Kontroliuojančios tarnybos (K540000)

Background: Data sharing accelerates scientific progress and improves evidence quality. Even though journals and funding institutions require investigators to share data, only a small part of studies made their data publicly available upon publication. The procedures necessary to share retrospective data for re-use in secondary data analysis projects can be cumbersome.

Background Data sharing is increasingly required in research and funding institutions to accelerate scientific progress (1–5). PrIMAVeRa project aims to gather anonymized individual patient data for secondary use in mathematical models to estimate the impact of monoclonal antibodies and vaccines on antimicrobial resistance. Here, we describe the process for gathering anonymized individual data collected for other purposes, challenges faced and possible solutions. Methods A systematic review was performed to identify eligible datasets according with PrIMAVeRa aims (PROSPERO ID CRD42022322029). Principal investigators (PIs) were contacted and invited to share data by completing an online scientific collaboration questionnaire. Ethical charter and data sharing agreement were signed with the studies’ PIs. Anonymized datasets were harmonized according to predefined data standards and imported into central database. Public access to data will be facilitated through an online request form via the freely accessible ECRAID-Base EPI-Net platform (www.epi-net.eu). Appropriate agreements governing management of data access will be signed in respect of GDPR. Challenges related to communication, legal requirements, data anonymization, harmonization, storage, and access were mapped and possible solutions to overcome them identified. Results In total, 108 PIs were contacted, from which 34 were interested in sharing data; however, only 12 have completed the legal requirements. Minimum time since first contact until data sharing was one year. Seventeen specific challenges with proposed solutions were identified (Table 1). Lack of PIs interest in sharing data might be related to time constrains and different ethical landscape at the time of original study. Legal barriers in data sharing also imposed important limitations, due to a little training or legal support regarding GDPR. Challenges related to data anonymization, harmonization, data storage and access were more straightforward to overcome, by implementing technical solutions. Conclusions Experience gained in this project can be useful to improve data sharing and re-use in research. Researchers should see it as an advantage and include it in the original study ethical approval. It is important that academic institutions provide legal and data management support. Funding bodies should foresee mechanisms to facilitate it.

Įvadas. Dažniausias mikroorganizmų perdavimo kelias –rankos! Tinkamai ir laiku atliekama rankų higiena yra vienas svarbiausių veiksnių siekiant išvengti hospitalinės infekcijos Rankų higiena gali užkirsti kelią atsparių antibiotikams mikroorganizmų plitimui Neatsitiktinai PSO gegužės 5 d. yra paskelbusi ,,Pasauline rankų higienos diena” COVID-19 pandemijos metu stebimas didesnis dėmesys rankų higienai. Teisės aktai, reglamentuojantys rankų higieną. HN 47-1:2020 „Asmens sveikatos priežiūros įstaigos: infekcijų kontrolės reikalavimai“ reglamentuota kaip ir kada atliekama rankų higiena kiekvienoje gydymo įstaigoje turi būti parengta rankų higienos reikalavimų laikymosi vertinimo tvarka SAM 2012 lapkričio 29 d. Nr. V-1073 ,,Dėl asmens sveikatos priežiūros įstaigų, teikiančių stacionarines asmens sveikatos priežiūros paslaugas, vertinimo rodiklių sąrašų patvirtinimo”, kuriame nurodyti stebimi kokybės rodikliai: periodinis rankų higienos vertinimas rankų antiseptiko sunaudojimas (skaičiuojamas per metus sunaudoto rankų antiseptiko kiekis mililitrais vienam lovadieniui. Rankų higienos audito atlikimui svarbu Teisinė bazė: rankų higienos procedūra rankų higienos vertinimo atlikimo tvarka  ASPĮ administracijos palaikymas  Skyriaus vadovų bendradarbiavimas rekomenduojama apie būsimą rankų higienos vertinimą informuoti skyriaus administraciją iš anksto  Darbuotojų geranoriškumas rankų higienos vertinimo duomenys turi būti renkami taip, kad nebūtų galima identifikuoti darbuotojo tapatybės (pvz., vardas, pavardė) rankų higienos vertinimo duomenys neturi būti naudojami kaip administracinio poveikio priemonė (pvz., darbuotojo veiklos rezultatams vertinti) [...].mlovadieniui)

