High prevalence of multidrug-resistant infections reported in Ukraine hospitals

News brief

A report today in Morbidity and Mortality Weekly Reports highlights rising concern about the spread of multidrug-resistant (MDR) organisms linked to the ongoing war in Ukraine.

To assess the prevalence of antimicrobial-resistant (AMR) infections in Ukrainian hospitals, the Center for Public Health of Ukraine (UPHC) and regional collaborators conducted healthcare-associated infection (HAI) and AMR point-prevalence surveys at three hospitals in the Ternopil, Khmelnytskyi, and Vinnytsia regions of Ukraine in November and December 2022. Among the 353 patients on surveyed wards, 50 (14%) had HAIs and 30 of the 50 (60%) had an infection with a carbapenem-resistant organism. Of the 20 Klebsiella pneumoniae isolates tested, 19 were carbapenem-resistant and all were resistant to third-generation cephalosporins.

"These rates are substantially higher than those reported from a 2016–2017 European Union–wide point prevalence survey, which included more than 300,000 acute care hospital patients and 100,000 long-term care facility residents," the study authors wrote. That survey found a 5.5% HAI rate, with a 6.2% carbapenem-resistance rate among a subset of infections caused by Klebsiella and other members of the Enterobacteriaceae family.

Inadequate lab capacity

While the rise in MDR organisms in Ukraine has been attributed in part to high pre-war AMR rates and an increase in traumatic war wounds, UPHC's assessment of infection prevention and control (IPC) capacity at the three hospitals found inadequate implementation of IPC measures such as hand hygiene and inadequate HAI surveillance. Assessment of AMR laboratory capacity revealed suboptimal laboratory quality, inadequate quantities of automated microbiology equipment, and staffing shortages.

Urgent capacity building to prevent, detect, and respond to antimicrobial resistance is needed to save lives within Ukraine and limit international spread.

The authors note that UPHC is collaborating with local and international partners to strengthen IPC measures and laboratory capacity at hospitals in the three regions but will need ongoing support to scale those efforts nationally. In August, the World Health Organization announced the donation of AMR surveillance equipment to labs in regions close to the frontline.

"Urgent capacity building to prevent, detect, and respond to antimicrobial resistance is needed to save lives within Ukraine and limit international spread," the authors wrote.

COVID-19 late in pregnancy linked to severe maternal health problems

News brief

Stephanie Soucheray, MA

pregnant lady with mass — Milan Markovic / iStock

A study yesterday in Open Forum Infectious Diseases shows women who have COVID-19 infections within a week before giving birth are at an increased risk for severe maternal morbidity (SMM) events, including acute renal failure and adult respiratory distress syndrome (ARDS).

The authors used electronic records of 93,624 deliveries occurring from March 11, 2020, to July 1, 2021, to look for positive COVID-19 tests and 21 SMM conditions.

Compared to uninfected pregnancies, the adjusted risk of SMM was 2.22 times higher (95% confidence interval [CI], 1.97 to 2.48) among those infected less than 7 days before delivery, and 1.66 times higher (95% CI, 1.23 to 2.08) among those infected 7 to 30 days before delivery.

"Those with SARS-CoV-2 infection within 7 days of delivery were more commonly younger (15-24 years old), Hispanic or non-Hispanic Black, resided in a rural area, had lower household income (<$40,000), and delivered after August 2020 compared to those without SARS-CoV-2 infections," the authors wrote.

Risk of acute respiratory distress 13 times higher

At a population-level, the authors estimate that 2% of SMM cases can be attributed to SARS-CoV-2 infection during the 7 days prior to delivery.

The highest risk associated with SARS-CoV-2 infection for ARDS (adjusted risk ratio 13.24; 95% CI, 12.86 to 13.61).

The authors said their findings should result in a more urgent push to vaccinate pregnant women, especially Black and Hispanic patients.

The coverage of COVID-19 vaccine is 13% lower among Black pregnant people and 12% lower among Hispanic pregnant people compared to non-Hispanic White pregnant people.

"Given the benefits of COVID-19 prevention, additional efforts to vaccinate Black and Hispanic pregnant people remain needed. The coverage of COVID-19 vaccine is 13% lower among Black pregnant people and 12% lower among Hispanic pregnant people compared to non-Hispanic White pregnant people," they concluded.

Special-needs kids' mental health differed by age when schools resumed after COVID closures

News brief

Mary Van Beusekom, MS

Sad young boy looking at laptop — Prostock-Studio / iStock

Preschoolers with special educational needs (SEN) functioned better emotionally and behaviorally when schools reopened after COVID-19 lockdowns, but the opposite was true for school-aged children and those with intellectual disabilities, suggests a study published today in JAMA Network Open.

University of Hong Kong researchers administered a questionnaire to the parents of 456 children aged 3 to 18 years with SEN enrolled in special schools in Hong Kong during COVID-19 school closures in April 2020 (wave 1). Six months after schools reopened, from July to October 2021 (wave 2), they repeated the questionnaire with the parents of 519 children with SEN.

In wave 1, the average child age was 7.4 years, and 69.1% were boys. In wave 2, the average child age was 8.2 years, and 70.3% were boys.

"Disruptions to daily routines can cause anxiety, frustration, and other negative behaviors in children with SEN," the researchers wrote. "During the pandemic, children with SEN were found to have poorer mental health and quality of life and were at higher risk of maltreatment."

Worse quality of life for those aged 6 to 11

After schools reopened, preschoolers aged 3 to 5 years with SEN had significantly fewer emotional difficulties (average Strengths and Difficulties Questionnaire [SDQ] score, 3.26 vs 2.68; standardized mean difference [SMD], 0.26) and behavioral problems (average SDQ score, 2.88 vs 2.41; SMD, 0.25).

But adolescents exhibited more behavioral problems (average SDQ score, 1.62 vs 2.37; SMD, 0.41), and children with intellectual disabilities had significantly lower scores for emotional functioning (average PedsQL score, 73.93 vs 68.12; SMD, 0.31).

Disruptions to daily routines can cause anxiety, frustration, and other negative behaviors in children with SEN.

The quality of life of children with SEN aged 6 to 11 years also declined after school resumption (average Pediatric Quality of Life Inventory [PedsQL]) score, 67.52 vs 60.57; SMD, 0.41).

"These findings suggest that the mental health outcomes varied according to the age and disabilities of children with SEN after school resumption, indicating that vulnerable groups might require additional support in the school setting," the study authors wrote.