This document summarizes healthcare in the Republic of Karelia, Russia. It notes that the population is over 620,000 people, with most living in urban areas. There are several large hospitals that provide services across specialties like infectious diseases, oncology, and maternity. The healthcare system faces weaknesses like a lack of unified databases and clinical training. However, there are also strengths, such as established clinical pharmacology and use of treatment guidelines. The document then outlines a draft program to improve antibiotic stewardship through public education, training, and monitoring of antibiotic use and resistance in the region.

1. REPUBLIC OF KARELIA
Key objectives and challenges, potential and
strengths
Natalia Vezikova

2. REPUBLIC OF KARELIA

3. REPUBLIC OF KARELIA
Population of the Republic,
according to the State Statistics
Committee of Russia, is 622464
people.(2018).
Population density - 3.5 people /
km2 (2015).
Urban population — 79,59 %
(2015).
818 inhabited localities :
 13 cities,
 11 urban-type settlements,
 794 — small towns,
settlements and villagers.

4. Healthcare facilities in Karelia
 Central Republican Hospital
 Central Children Republican Hospital
 Cancer Hospital
 Central Infectious Disease Republican Hospital
 Emergency Care Hospital
 Prenatal Center
 Central Maternity Hospital
 Central City Children Hospital
 STI Clinic
 3 Medical facilities affiliated with various Public Agencies

5.  4 Outpatient clinics for adults
 4 Outpatient clinics for children
 Dental services (for children and adults)
 Republican TB Clinic
 Mental Clinic
 Drug Abuse Clinic
 Central district hospitals
 Two bacteriological laboratories

6. WEAKNESSES
 Non-existence of a unified central bacteriological laboratory in the
Republic of Karelia:
 Central Child Republican Hospital, Central Infectious Diseases
Republican Hospital and Center for Hygiene and Epidemiology have
own bacteriological laboratories.
 Other healthcare facilities (including Central Republican Hospital)
purchase services of bacteriological laboratories located in
St.Petersburg (‘Citylab’, ‘Invitro’, ‘Liis’, etc., under Federal Law # 44)

7. WEAK POINTS
Non-existence of a unified database of bacteriological culture results;
Insufficient recording of nosocomial infections;
Lack of properly trained clinical microbiologists and epidemiologists;
A number of medical facilities (located in the districts of the Republic) have
no formularies (logbooks) of antimicrobials and no protocols of perioperative
antibiotic prophylaxis;
Insufficient recording of inefficient antimicrobials use and adverse effects.

8. STRENGTHS
 Clinical pharmacology service has been established (there are clinical
pharmacologists available in almost all large inpatient healthcare facilities);
 Antimicrobial therapy is carried out in consistency with the results of culturing;
 Antimicrobial formularies (logbooks) generated in consistency with the results
of culturing are in use in Petrozavodsk inpatient facilities;
 In consistency with the National Vaccination Plan, Republic of Karelia has
introduced Preventive Vaccination Calendar (in addition to that preventive
vaccination with anti-pneumococcal vaccine is provided for patients with
chronic lung diseases as part of the “Prevention of Disability in the Republic of
Karelia” special programme)

9. Antimicrobial formulary (logbook)
 Antimicrobial formulary (logbook) does not come down to a list of
antimicrobials used by physicians in medical facilities
 The formulary (logbook) contains empirical therapy programs
 To provide more precise AB ‘stationing’ , Guidelines on Infections
Treatment recommend to mark out the 1st, 2nd and 3rd line of
therapeutic agents instead of breaking down agents into agents of
primary choice and alternative ones - the latter would have allowed
for more loose interpretation.

11. Draft program to combat the spread of antibiotic resistance
Improving public awareness on antibiotic resistance:
 promoting public awareness on AMA use and antimicrobial
resistance
 promotion of immunization, healthy lifestyle and personal hygiene
 Involvement of medical prevention centers and “Medical Student
Volunteers” movement
 Cooperation with Petrozavodsk State University’s medical institute
 Work with mass media and other non-commercial organizations

12. Draft program on containment of antibiotic resistance
Training for specialists
 Schools of efficient pharmacotherapy for primary care and
hospital specialists
 Conferences on vaccine prevention and treatment of infectious
diseases that involve medical professionals participating in the
continuous medical education program.
 Training for clinical microbiologists-bacteriologists on the
premises of the Antimicrobial Chemotherapy Scientific
Research Institute at Smolensk Medical University or at other
corresponding healthcare facilities

