Abstract
Surgical environment can play as a source of multidrug-resistance organism, what can pose as a big threat to the patients and health care professionals. This study aimed to evaluate the prevalence and antimicrobial resistance profile of Gram-positive cocci (GPC) and Gram-negative bacilli (GNB) isolated from the surgical environment. All samples were collected during the intraoperative period of clean/clean-contaminated (G1) and contaminated (G2) surgery. A total of 150 samples were collected from the superficial surgical site in the beginning (n = 30) and the end (n = 30) of the procedure, surgeon's hands before (n = 30) and after (n = 30) antisepsis, and the surgical environment (n = 30). MALDI-TOF MS and antimicrobial susceptibility testing by disk diffusion method were performed for species identification, and determination of the resistance profile. Sixty-eight isolates of GPC and 15 of GNB were obtained. Staphylococcus spp. were the most frequent species isolated from surgical site (55.26% [21/38]), surgeon's hands (46.15% [6/13]), and environment (56.67% [17/30]). GPC were mostly resistance to penicillin (85.71% [54/63]), and erythromycin (77.78% [49/63]), and GNB were mostly resistance to cefazolin (58.33% [7/12]), and azithromycin (58.33% [7/12]). High incidence of multidrug resistance was observed in coagulase-negative staphylococci (86.21% [25/29]), coagulase-positive staphylococci (86.67% [13/15]), Enterococcus spp. (68.42% [13/19]) and Gram-negative bacilli (60% [9/15]). The high rate of resistance of commensal bacteria found in our study is worrying. Coagulase-negative staphylococci are community pathogens related to nosocomial infections in human and veterinary hospitals, their presence in healthy patients and in veterinary professionals represent an important source of infection in the One Health context. Continuous surveillance and application of antimicrobial stewardship programs are essential in the fight against this threat.
Highlights
The infection caused by multidrug-resistant bacteria (MDR) presents a main challenge in the one health context because it increases morbidity, mortality and the costs related to healthcare (Suthar et al 2014; Schwarz et al 2016; McEwen and Collignon, 2018)
MDR were high in coagulasepositive staphylococci (CoPS) (11/11 [100%]) and Gram-negative bacilli (10/13 [76.92%]) presented high proportion of oxacillin and clindamycin-resistance (11/11 [100%]) (Fig. 2)
This study identified a high rate of methicillin-resistant coagulase-negative staphylococci (CoNS) (90%), Gram-negative bacilli resistant to cefotaxime (82%) and MDR strains (87.50%)
Summary
The infection caused by multidrug-resistant bacteria (MDR) presents a main challenge in the one health context because it increases morbidity, mortality and the costs related to healthcare (Suthar et al 2014; Schwarz et al 2016; McEwen and Collignon, 2018). Methicillin-resistant Staphylococcus (MRS), extended-spectrum β-lactamases (ESBL) Enterobacteriaceae species, Pseudomonas aeruginosa and Acinetobacter baumannii are commonly cause of surgical site infections in pets and humans. These bacterial groups are the most prevalent microorganism acquired during the hospitalisation in the intensive care unit in human and veterinary medicine (GandolfiDecristophoris et al 2012; Turk et al 2014; Andrade et al 2016; Walther et al 2016; Chaudhary et al 2017; Kaspar et al 2018; McEwen and Collignon 2018; Shoen et al 2019). The introduction of these strains in the hospital environment poses a big threat to health care professionals, which become carriers and disseminators of MDR bacteria (Paul et al 2011; Rodrigues et al 2017; Kaspar et al 2018)
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