Surveillance of multi-drug resistant pathogens in two Romanian university hospitals

Abstract

Health care associated infections (HC aIs) and bacterial multi-drug resistance (MDR) involve high costs and are difficult to manage in medical systems with limited resources. This study, part of the PNCDII 42121/2008 national research project, proposed the investigation of multidrug-resistant bacteria prevalence, concurrent with costs evaluation in two intensive care units (ICUs) from Timisoara university hospitals: Emergency Clinical County Hospital (ECCH) and Institute of Cardiovascular Diseases (ICD). During January-october 2010, we performed a surveillance focused on the following major exponents: meticillin-resistant Staphylococcus aureus (MRSa), extended spectrum beta-lactamase (ESBL) producing enterobacteria and carbapenem-resistant non-fermentative gram negative bacilli, with duplicates and colonisation germs exclusion. Selected germs identification and phenotyping were performed with the help of automatic VITEK 2 compact system, using VITEK 2 GP/GN identification cards and AST cards for antimicrobial sensitivity tests. We also performed Hodge tests for ESBL producing carbapenem resistant enterobacteria. at ECCH we isolated 534 bacterial strains, with a 35.44% prevalence for MRSa, 37.32% ESBL enterobacteria and 43.94% carbapenem-resistant nonfermenters. From 73 strains isolated from ICD, the MRSa prevalence was 8.00%, 23.33% ESBL enterobacteria and 11.11% carbapenem-resistant non-fermentatives. The average number of antimicrobial treatment days/ MDR infectious episode was 9.11 days in ECCH and 29.57days in ICD, with an average hospitalisation cost of