Introduction Antibiotics resistant Gram-negative rod (GNR) bacteremia is increasing worldwide every year. Diagnosis of nosocomial Gram-negative rod monobacteremia (N-GNRM) in critically ill patients has been associated with prolonged hospitalization in intensive care units (ICUs) and a higher rate of mortality. The identification of pathogens, the pervasiveness of multiple antibiotic resistance, and risk factors for resistant strains are helpful in selecting appropriate empirical antibiotic therapy to reduce hospitalization time and mortality. The aim of this study was to identify the risk factors for the development of nosocomial multiple antibiotic resistance strains and mortality. Methods A retrospective cohort study was performed, analyzing the data of patients treated in ICU after 72 hours of hospitalization, with positive gram-negative rod monobacteremia over a period of 10 years. Results Over the year 2009-2018, 261 cases of N-GNRM were identified. The detected pathogens include: 31.8% (n=83) Acinetobacter spp., 19.9% (n=52) Klebsiella spp., 18% (n=47) Escherichia coli and etc. Monobacteremia caused by P. aeruginosa was detected only in the last three years of the researched period, from 4 (8.5%) cases in 2016 to 7 (28%) cases in 2018 (p <0.05). The sensitivity to Imipenem was 88.8% (n = 206), to Meropenem 85.4% (n = 199), to Amikacin 65.1% (n = 142), to Cefoperazone / Sulbactam 61.6% (n = 141) and to Piperacillin / Tazobactam 48% (n = 120). 61.6% (n=161) of all the cases studied, had multiple antibiotic resistance, out of which 39.8% (n=104) was extensively drug-resistant (XDR) (p <0.001). Of all Acinetobacter spp., XDR made up 69.9% (n=58) (p <0.001). The identified risk factors for bacteremia in resistant strains include male gender (p = 0.012), age >= 65 year old (p = 0.010), hospitalization in ICU >= 16 days (p = 0.012), and the duration of mechanical lung ventilation (IMV) >= 14 days (p <0.001). I[...].

Introduction: Acinetobacter baumannii (AcB) remains one of the most prevalent ventilator-associate pneumonia (VAP) causing pathogen. In recent years, share of drug resistant AcB strains across Europe was found to be steadily increasing. Consequently, in 2017, AcB was included in the WHO global priority list of drug-resistant bacteria to highlight the need for the research development. The aim of this study was to identify the relation of risk factors for ventilatorassociated pneumonia (VAP) and mortality with drug resistance profiles of AcB. Methods: A retrospective cohort study of patients treated in medical-surgical ICUs with drug-resistant strains of AcB as pathogens of VAPover a 2-year period was carried out. Results: The data of 60 medical-surgical ICUs patients with VAP due to drug-resistant AcB were analysed. The proportions of multidrugresistant (MDR), extensively drug-resistant (XDR), and potentially pandrug-resistant (pPDR) AcB were 13.3%, 68.3%, and 18.3%, respectively (p<0.05). The SAPS II scores on ICU admission were 42.6, 48.7, and 49 (p<0.048); hospital length of stay prior to ICU was 0, 1, and 2 days (p<0.036), prior to mechanical ventilation - 0, 0, and 3 days (p<0.013), and carbapenem use prior to VAP - 50%, 29.3%, and 18.2% (p <0.036) in MDR, XDR, pPDR AcB VAP groups respectively. The overall in-hospital mortality rate was 63.3%. In MDR, XDR, and pPDR AcB VAP groups it was 62.5%, 61.3%, and 72.7%, respectively (p = 0.772). Conclusions: The VAP risk factors: higher SAPS II score, increased hospital length of stay prior to ICU and mechanical ventilation were related to higher resistance profile of AcB. Carbapenem use was found to be associated with the risk of MDR AcB VAP. Mortality due to drug-resistant AcB VAP was high, but not associated with AcB drug resistance profile. Thus, timely mechanical ventilation and ICU treatment may reduce the risk of VAP due to higher drug-resistant AcB, especially in[...].

Introduction: Acinetobacter baumannii (AcB) remains one of the most prevalent ventilator-associate pneumonia (VAP) causing pathogen. In recent years, share of drug resistant AcB strains across Europe was found to be steadily increasing. Consequently, in 2017, AcB was included in the WHO global priority list of drug-resistant bacteria to highlight the need for the research development. The aim of this study was to identify the relation of risk factors for ventilator-associated pneumonia (VAP) and mortality with drug resistance profiles of AcB. Methods: A retrospective cohort study of patients treated in medical-surgical ICUs with drug-resistant strains of AcB as pathogens of VAP over a 2-year period was carried out. Results: The data of 60 medical-surgical ICUs patients with VAP due to drug-resistant AcB were analysed. The proportions of multidrug-resistant (MDR), extensively drug-resistant (XDR), and potentially pandrug-resistant (pPDR) AcB were 13.3%, 68.3%, and 18.3%, respectively (p<0.05). The SAPS II scores on ICU admission were 42.6, 48.7, and 49 (p<0.048); hospital length of stay prior to ICU was 0, 1, and 2 days (p<0.036), prior to mechanical ventilation - 0, 0, and 3 days (p<0.013), and carbapenem use prior to VAP - 50%, 29.3%, and 18.2% (p <0.036) in MDR, XDR, pPDR AcB VAP groups respectively. The overall in-hospital mortality rate was 63.3%. In MDR, XDR, and pPDR AcB VAP groups it was 62.5%, 61.3%, and 72.7%, respectively (p = 0.772). Conclusion: The VAP risk factors: higher SAPS II score, increased hospital length of stay prior to ICU and mechanical ventilation were related to higher resistance profile of AcB. Carbapenem use was found to be associated with the risk of MDR AcB VAP. Mortality due to drug-resistant AcB VAP was high, but not associated with AcB drug resistance profile. Thus, timely mechanical ventilation and ICU treatment may reduce the risk of VAP due to higher drug-resistant AcB, especially

