Papers by Rossitza Dobrevska
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The role and utilisation of public health
The role and utilisation of public health case study of national had undergone an evaluation and ... more The role and utilisation of public health case study of national had undergone an evaluation and 55 % of those utilised the WHO hand hygiene intervention self-assessment tool. Evaluations utilised a variety of methodologies and indicators in assessing changes in hand hygiene behaviours pre Latham et al. BMC Public Health 2014, 14:131
Eurosurveillance, 2009
Hand hygiene represents the single most effective way to prevent healthcare-associated infections... more Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.
European Journal of Clinical Microbiology & Infectious Diseases, 2012
The purpose of this investigation was to assess the impact of selective reporting of antibiotic s... more The purpose of this investigation was to assess the impact of selective reporting of antibiotic susceptibility data on the appropriateness of intended documented antibiotic prescriptions in urinary tract infections (UTIs) among residents training in general practice. We conducted a randomisedcontrolled case-vignette study in three French universities using a questionnaire with four UTI vignettes. In each university, residents were randomly allocated to two groups: a control group with usual full-length reporting of antibiotic susceptibility data (25 antibiotics) and an intervention group with selective reporting of antibiotic susceptibility data (2 to 4 antibiotics only). 326/611 residents (53 %) participated in the survey, 157/305 (52 %) in the intervention group and 169/ 306 (55 %) in the control group. For all four UTI scenarios, selective reporting of antibiotic susceptibility data significantly improved the appropriateness of antibiotic prescriptions (absolute increase ranging from 7 to 41 %, depending on the vignette). The variety of antibiotic prescriptions was reduced in the intervention group, and cephalosporins and fluoroquinolones were less often prescribed. Among 325 respondents, 124 (38 %) declared being either not really or not at all at ease with antibiotic susceptibility data, whereas 112/157 (71 %) of the residents in the intervention group declared that selective reporting of antibiotic susceptibility data made their antibiotic choice easier. Selective reporting of antibiotic susceptibility data could be a promising strategy to improve antibiotic use in UTIs, as part of a multi-faceted antibiotic stewardship programme. Microbiology laboratories should be aware that they can have a significant influence on antibiotic use.
THE ULUTAS MEDICAL JOURNAL, 2016
Introduction: The objective of this study was to establish the efficacy of local probiotic monoth... more Introduction: The objective of this study was to establish the efficacy of local probiotic monotherapy for the treatment of bacterial vaginosis. Method: A total of 141 women with bacterial vaginosis, randomized into two groups, were examined. In the first group, 85 women were treated with local probiotic medicine (QD for 10 days) containing Lactobacillus casei var rhamnosus Döderlein (Lcr35®). In the second group, 56 patients received the same local probiotic treatment as those in the first group, in addition to treatment with an oral administration of metronidazol (500 mg tablet BID for 7 days). The efficacy of the monotherapeutic scheme was evaluated by comparing the number of clinical complaints and the results of clinical examinations and microbiological tests in the two groups. Results: One month after the probiotic monotherapy in the first group, the clinical efficacy was 47.1% and the microbiological efficacy was 41.1%. The combined treatment in the second group was more efficacious (clinical efficacy: 89.3%; microbiological efficacy: 76.7%). Conclusion: Our results indicate that local probiotic monotherapy is less effective than combined metronidazole/probiotic scheme for the treatment of bacterial vaginosis.
Eurosurveillance, 2015
We present a pilot validation study performed on 10 European Union (EU) Member States, of a point... more We present a pilot validation study performed on 10 European Union (EU) Member States, of a point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in Europe in 2011 involving 29 EU/European Economic Area (EEA) countries and Croatia. A total of 20 acute hospitals and 1,950 patient records were included in the pilot study, which consisted of validation and inter-rater reliability (IRR) testing using an in-hospital observation approach. In the validation, a sensitivity of 83% (95% confidence interval (CI): 79-87%) and a specificity of 98% (95% CI: 98-99%) were found for HAIs. The level of agreement between the primary PPS and validation results were very good for HAIs overall (Cohen's κappa (κ): 0.81) and across all the types of HAIs (range: 0.83 for bloodstream infections to 1.00 for lower respiratory tract infections). Antimicrobial use had a sensitivity of 94% (95% CI: 93-95%) and specificity of 97% (95% CI: 96-98%) with a very good level of agreement (κ: 0.91). Agreement on other demographic items ranged from moderate to very good (κ: 0.57-0.95): age (κ: 0.95), sex (κ: 0.93), specialty of physician (κ: 0.87) and McCabe score (κ: 0.57). IRR showed a very good level of agreement (κ: 0.92) for both the presence of HAIs and antimicrobial use. This pilot study suggested valid and reliable reporting of HAIs and antimicrobial use in the PPS dataset. The lower level of sensitivity with respect to reporting of HAIs reinforces the importance of training data collectors and including validation studies as part of a PPS in order for the burden of HAIs to be better estimated.
