Resistance Pattern of Antibiotics in Patient Underwent Open Heart Surgery With Nosocomial Infection in North of Iran

Abstract

Background:Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens.Objectives:The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014.Methods:In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used.Results:Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR).Conclusions:We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and ESBL bacteria is increasing in our region.

High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

“…* indicate significant differences Table 3; SSI, surgical site infections. NHSN rates were based on the two published NHSN reports (references [13,14]). NHSN VRE rate shown was the rate of both Enterococcus faecalis and Enterococcus faecium combined.…”

“…Moreover, data on surgery-specific pathogens in these reports were absolutely lacking or retrieved from a small number of patients [10][11][12]. Likewise, very limited data on the resistance patterns of pathogens causing SSI were reported in the Gulf Cooperation Council (GCC) [10] and the Middle Eastern countries [13,14]. For example, a study that combined aggregate SSI data from 30 developing countries (including some regional ones) could not present data on pathogen profile nor bacterial resistance [15].…”

Co-occurrence of Extended-Spectrum Beta-Lactamases in Isolated Enterobacter spp. From Patients Specimens

“…The ESBL-producing isolates' outbreak in hospitals is related to different risk factors such as use of antimicrobials and indwelling catheters (urinary catheters and tracheal tubes) and person-to-person transmission, and since these genes are located on plasmids, they can easily spread in hospital environments. Different studies have reported the need for more precaution in use of antibiotics and the contorting rate of antibiotic resistance in ICU and neonatal care units (14)(15)(16). Varkey et al in India reported that out of 361 isolated bacteria from blood samples, including E. coli, K. pneumoniae and E. cloacae, 250 isolates were found to be ESBLs-producing organisms.…”

Kardiyak cerrahi sonrası gelişen sağlık bakımı ile ilişkili enfeksiyonların değerlendirilmesi-tek merkez deneyimi

“…Kardiyak cerrahi sonrasında gelişen SBİE'lar da; uzayan hastane yatışının, maliyet artışının ve mortalitenin önemli bir nedeni olarak karşımıza çıkmaktadır 1 . Literatürde bu enfeksiyonların sıklığı %2,25-24,9 arasında bildirilmektedir [1][2][3][4][5][6][7] .Kalp ameliyatları sonrası, SBİE gelişme riskini artıran en önemli neden; kardiyopulmoner "by-pass" ve ekstrakorporeal dolaşıma bağlı artan stress faktörlerinin genel bir inflamatuvar yanıt oluşturmasıdır. Bazı durumlarda bu inflamatuvar yanıtın abartılı bir durumda meydana gelmesi, sistemik inflamatuvar yanıt sendromuna ve çoklu organ disfonksiyonuna yol açabilmektedir.…”

“…Bazı durumlarda bu inflamatuvar yanıtın abartılı bir durumda meydana gelmesi, sistemik inflamatuvar yanıt sendromuna ve çoklu organ disfonksiyonuna yol açabilmektedir. Ayrıca; birden fazla cerrahi insizyon bölgesinin bulunması, ameliyat süresinin uzunluğu, postoperatif dönemde invazif araçların sıklıkla kullanılması ve yine bu dönemde hastane personeli ile temasın fazla olması, inflamasyonenfeksiyon ayırımındaki klinik zorluklar nedeni ile bazen geniş endikasyonla antibiyotik kullanımı, ameliyat yapılan hasta grubunda ileri yaş, komorbidite ve kompleks cerrahi girişimlerin olması SBİE'ların artması ile ilgili diğer risk faktörleri olarak sıralanabilir 8 Literatürde kardiyak cerrahi sonrası görülen SBİE'lar arasında en sık (%32,9-52,6) rastlanan enfeksiyon türü genellikle CAE'larıdır ve hızı %2-10 arasındadır 1,3,4,6,12,17,18 . Cerrahi alan enfeksiyonları artmış morbidite, mortalite, uzayan hastane yatışı ve artan maliyet ile beraber istenmeyen komplikasyonlardandır [19][20][21] .…”