Introduction: Growing antimicrobial resistance among Gramnegative rod (GNR) strains is a worldwide issue. Flora monitoring is associated with right first choice of antimicrobial treatment. The aim of study was to analyze sensitivity of hospital-acquired (HA) GNR monobacteremia strains to antimicrobial drugs and risk factors for mortality in Intensive Care Unit (ICU). Methods: Ongoing retrospective cohort study of patients treated in ICUs of Kaunas Clinic’s with positive blood culture for GNR taken after 72 hrs of hospitalisation during 7yrs period was carried out. Results: We’ve found 196 cases of HA bacteremia due to GNR: 72 (36.7%) caused by Acinetobacter spp. (P=.03), 38 (19.4%) by Escherichia coli, 34 (17.3%) by Klebsiella spp., 19 (9.69%) by Serratia spp. and just few others. Sensitivity to carbapenems (n=182, 92.9%), amikacin (n=131, 66.8%) cefoperazon/sulbactam (n=116, 59.2%), and piperacillin/ tazobactam (n=93, 47.4%) was found. There were found 151 (77%) multi-drug-resistant (MDR) and among them 64 (42.4%) – extra-drug-resistant strains. Among Acinetobacter spp. there were found 61 (84.7%) MDR strain (P=.04). In general it was related with male gender (n=90/118, P=.04, OR=4.56, CI95%=2.4-15.4), elderly (P=.001, RR=13.3), acute kidney injury (AKI) (n=98/128, P=.03, OR=0.84, CI95%=0.35-0.92). In multi-variate analysis lethal outcome 73.5% (n=144) was associated with male gender (P=.04, OR=2.92, CI95%=1.98-8.67), mechanical ventilation (P=.04, OR=4.125, CI95%=2.70-6.34), septic shock (P=.001, OR=8.21, CI95%=1.33-6.26),AKI (P=.02, OR=5.67, CI95%=1.18-27.25), MDR strain (P=.01, OR=3.47, CI95%=2.46-7.56). Conclusions: 7yrs study revealed Acinetobacter spp. as predominant, mostly MDR pathogen of HA GNR bacteremia in ICUs. HA MDR GNR bacteremia was related with male gender, elderly and AKI. High sensitivity of GNR to carbapenems was found. High rate of mortality 74% was associated with male gender, mechanical ventilation, septic shock, AKI and MDR...

Introduction: The aim of study was to analyze antimicrobial resistance of E. coli inmonobacteremia and associated factors with length of stay in Inten-sive Care Unit (ICU) > =7 days and mortality.MethodsThe retrospective data analysis of patients (pts) treated in surgicaland medical ICU of Kaunas Clinics with E. coli positive blood cultureduring 2005-2015 was carried out.ResultsThere were found 123 cases of E. coli monobacteremia, and thisgroup was homogenous in point of gender, age, comorbidities,source of bacteremia (P > 0.05).104 (84.6%) strains of E. coli were resistant to ampicillin, 94 (76.4%) -ampicillin/sulbactam, 90 (73.2%) - gentamicin, 88 (71.5%) –cefotaxim, 57 (46.3%) –ciprofloxacin, 56 (45.5%) - piperacillin, 34(27.6%) - piperacillin/tazobactam, 29 (23.6%) - amikacin. Resistance tocarbapenems was 0/123 (0%). 87/123 (70.7%) E. coli strains werefound to be multidrug-resistant (MDR) (P = 0.046). 57/87 (65.5%) E.coli MDR strains were producers of extended spectrum beta-lactamases (ESBL) (P = 0.04). 32/123 (26.0%) pts stayed in ICU > =7days. 30 (93.6%) pts among them were on mechanical ventilation >=3 days (P = 0.004, RR = 23.097), 29 (90.6%) had SOFA score > =13.[...].

