Abstract
To analyze the occurrence of resistant bacterial infection in patients undergoing cardiac surgery hospitalized in the surgical specialty hospital, in Erbil city, Iraq. A prospective study was done on a total of 138 patients operated and hospitalized in an intensive care unit and surgical wards. Bacterial isolates identification was done according to cultural characteristics, microscopic examination, some biochemical tests, analytic Profile Index 20E& API Staph, confirmed with VITEK® 2 compact system (BioMérieux). Antimicrobial susceptibility for disc diffusion tested to 17 antimicrobial agents. Resistance isolates were confirmed phenotypically for carbapenemase by Rapidec Carba NP Test (bioMe´rieux SA, Marcy-l'E´toile, France) for ESBLs producers by ESBL screening test VITEK 2 system. Molecularly blaIMP blaTEM, blaKPC, AmpC and blaCTX-M were detected by PCR. In 134 patients, 28.3% of patients got infected post-operatively. The most frequent source of isolation was from ICU patients (75%). Isolated bacteria included gram-positive 29 (54.7%) and gram-negative bacteria 24 (45.3%). Most frequently: Staphylococcus aureus (24.4%), each of pseudomonas aeroginosa, Klebsiella pneumonia (15.1%), Streptococcus spp. (11.3%), Escherichia coli (9.4%). Whereas included Coagulase Negative Staphylococci species (CoNS) (13.2%) and Enterococci species (5.7) Statistical analysis showed significantly higher sensitive isolates as compared with resistance isolates. Resistance to Carbapenems calss was 18.9% and Cephalosporins class 41.5% of isolates. The antimicrobial resistance pattern indicated that MDR bacterial isolates (81.1%) were widespread. Of the 34 phenotypically ESBL positive isolates, the ESBL genes (AmpC, blaCTX-M, and blaTEM) were amplified in 7(20.6), 6(17.6) and 6(17.6) isolates respectively. Out of 8 K. pneumonia (37.5%) harboring both blaAmpC and bla-CTX-M genes, while 6(75%) carries blaTEM. The blaCTX-M gene was found in only 1 (12.5%) out of 8 isolates of P. aeruginosa. While blaAmpC genotyping revealed that 1(7.7%) out of 13 Staph. aureus isolates were harboring it. Finally, 3(60%) out of 5 E. coli isolates harboring both AmpC and bla-CTX-M genes. Cardiac surgery patients wound show increasingly emerging strains of ESBL-producing gram-negative bacteria K. pneumonia, P. aeruginosa and E. coli especially patients prolonged in the intensive care unit.
Highlights
In spite of advances of knowledge in the area of controlling hospital and different systems of scoring tried to predict the infection risk, the surgical site infection (SSI) with antimicrobial resistance clinically important pathogens is increased and remain one of the most common postoperative contraindications and causes remarkable postoperative morbidity and death and could be life-threatening resulting in 100,000 deaths annually in additional health care expenditures
Cardiac surgery patients wound show increasingly emerging strains of extended-spectrum beta-lactamases (ESBL)-producing gram-negative bacteria K. pneumonia, P. aeruginosa and E. coli especially patients prolonged in the intensive care unit
The prevalence of Gram-negative bacteria developing broad-spectrum β-lactamase enzymes has resulted in higher use of carbapenem, which has contributed to the broader incidence and dissemination of Enterobacteriaceae generating carbapenemase [4, 5]
Summary
In spite of advances of knowledge in the area of controlling hospital and different systems of scoring tried to predict the infection risk, the surgical site infection (SSI) with antimicrobial resistance clinically important pathogens is increased and remain one of the most common postoperative contraindications and causes remarkable postoperative morbidity and death and could be life-threatening resulting in 100,000 deaths annually in additional health care expenditures. The antibiotic resistance of bacteria or multidrug-resistant MDR gram-negative bacilli as extended-spectrum-β-lactamases (ESBL)-producing Enterobacteriaceae and Metallo-β-lactamases (MBLs) have increasing in hospitals and in the intensive care unit (ICU) setting and become a growing problem that is continuing to expand and widely distributed for several gram-negative pathogens and is recognized as a medical issue that raises the morbidity and mortality rates, suggesting duration of hospital stays as well as costs and bad prognosis [2]. There is little research on resistance bacteria in an intensive care unit (ICU) and operation ward patients in Erbil hospitals. The aim of this study is the real infections evaluation because of gram-negative bacteria resistance in patients who undergo cardiac operations and admitted to ICU and SW in surgical specialty hospital, in Erbil city, Iraq
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
