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) are still one of the most frequent healthcare-associated infections. The presence of resistant pathogens can further augment their clinical and economic impacts. The objective was to estimate the distribution and resistance in SSI pathogens in Saudi Arabia and to compare them to the 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 aeruginosa (20.1%), Klebsiella spp. (12.2%), and Escherichia coli (12.2%), with marked variability between surgeries. Approximately 30.3% of Staphylococcus aureus was methicillin-resistant (MRSA), 13.0% of Enterococcus spp. was vancomycin-resistant (VRE), and 5.5% of Enterobacteriaceae were carbapenem resistant (CRE). The highest multidrug-resistant (MDR) GNPs were Acinetobacter spp. (58.3%), Klebsiella spp. (20.4%) and Escherichia coli (16.3%). MRSA was significantly less frequent while cephalosporin-resistant Klebsiella spp., MDR Klebsiella spp., 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 more than 60% of SSI with more resistant patterns than Western countries. This information may be critical to secure resources and ensure support for caregivers and healthcare leaders in implementing antimicrobial stewardship programs and evidence-based SSI preventive practices.

Antimicrobial susceptibility of gram-positive and gram-negative bacteria: a 5-year retrospective analysis at a multi-hospital healthcare system in Saudi Arabia

“…Our prevalence of Staphylococcus aureus was similar to the rate described in a previous report done in Riyadh (12.6% vs 13.9%) [ 6 ]. We report a lower rate of MRSA (15.9%) compared to two previous studies made in Riyadh (24.4% and 30.3%, respectively) [ 28 ] but similar to the rate reported before in another study in Riyadh (17.5%) [ 29 ]. We report a higher susceptibility of Enterococcus species to vancomycin (85.9% vs 79.7%) compared to one study in Riyadh [ 6 ].…”

“…As expected, HAI events were more frequent in the ICUs (37.2%) compared with non-ICU locations [HAI events in wards and outpatients were 32.9% and 29.9%, respectively], a finding which was previously described in local studies [ 10 , 28 ] and may reflect the epicenter role of ICU in both infections and antimicrobial resistance. The predominant isolates to cause HAIs were gram-negative organisms (71.9% vs. 28.1%); this finding was similar with many Saudi studies made in different cities in Saudi Arabia including Riyadh [ 6 , 28 , 29 ], Makkah [ 30 , 31 ], Dhahran [ 32 ], Bisha [ 33 ], and Aljouf [ 10 ]; with the majority being Escherichia coli (38%) accounting approximately for 52.9% of the gram-negative bacterial growth in line with previous national studies [ 7 , 29 , 30 , 32 , 34 ]. The second predominant isolates of the gram-negative organisms were the Klebsiella species (15.1%), this finding was similar to the bacterial isolates prevalence studies from Dhahran [ 7 ], and Riyadh [ 6 ].…”

High Prevalence of Antibiotic-Resistant Gram-Negative Bacteria Causing Surgical Site Infection in a Tertiary Care Hospital of Northeast India

“…In-vitro antibiotic susceptibility testing revealed that the isolated bacteria reacted differently to different antibiotics. Enterobacteriaceae like E. coli and Klebsiella showed very high resistance to ampicillin (92.2% and 95.7%) and first-generation cephalosporins like cefazolin (82.4% and 93.6%) similar to findings of other studies [13,19,20]. They also showed high resistance to amoxycillin-clavulanic acid (38-43%), gentamicin (45-48%), tetracycline (46-51%), and co-trimoxazole (37-45%).…”

“…[12]. E. coli has been implicated as a major pathogen in abdominal surgeries [19,20], and the source can be both endogenous (patient's gut flora) or exogenous (unhygienic surroundings, poor personal hygiene, or post-procedural contamination) [12,21]. Source of non-fermenters like Acinetobacter and Pseudomonas is usually exogenous like hospital surroundings or contaminated devices or dressings [12].…”

“…Source of non-fermenters like Acinetobacter and Pseudomonas is usually exogenous like hospital surroundings or contaminated devices or dressings [12]. Overall Gramnegative bacilli are also more resistant to disinfectants compared to Gram positives [19,21]. The greater complexity of the structure of the GNB cell wall renders intrinsic resistance to most disinfectants and antibacterial agents used in the hospitals.…”