Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit

Abstract

Background:Nosocomial infections (NIs) in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a) evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b) identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU).Patients and Methods:After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient-outcome were determined.Results:Three hundred and nineteen of 6864 patients (4.6%) developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs) accounted for most of the infections (44.2%) followed by surgical-site infection (SSI, 11.6%), bloodstream infection (BSI, 7.5%), urinary tract infection (UTI, 6.9%) and infections from combined sources (29.8%). Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram-negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics.Conclusion:The incidence of NI and sepsis-related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram-negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

Nosocomial infection caused by multidrug resistant Enterobacteriaceae and their spread in inanimate surfaces in East-Algerian hospitals

“…Several studies reported the prevalence of Enterobacteriaceae as causative of nosocomial infections, in India; a recent study revealed that Enterobacteriaceae are the most frequently isolated in hospitals (Sahu et al, 2016), this concur with the high frequency of Enterobacteriaceae (59%) revealed in the present study. In the present study, the proportion of surfaces contamination with MDR-E was 61%.…”

“…In these series of strains, all Enterobacteriaceae presented high level resistance to most antibiotics tested, this results have been likely previously reported in several studies worldwide, either clinical or surfaces isolates (Karlowsky et al, 2003;Touati et al, 2010;Sahu et al, 2016;Jalapoor, 2011).…”

Management of the open abdomen using negative pressure wound therapy with instillation in severe abdominal sepsis

“…Surgical source control in patients with severe abdominal sepsis is critical to patient survival [26], and is especially important with the current increase in antibiotic resistance in surgical ICU patients [27], as well as suboptimal practices related to the use of antibiotics [28]. Novel therapeutic approaches, such as NPWT-I, that allow for rapid source control without the use of drugs, appear to be valuable addition to traditional therapeutic strategies for management of contaminated abdominal cavities.…”

Antibiotic efficacy patterns in the critically ill

“…In respiratory tract infections (n=29), Klebsiella (9), Acinetobacter (8) and CoNS (4) were the pathogens frequently isolated.…”

“…8 Because of widespread and irrational use of antibiotics, antibiotic resistance has increased exponentially causing grave prognosis in the management of infectious diseases. 2 The study results also indicate the same.…”