were asked 1126 pregnant women on various durations of gestation and 447 health workers in various territories of the Russian Federation. Statistical processing was carried out with use of the Microsoft Excel 2010 and IBM SPSS Statistics 20.0 programs. Results and discussion: Among the interviewed pregnant women planned or were already vaccinated against influenza only 8% of women. The most frequent causes of failure from vaccination against influenza during pregnancy: doubt in safety (41.8%), ignorance about possibilities of vaccination (21,1%), lack of need for vaccination (18,7%). Only 25% of respondents knew about entering vaccination against influenza during pregnancy into a national calendar. At the same time only in 15% of health workers suggested pregnant women to be vaccinated from influenza. 73% of the interviewed health workers didn't recommend vaccination against influenza to pregnant women because they consider undesirable an intervention in immunity of the pregnant woman, 33% doubt in safety of vaccination, 13% don't know about a possibility of vaccination of pregnant women at all, 6% have personal negative experience of vaccination, and 4% don't see need for vaccination from influenza. Conclusion: the received materials showed need of development of knowledge at health workers of a vaccinal prevention of infectious diseases, including also vaccination against influenza during pregnancy, and also to carry out broad and active information work with the population, attracting mass media.

Aim. To give epidemiological assessment of potential risk factors for prevalence of antibiotic resistant strains of upper airways and ENT-organs infectious pathogens in children. Materials and methods. The study included children (165 persons) aged 1 to 17years, who asked for ambulatory-polyclinic medical care in connection with upper airways and ENT-organs diseases and formed the group of “cases” (75 persons) - patients, colonized by Streptococcus spp. and Staphylococcus aureus strains with antibiotic resistance not less than one of three classes (beta-lactams, macrolides, lincosamides) and the control group (90 persons) - patients without the facts of colonization by antibiotic-resistant strains of the studied microorganisms. During doctor’s reception, parents of all patients were surveyed. Results. According to the results of a survey carried out, there was estimated connection of 18 potential risk factors with carriage of antibiotic-resistant strains. Pneumococcal vaccination in the investigated population was a factor, rendering preventive effect on the colonization rate of antibiotic-resistant strains Streptococcus spp. and Staphylococcus aureus ( OR = 0,40 [95 %DI 0,19-0,86]). At the same time, no ties between colonization by antibiotic-resistant microorganisms and risk factors, connected with previous use of antibiotics, especially without doctor’s administration, was noted. Conclusions. Vaccination with pneumococcal vaccines in the studied population is a factor, controlling prevalence of resistance to antimicrobial drugs

Enterococcus faecium 58m is a putative ancient nonpathogenic strain isolated from the intestinal content of an adult woolly mammoth (Mammuthus primigenius). Here, we report its draft genome sequence, consisting of 60 contigs. In silico genomic analysis was performed to determine the genetic features and pathogenic potential of this microorganism.

Aim. Multi-level evaluation by case-control method of social, sociocultural and behavioural risk factors of HIV-infection spread among male migrant workers arriving to Russia from near abroad countries. Materials and methods. Interviews of migrants, that had appealed for medical examination for work permit, were carried out for detection of risk factors. Results of interviewing of 191 migrants with HIV-infection (case group) and 190 migrants without HIV-infection (control group) were analyzed. Methods of descriptive statistics and logistical regression were used for the analysis. Results. Factors, related to dangerous sexual behavior, were leading in development of HIV-infection. Furthermore, HIV-infected migrants had inferior work and accommodation conditions, lower salary, lower subjective health evaluation, became object of xenophobia more frequently and had more previous travels into the receiving country. Factors, that reduce risk of infection and spread of HIV-infection, were detected: HIV-infection awareness, adherence to religion and legal requirements of the receiving country. Advantages and disadvantages of surveying during detection of HIV-infection risk factors are discussed. Conclusion. The same risk factors of HIV-infection spread are significant in the population of migrant workers as in the indigenous population. Factors specific for migrants, that facilitate infection spread, were also established. HIV prophylaxis system among migrants should be based on prevention and correction of risk factors detected in the study and enhancement of factors, that cause preventive effect.