Background and Objective : Surgical site infections (SSIs) have an enormous impact over the opera... more Background and Objective : Surgical site infections (SSIs) have an enormous impact over the operative intervention outcome. In the last 20 years the use of antibiotic prophylaxis (ABP) has been greatly improved as regards appropriate choice of antibacterial drugs, timing of initial dose and precised duration of the administration scheme. Methods: The study should be considered a compiling work (references review), reviewing some latest original statements on antibitic prophylaxis in surgery of experienced centers and a society of anesthesiology and reanimation. The recommendations discussed were selected with the presumption of demonstrating practical guidelines of highly interested in antibiotic prophylaxis institutions. The analysis takes into consideration the specific definitions and risk-related factors for SSI. Thus the recommended new (2010) algorithms of the strategy for antibiotic prophylaxis are presented in the context of, and in compliance with the classification systems...
European Journal of Clinical Microbiology & Infectious Diseases, 2019
Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complement... more Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 17, 2018
Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic ... more Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among hospitalised patients with cUTIs. A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. The primary outcome was treatment failure. Secondary outcomes included all-cause mortality 30 days, among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for treatment failure and 30 day mortality. A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981) of patients; all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for...
The Lancet. Infectious diseases, Jan 12, 2017
In 2011-12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-w... more In 2011-12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-wide point-prevalence survey of health-care-associated infections in acute care hospitals. We analysed paediatric data from this survey, aiming to calculate the prevalence and type of health-care-associated infections in children and adolescents in Europe and to determine risk factors for infection in this population. Point-prevalence surveys took place from May, 2011, to November, 2012, in 1149 hospitals in EU Member States, Iceland, Norway, and Croatia. Patients present on the ward at 0800 h on the day of the survey and who were not discharged at the time of the survey were included. Data were collected by locally trained health-care workers according to patient-based or unit-based protocols. We extracted data from the ECDC database for all paediatric patients (age 0-18 years). We report adjusted prevalence for health-care-associated infections by clustering at the hospital and country ...
Clinical Microbiology and Infection, 2016
We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and... more We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internetbased survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physicianebed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56e2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring devicerelated or surgical site infections), the ratio was 1.21 (interquartile range 0.57e2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance.
Clostridium difficile is one of the most important causative agents of severe diarrhoea in hospit... more Clostridium difficile is one of the most important causative agents of severe diarrhoea in hospitalised patients treated with antibiotics. Since 2008, Bulgaria participated in the Pan-European Surveillance Study investigating the prevalence of C. difficile infections (CDI) in different European countries. In the period November 2008 - March 2010, the incidence of CDI in nine participating hospitals was 7.94 per 10 000 patient admissions (0.34 per 10 000 patient-days). In total, sixty five fecal samples from patients with mild to severe enterocolitis and previous antibiotic treatment were investigated for CDI. Strains were typed and further characterized for the presence of toxins A (TcdA), B (TcdB) and binary toxins (CdtA and CdtB). Of 65 stool samples included, 15 were toxin and culture positive for C. difficile. Six of the isolates (40%) belonged to PCR ribotype 017 (TcdA -; TcdB +; CdtA/B -), followed by 002 (n = 2 isolates) and 014 (n =2 isolates). The remaining C. difficile iso...
Problems of Infectious and Parasitic Diseases
Background: Clostridium difficile has become a critically important pathogen worldwide, particula... more Background: Clostridium difficile has become a critically important pathogen worldwide, particularly in hospitalized patients. In 2008, the European Center for Disease Prevention and Control (ECDC) initiated a pan European surveillance study to collect epidemiological and microbiological data of C. difficile associated diseases (CDAD). Since Bulgaria has joint this study a number of CDAD cases were discovered. The objective of the present work is to report the first cases of CDAD occurring in Sofia, Bulgaria. Material and Methods: For the period November 2008 - February 2009, thirty six fecal samples from patients with severe enterocolitis and previous antibiotic treatment have been investigated. The stool samples derived from 3 hospitals in Sofia. Strains were typed and further characterized for the presence of toxins A (TcdA), B (TcdB)_and binary toxins (CdtA and CdtB). Results: No outbreaks were reported and the incidence of C. difficile infection (CDI) in the hospitals was 3.12 ...
Problems of Infectious and Parasitic Diseases
C. difficile infections (CDI) are associated with patients who have contact with health care sett... more C. difficile infections (CDI) are associated with patients who have contact with health care settings and with antibiotic exposures. This anaerobic bacterium causes asymptomatic colonization to severe diarrhea; pseudomembranous colitis, toxic megacolon, intestinal perforation and death. C. difficile is recognized as a gut colonizer and a cause of diarrhea in several animal species. The enteropathogen produces enterotoxin A and cytotoxin B. The majority of strains with changes in coding genes tcdA and tcdB produce a binary toxin CDT. PCR-ribotyping method and PCR methods for detection of toxin cod¬ing genes were presented for characterization of C. difficile strains. Ninety stool samples from patients (65/90) and animals (25/90) were investigated for C. difficile. 20% (18/90) of all samples were positive for C. difficile. 23% (15/65) from clinical samples and 12% (3/25) from horses were positive for C. difficile by culture test. 21, 5% (14/65) of clinical isolates produce toxins A an...