Introduction: The aim of study was to evaluate antimicrobial resistance of Gram-negative bacteria (GNB) as pathogens of ventilator-associated pneu-monia (VAP) and to determinate predictors of in-hospital mortality.MethodsRetrospective data analysis of patients treated in ICU with multidrug-resistant strains of GNB as pathogens of VAP during 2015 was carriedout.ResultsIn 77 VAP pts 98 multidrug-resistant strains of GNB were revealed: 37(37.8%) of A. baumannii, 16 (16.3%) of Klebsiella spp., 11(11.2%) ofEnterobacter spp., 10 (10.2%) of P. aeruginosa and others 24 (24.5%)as S. marcescens, Morganella spp., Citrobacter spp., E. coli, Proteusspp. In 34 (34.7%) of GNB strains multidrug-resistance (MDR), in 63(64.3%) extensive drug-resistance (XDR) and in 1 (1%) pandrug-resistance (PDR) was ascertained. MDR was found in 7 (63.6%) of En-terobacter spp. and 7 (70%) of P. aeruginosa (p < 0.001), XDR - in 36(97.3%) of A. baumannii strains (p < 0.001). One (10%) of P. aerugi-nosa strains was found to be PDR. 37 (48%) pts with multidrug-resistant pathogens of VAP have died. Statistical significant differ-ences of survivors vs nonsurvivors were found in means of hospital-isation days prior of VAP 53.8 (SD = 34) vs 29,1 (SD = 17), p = 0.001,neutrophils percent 81 (SD = 8.9) vs 85 (SD = 6.3), p = 0.045, and be-tween proportions of internal disease 7 (33%) vs 14 (67%), p = 0.042,co-infection 13 (30%) vs 30 (70%), p = 0.001, shock 16 (36%) vs 28(64%), p = 0.03, multiple organ dysfunction syndrome 17 (40%) vs 25(60%), p = 0.039, inappropriate initial antimicrobial treatment 18(40%) vs 27 (60%), p = 0.02. OR for in-hospital mortality was: 8.9 (95%OR CI 2.24; 33.72) for co-infection, 4.67 (95% OR CI 1.7; 12.6) forshock and 3.3 (95% OR CI 1.27; 8.59) for inappropriate initial anti-microbial treatment.Conclusions[...].

Introduction: The aim of study was to analyze multidrug-resistant (MDR) and ex-tended spectrum beta –lactamases (ESBL) producing E. coli strainsof monobacteremia also associated factors with length of stay inIntensive Care Unit (ICU) > =7 days and mortality. MethodsThe retrospective data analysis of patients (pts) treated in surgicaland medical ICU of Kaunas Clinics with E. coli positive blood cultureduring 2005-2015 was carried out.ResultsThere were found 87 (70.7%) MDR strains among 123 cases of E. colimonobacteremia (P = 0.046). Rate of MDR strains during study periodwas: 6 (42.9%) cases in 2005, 12 (66.7%) in 2010, 12 (85.7%) in 2015(P = 0.027, RR = 17.324).There were found 57/87 (65.5%) cases of ESBL producing strainsamong E. coli MDR strains (P = 0.04). Rate of ESBL producers duringstudy period was: 2 (16.7%) cases in 2005, 7 (58.3%) in 2010, 10(76.0%) in 2015 (P = 0.03, RR = 14.856).28/57 (49.1%) pts with both MDR and ESBL E. coli strain stayed inICU > =7 days. All 28 (100%) pts had SOFA score > =13, weremechanically ventilated > =3 days and were in shock, respectively (P= 0.001), 25/28 (89.3%) were admitted from emergency department(P = 0.03).79/87 (90.8%) pts with E. coli MDR strain have died. All 79 (100%) ptswere mechanically ventilated (P = 0.04), 78 (98.7%) were in shock (P= 0.001, OR = 5.909, CI95% = 2.176–16.049), 68 (81.0%) had diabetesmellitus (P = 0.03), 66 (78.6%) had renal dysfunction (P = 0.046), 59(70.2%) had SOFA score > =13 (P = 0.032, RR = 12.00) and 54 (65.5%)pts had ESBL strain (P = 0.04).54/57 (94.7%) pts with ESBL producing E. coli strain have died. Allthese 54 (100%) pts were mechanically ventilated (P = 0.001), were inshock (P = 0.001), 50 (92.6%) had SOFA score > =13 (P = 0.01), 45(83.3%) had diabetes mellitus (P = 0.02) and 35 (64.8%) pts had renaldysfunction (P = 0.04).Conclusions.[...].