13. Draft program on containment of antibiotic resistance
Control of antimicrobial resistance and antimicrobials use:
 To establish a unified microbiological laboratory (service) in the Republic of Karelia
(on the premises of the Child Republican Hospital);
 To set up a unified database of nosocomial pathogens;
 To introduce and validate antimicrobial formularies (logbooks) for non-nosocomial
and nosocomial infections; protocols for perioperative antibiotic prophylaxis (to be
introduced in the healthcare facilities);
 To improve infection control of nosocomial infections in the healthcare facilities;
 To introduce evaluation of antibacterial agents effectiveness in real clinical practice.

14. Draft program on containment of antibiotic resistance
Controlling the spread of multi-drug resistant bacteria:
 Collaboration between clinical pharmacologist, clinical microbiologist
and clinical epidemiologist in the medical facility;
 Introduction of protocols for the prevention of nosocomial infections in
every medical facility;
 Introduction and validation of the disinfectants formularies (logbooks)
in the medical facilities.

15. Central Republican Hospital
 The hospital comprises: 16 specialized clinical units, 2 intensive care
units, 15 paraclinic units, 12 diagnostic units.
 Hospital bed capacity: 822 beds in the round-the clock inpatient
department, 18 beds in the day-patient hospital, and 25 beds in the
outpatient day-care ward.

16. Central Republican Hospital
Department of Clinical Pharmacology and Drug Supply
2,700 to 3,000 consultations are provided annually.
Main goals of the consultations:
 AM therapy correction;
 prescription of reserve antibiotics;
 nosocomial flora analysis (ICU, surgical units, ACE units)

17. Central Republican Hospital
Department of Clinical Pharmacology and Drug Supply
Starting from 2001, in order to streamline the use of antimicrobial
drugs and provide control of nosocomial infections, the following
measures have been introduced in the Hospital:
 Hospital formulary (logbook) of antimicrobials including
recommendations on diagnosis and treatment of infections,
 Chief physician order on antibiotic prophylaxis of surgical
infections,
 Protocol for sepsis diagnostics and treatment.

18. Central Republican Hospital
Department of Clinical Pharmacology and Drug Supply
 The formulary of antimicrobial drugs is being reputedly reviewed
in consistency with new data on local antibiotic resistance,
introduction of new antimicrobial agents, and changes in
infections treatment guidelines

19. RESULTS FROM 2014
 Total number of biological samples sent to
the laboratory for microbiological testing -
2561
 In 2014, according to the laboratories, 4520
various infectious pathogens were identified
as a result of culturing.
 Positive samples accounted for 70% of the
total number of clinical samples.

20. Microbial landscape
Microorganisms Number
of strains
Frequency of
isolation,
%
Gramm-negative
bacteria
3339 73,8
Gram-positive
bacteria
1150 25,4
Fungi (Candida spp) 31 0,8
Total 4520 100

21. Gramm-negative bacteria
Microorganisms Number
of strains
Frequency of
isolation, %
K.pneumoniae 839 25,1
Acinetobacter spp. 606 18,1
Escherichia coli 521 15,6
P.aeruginosa 442 13,2
Proteus spp. 332 9,9
Enterobacter spp. 212 6,3
Serratia spp. 93 2,8
S.maltophilia 79 2,4
Others 215 6,6
Total 3339 100

22. Gram-positive bacteria
Microorganisms Number
of strains
Frequency of
isolation, %
S. aureus 405 35,2
Enterococcus spp. 378 32,9
Coagulase negative
staphylococci
158 13,7
Others 209 18,2
Total 1150 100

23. Acinetobacter sensitivity

24. P. Aeruginosa sensitivity

25. Klebsiella pneumoniae sensitivity,
ESBL producents

26. Escherichia coli sensitivity

27. Tests and studies results:
 Gram-negative microflora takes the lead in the etiological
structure of infections identified in the Central Republican
Hospital(73.8%)
 K.pneumoniae (18,6%), Acinetobacter spp. (13,4%), Escherichia
coli (11,5%), P.aeruginosa (9,7%), S. aureus (8,9%), Enterococcus
spp. (8,4%) predominate among all pathogens

28. Спасибо за внимание!
Thank you for your attention!