High Contribution and Impact of Resistant Gram Negative Pathogens Causing Surgical Site infections at a Multi-Hospital Healthcare System in Saudi Arabia, 2007-2016

Abstract

BACKGROUND Despite being largely preventable, surgical site infections (SSIs) is still one of the most frequent healthcare associated infections worldwide. The presence of resistant pathogens can further augment its clinical and economic impact. The objective was to estimate the prevalence and extent of resistance in SSI pathogens in a tertiary care setting in Saudi Arabia and to compare such data to US National Healthcare Safety Network (NHSN) hospitals.METHODS Targeted SSI surveillance was prospectively conducted on several surgical procedures done between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of SSI and bacterial resistance were based on NHSN.RESULTS A total 492 pathogens causing 403 SSI events were included. The most frequent pathogens were Staphylococcus aureus (22.8%), Pseudomonas (20.1%), Klebsiella (12.2%), and Escherichia coli (12.2%), with marked variability between surgeries. Approximately 30.3% of Staphylococcus aureus were methicillin-resistant (MRSA), 13.0% of Enterococci were vancomycin-resistant (VRE), and 5.5% of Enterobacteriaceae were carbapenem resistant (CRE). The highest multidrug-resistant (MDR) GNPs were Acinetobacter (58.3%), Klebsiella (20.4%) and Escherichia coli (16.3%). MRSA was significantly less frequent while cephalosporin-resistant Klebsiella, MDR Klebsiella, and MDR Escherichia coli were significantly more frequent in our hospitals compared with NHSN hospitals.CONCLUSION GNPs in a tertiary care setting in Saudi Arabia are responsible for approximately 60% of SSI with more resistant patterns than Western countries. This information may be critical to secure resources and ensure support of caregivers and healthcare leaders in implementing antimicrobial stewardship programs and evidence-based SSI preventive practices.KEYWORDS Antimicrobial resistance, multidrug resistance, surgical site infections, surveillance, pathogens, hospital, Saudi Arabia