Presentations from NW Russian regions – gaps and challenges, opportunities and strengths: St. Petersburg

1. Current issues of microbiological resistance
in St. Petersburg - the view of a clinician
Thematic Programme for Health Promotion and
prevention: Nordic – Russian Cooperation on
Antimicrobial Resistance (AMR) Containment,
2019-2020»
A. Yakovlev, V.Musatov
Botkin Infectious Disease Hospital
28th February, 2019

3. Number of inpatients trend
28 537
35 146 33 395
36 827 35 531
39 141 39 718
44 717 45 999 47 782
57 313
1420
1210 1210 1149 1149 1147 1147
1000
1200
1400
1600
1800
2000
2200
2400
0
10000
20000
30000
40000
50000
60000
70000
1994 2004 2005 2006 2012 2013 2014 2015 2016 2017 2018
Number of beds

4. Inpatients in the Botkin Infectious Disease Hospital
Indications
Years
2014 2015 2016 2017 2018
Total inpatients in the hospital 39 718 44 717 45741 47 782 57 313
Acute Intestinal Infection 10506 10 446 11 452 10432 13 434
Acute and chronic viral hepatitis 4038 4070 3342 4894 5187
Flu 648 680 1447 703 1042
ARVI 7617 3687 11 093 10262 9056

5. Microbiological monitoring (according to the Botkin
Hospital laboratory)

6. Isolation of cultures from feces
Potentially pathogenic flora
835
1865
1384
2350
224
792
1510
1374
1749
1490
1440
663
1067
2785
1067
666
1535
1518
1047
1778
1027
687
978
2810
1845
653
678
0 2000 4000 6000 8000 10000 12000
St. aureus Proteus Candida (др)
Citrobacter Klebsiella Enterobacter
EHEC Pseudomonas Others
Pathogenic microorganisms
1429
938
1057
961
148
135
227
209
152
142
216
142
44
59
34
20
17
4
8
6
3
0 500 1000 1500 2000
2014
2015
2016
2017
Salmonella spp EPEC
Shigella spp Campilobacter
Typhus, paratyphoid Yersinia spp
1341
1542
1278
1790
76,600
83,200
83,500
78,500
# of tests
10279
11373
9052
6932
«+» tests«+» проб

7. Isolation of cultures from blood
361
511
344
99
67
52
248
219
206
0 200 400 600 800 1000
2015
2016
2017
Staph. coagulase «-» Staph. aureus Other m/о
17
35
3
29
3
37
34
19
18
15
4
37
6
169
119
128
0 100 200 300
K. pneumonia Klebsiella spp
E. coli Enterococcus faecalis
Enterococcus spp Other m/о
> 15 various m/о
> 15 various m/о
≈ 40 various m/о
6108
5217
5211
Number of
samples
602
797
708
Total
«+» tests
57,1%
64,1%
51,0%
9,5%
8,4%
13,9%

8. Culture isolation from CSF
65
78
105
62
20
18
16
18
3
10
4
11
8
3
5
3
4
4
2
7
3
7
3
3
9
11
13
8
0 20 40 60 80 100 120 140 160
2014
2015
2016
2017
Cr. neoformans
S. pneumonia
Listeria monocytogenes
N. meningitidis
S. aureus
S. coagulase«-»
Others
907
1716
1186
Number of samples
1375
112 «+»
131 «+»
148 «+»
112 «+»

9. Comparison of resistance of a number of pathogens
• Data from Botkin Hospital (2015-2017 )
• MRSA 9,1 – 8,9 – 5,8%, MRSA mean level 8,3%
• K. рneumonia having ESBL, mean value– 32,1%
• E.coli, having ESBL, mean value– 28,9%
• In December 2018 and in February 2019 впервые в of
vancomycin resistant enterococcus (VRE)
cultures were isolated for the first time
• ECDC data (2016)
• MRSA 13.7%. In 2013-2016 there was statistically
significant decrease in the level of MRSA in all
countries
• K. Pneumonia - 34.5% were resistant to at least one
antimicrobial agent - Fq, 3rd generation Cs,
carbapenems, aminoglycosides
• E.coli - 58.6% were resistant to at least one
antimicrobial agent - aminopenicillins, Fq, III
generation Cs, carbapenems, aminoglycosides
Мусатов В.Б. с соавт., Вестник Российской военно-медицинской академии,
2018, 4 (64) пр. 2 с. 63

10. Monitoring of the microorganisms resistance in St. Pet.
• Since 2008, microorganisms isolated in the city hospitals are being monitored, the
analysis is performed with the help of the WHONET program database
• In 2008 - 2014 information on more than 250,000 cultures has been entered.
• Most important pathogens
– S. aureus 17%
– E coli 12%
– K.pneumonia 8–10%
• The proportion of microorganisms with established resistance (2014 )
– MRSA 19,6%
– Resistance to Cs of III generation
• E. coli 30,9%
– Resistance to carbopenems
• K. pneumonia 67,2%
• P. aeruoginosa 37,5%
Резистентность микроорганизмов в Санкт-Петербурге» Зуева Л.П., с соавт., 2015

11. MBT multiple drug resistance
14,0% 13,7%
The proportion of
patients
discharging
bacteria
148 165Number of
primary
detected
patients with
MDR
2017 2016
42,2% 26,0%
%% of all isolated
cultures
143 131Number of
detected
patients with
MDR
2017 2011-2012SPb Botkin Hospital

12. PROPOSALS
• To continue monitoring, to organize a system for obtaining
information on the entire range of microbiological
resistance data available in St. Petersburg
• To discuss the issues of pathogenic viruses resistance
(herpes group, HIV)
• To discuss the feasibility of developing protocols for clinical
use of antimicrobial agents.

13. V. Musatov
Botkin Infectious Disease Hospital
Тел 717 77 61, 409 79 99
doctormusatov@gmail.com