Species of non-fermentative Gram–negative bacilli other than Pseudomonas aeruginosa isolated from surgical wards in Regional Institute of Gastroenterology and Hepatology Cluj Napoca, Romania

Abstract

Pseudomonas aeruginosa is one of the main opportunistic pathogen agents that cause increased morbidity and mortality in the hospital environment, mainly in surgical and intensive care units.The purpose of this study was to analyze the resistance profiles of P. aeruginosa strains isolated from patients hospitalized in surgical wards in Regional Institute of Gastroenterology and Hepatology, Cluj -Napoca.Methods & Materials: We conducted a retrospective study during January-December 2014. Isolation of P. aeruginosa strains was performed on selective media for Gram-negative. Identification of strains was done both by conventional methods and by automated methods using Vitek ® 2 Compact. Antibiotic susceptibility testing was done using the Vitek ® 2Compact, but also by Kirby-Bauer method. Interpretation susceptibility was performed according to the CLSI standard.Results: They were analyzed 259 isolates from 244 patients hospitalized in surgical wards, 50.8% male, respectively 49.2% women. These strains were isolated from different pathological products: lower tract respirator (75), pus (65), peritoneal fluid (26), urine (18), central venous catheter insertion (17), blood (13), faeces (9), bile (8) and other secretions (13). Patients were aged between 19 and 98 years, with a median value of 60.5 years. Most patients were immunosuppressed by malignancy, pancreatitis, gastric and duodenal ulcers, peritonitis, gallstones, and others. Clinical outcome was infaust, registering death in 49.6% of patients.P. aeruginosa strains showed the following levels of antibiotic resistance, respectively, 86.1% to ticarcillin, 62.1% to piperacillin, while resistance to the penicillins combined with beta-lactamase inhibitors, ticarcillin with clavulanic acid and piperacillin with tazobactam was 75.1%, respectively 51.8%. Resistance to antipseudomonal cephalosporins was 61.8% to ceftazidime and 48.8% to cefepime, while the level of resistance to carbapenems was 68.7% to imipenem and 69.8% to meropenem. Resistance to aminoglycosides was 76.6% to gentamicin, 65.4% to tobramycin and 75.6% to amikacin. 66.4% of strains showed cross-resistance to fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin), while resistance to colistin was only 0.6%. Conclusion:The studied strains showed high levels of resistance to all classes of antibiotics, colistin remains often the only therapeutic option. Judicious administration of antibiotics in combination with nosocomial infection control measures need to be introduced in hospitals to prevent the circulation of these multidrugresistant strains.