Microflora in patients with community-acquired pneumonia and hospital environment in Blagoveshchensk during pandemic

Abstract

Purpose: An increase of community-acquired pneumonia (CAP) incidence has been detected during COVID-19 pandemic. Aim: to conduct analysis of bacterial microflora isolated from patients suffering from CAP and hospital environment in hospitals. Methods & Materials: Bacteriological survey of sputum obtained from 210 hospitalized patients with CAP was conducted from December 2020 - March 2021 in the Blagoveshchensk city. A simultaneous sanitary-bacteriological control of hospital environment was performed (210 environment samples and 24 air samples). The research was conducted during 12 weeks (6 cycles, one cycle lasted two weeks). Bacteriological assessment was performed via classical method. Identification of isolated pathogens and evaluation of drug-resistant strains were performed with bacteriological analyzer “Multiscan”. Results: Examination of sputum that was obtained from 151 patients with CAP revealed 43 isolates and 8 bacterial species in 32 patients (21.2%). Candida spp. fungi (51.16±7.62%) and Gramm-positive microflora without drug-resistant strains (39.53±7.46%) were prevailing in the structure of detected isolates Gramm-negative enterobacteria were presented by one species of Klebsiella pneumoniae with multiple drug-resistance – ESBL (4.65±3.21%) and non-fermenting Gramm-negative bacteria – one species of Pseudomonas aeruginosa (2.33±2.30%). Evaluation of 210 environmental samples showed bacterial microflora in 49 samples (23.3% cases) that was comparable to frequency detection of bacterial pathogens from patients (21.2%). Microflora identified from environment was presented by 12 pathogenic species including Gramm-positive microflora (S. aureus, S. epidermidis, S. hominis, E.faecalis, E. Faecium) – 55.0%, Gramm-negative enterobacteria (K. pneumoniae, E. coli, E.agglomerans, E. cloacae, C. freundii) – 38.8%, non-fermenting Gramm-negative bacteria (A. baumannii, A. lwoffii) – 6.1%. Should be noted that during first three cycles bacterial contamination was detected in 19 out of 90 samples (21.1%) including 3 cases with multiple drug-resistance (3.3%). During following three cycles, bacterial contamination was revealed in 25.0% of samples (30 out of 120 samples) including 13 samples that had multiple drug-resistant bacteria (10.8%). Evaluation of 24 air samples showed no evidence of microbial contamination. Conclusion: Dynamic surveillance revealed wide circulation of bacterial pathogens in the hospital as well as build up of epidemiologically significant pathogen strains in hospital environment during observation period. These findings indicate considerable risk of nosocomial infections formation among patients.