Probiotics and Antimicrobial Proteins, 2014
The high rate of vaginal Candida albicans recurrence is attributed to azole resistance rates as h... more The high rate of vaginal Candida albicans recurrence is attributed to azole resistance rates as high as 15 %. The aim of this study was to determine the clinical and microbiological efficacy of standard azole therapy for treatment of vaginal C. albicans infection alone and in combination with local probiotic as well as the effects on vaginal microbiota. This study included 436 women with vaginal candidiasis randomly assigned to two treatment groups. The first group, with 207 patients (12 dropouts), was administered 150 mg fluconazole and a single vaginal globule of fenticonazole (600 mg) on the same day. The second group of 209 patients (8 dropouts) followed the same treatment schedule; however, ten applications of a vaginal probiotic containing Lactobacillus acidophilus, L. rhamnosus, Streptococcus thermophilus, and L. delbrueckii subsp. bulgaricus were also administered beginning the fifth day after azole treatment. Microbiological analysis of the therapy efficacy in the first treatment group showed C. albicans resistance in over 30 % of patients. Clinical complaints persisted after treatment administration in 79.7 % (n = 165) of women in this group. Clinical complaints in the second group decreased to 31.1 % (n = 65) and microbiological efficacy also improved among investigated parameters, from 93.7 % (n = 193) to 95.2 % (n = 198). The local application of probiotics after administration of combined azoles for treatment of vaginal C. albicans infections increases therapy efficacy and could prevent relapse.
Microbial Drug Resistance, 2013
A panel of 29 multidrug-resistant (MDR) Pseudomonas aeruginosa isolates recovered from seven hosp... more A panel of 29 multidrug-resistant (MDR) Pseudomonas aeruginosa isolates recovered from seven hospitals as part of a country-wide surveillance of antimicrobial resistance in Bulgarian hospitals was studied. Molecular typing through multiple-locus variable number tandem-repeat analysis (MLVA6) yielded 23 different profiles. Phenotypic and genotypic tests for the detection of acquired carbapenemases yielded negative results in all cases. In contrast, 76% of the isolates produced other acquired β-lactamases, including extended-spectrum β-lactamases (ESBLs). Namely, 6 of the isolates (21%) produced a VEB-1 ESBL; 14 (48%) produced an OXA-10-type enzyme (7 OXA-10 and 7 OXA-10 ESBL variants, including 2 OXA-17 [A218G], 2 OXA-74 [C197T, A218G], and 3 OXA-142 [A218G, G470A]); 8 (28%) an OXA-2-type enzyme (all OXA-2); and 1 (3%) a PSE-1 carbenicillinase. Further analysis through multilocus sequence typing (MLST) revealed that the six VEB-1-producing strains, recovered from four hospitals, belonged to ST111 or ST244 international high-risk clones. Additionally, nearly all of the isolates (97%) lacked OprD production, explaining carbapenem resistance. Overexpression of AmpC was documented in 5 (17%) of the isolates, including most of the MDR isolates not producing any acquired β-lactamase. Particularly noteworthy was the very high prevalence of MexXY-OprM overexpression, documented in 72% of the isolates, whereas the prevalence of MexAB-OprM overexpression was lower (21%). In summary, while the production of metallo-β-lactamases is uncommon among P. aeruginosa isolates from Bulgarian hospitals, MDR profiles frequently result from the production of ESBLs combined with the lack of production of the carbapenem porin OprD and the overexpression of the MexXY-OprM efflux pump.
Journal of Medical Microbiology, 2013
The increasing incidence of Clostridium difficile infection (CDI) in Bulgaria has indicated the n... more The increasing incidence of Clostridium difficile infection (CDI) in Bulgaria has indicated the need to implement better surveillance approaches. The aim of the present work was to improve the current surveillance of CDI in Bulgaria by introducing innovative methods for identification and typing. One hundred and twenty stool samples obtained from 108 patients were studied over 4 years from which 32 C. difficile isolates were obtained. An innovative duplex EvaGreen real-time PCR assay based on simultaneous detection of the gluD and tcdB genes was developed for rapid C. difficile identification. Four toxigenic profiles were distinguished by PCR: A+B+CDT− (53.1 %, 17/32), A−B+CDT− (28.1 %, 9/32), A+B+CDT+ (9.4 %, 3/32) and A−B−CDT− (9.4 %, 3/32). PCR ribotyping and multilocus variable number of tandem repeat analysis (MLVA7) were used for molecular characterization of the isolates. In total, nine distinct ribotypes were confirmed and the most prevalent for Bulgarian hospitals was 017 f...
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Papers by Rossitza Dobrevska