Phenotypic characterization and susceptibility of gram negative bacteria from surgical site infections in a tertiary care hospital

Akhilesh P. S. Tomar; Anjali Kushwah

doi:10.18203/2319-2003.ijbcp20182684

Authors

Akhilesh P. S. Tomar Department of Microbiology, NSCB Medical College, Jabalpur, Madhya Pradesh, India
Anjali Kushwah Department of Pharmacology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20182684

Keywords:

Klebsiella pneumoniae, Multi drug resiatant organism, Pseudomonas aeruginosa, Surgical site infections

Abstract

Background: Gram negative bacteria are the common isolates among the cases of Surgical Site Infections (SSI). Resistant and specially Multi Drug Resistant (MDR) Gram negative isolates are a serious challenge for the treatment to clinicians. Present study was undertaken for phenotypic characterization and susceptibility pattern of Gram negative bacterial isolates from cases of surgical site infections in a tertiary care institute.

Methods: This descriptive cross sectional hospital based study was conducted in a tertiary care teaching hospital over a period of one and half year from January 2012 to June 2013. Centers for disease control and prevention (CDC) SSI case definitions were used to label a case as SSI. Only culture proven cases, out of clinically suspected was included in the study for evaluation.

Results: During the study period a total of 5949 patients were operated and screened for SSI in the wards under surveillance. Out of which 556 were clinically suspected as a case of SSI. With 408 culture proven cases of SSI the rate of SSI in present study was (6.86%). Rates of SSI were more in dirty (22.54%) and contaminated (13.78%) type of wounds. Among Gram negative bacterial isolates (n=343) from SSI, E. coli (45.18%) was the commonest followed by Pseudomonas aeruginosa (16.03%) and Klebsiella pneumoniae (13.42%). Unpleasant trend in antimicrobial resistance observed during study is a serious concern.

Conclusions: The data presented in this study clearly indicate the continuous need of surveillance of SSI. This will clearly help health care personnel in curtailing down the incidences of SSI.

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References

Burke JP. Infection control-a problem for patient safety. N Engl J Med. 2003;348:651-6.

World Health Organization. Report on the burden of endemic health care-associated infection worldwide: clean care is safer care. (WHO Document Production Services: Geneva, Switzerland, 2011).

Raka L. Prevention and control of hospital-related infections in low and middle-income countries. The Open Infectious Disease Journal. 2010;4:125-31.

Samuel, S et al. Nosocomial infections and the challenges of control in developing countries. Afr J Cln Exper microbial. 2010;11:102-10.

de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009 Jun 1;37(5):387-97.

World Health Organization. The evolving threat of antimicrobial resistance: options foraction. (WHO Library Cataloguing-in-Publication Data: Geneva, Switzerland, 2012).

Centre for Disease prevention and control. Types of health care-associated infections. (CDC 2012). Available at: http://www.cdc.gov/HAI/infection types.html.

Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson KD, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. American journal of infection control. 2014 Aug 1;42(8):820-8.

Koneman EW, Allen S, Janda W, Schreckenberger P, Winn WC. Color Atlas and Text book of Diagnostic Microbiology, 6th Edn. New York: Lippincott; 2006.

Collee JG, Marmion BP, Fraser AG, Simmons A, Eds, Mackie & McCartney Practical Medical Microbiology, 14th Edition, Churchill Livingstone, New York, 11:245-258,4:151-177.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement. CLSI document M100-S20. Wayne, PA: Clinical and Laboratory Standards Institute; 2010.

Lilani SP, Jangle N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J of Med Microbiol. 2005;23:249-52.

National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992-June 2001, issued August 2001. Am J Infect Control. 2001;29:404-21.

Tietjen L, Bossemeyer D, McIntosh N. Infection Prevention. Guidelines for Healthcare Facilities with Limited Resources. Baltimore, MD: JHPIEGO; 2003.

Weinstein R. Hospital-acquired infections. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ (eds.) Harrison's Principles of Internal Medicine. 16th Ed. New York: McGraw Hill; 2004.

Cheadle W. Risk factors for surgical site infection. Surg Infect (Larchmt). 2006;7:7-11.

Auerbach AD. Prevention of surgical site infections. In: Shojania KG, Duncan BW, McDonald KM, Wachter RM (eds). Making Health Care Safer A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment, No. 43. Rockville, MD: Agency for Healthcare Research and Quality; 2001.

National Noscomial Infections Surveillance. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470-85.

Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70:3-10.

Sikka R, Mann JK, Deep, Vashist MG, Chaudhary U, Deep A. Prevalence and Antibiotic Sensitivity Pattern of Bacteria Isolated from Nosocomial Infections in a Surgical Ward. Indian J of Clin Pract. 2012;22:519-25.

Raja NS, Singh NN. Antimicrobial susceptibility pattern of clinical isolates of Pseudomonas aeruginosa in tertiary care hospital. J Microbiol Imm Infect. 2007;40:45-9.

Weber SG, Miller RR, pereneevich EN, Tolentino J, Meltzer D, Pitrak D, et al. Prevalence of antimicrobial resistant bacteria isolated from older versus younger hospitalized adults: Results of a two centre study. J Antimicrob Chemother. 2009;64:1291-8.

Fadeyi A, Akanbi AA, Nwabuisi C, Onile BA. Antibiotic disc sensitivity pattern of Pseudomonas aeruginosa isolates obtained from clinical specimen in Ilorin, Nigeria. Afr J Med. 2005;34:303-6.

Gales AC, Jones RN, Turnidge J, Rennie R, Ramphal R. Characterization of Pseudomonas aeruginosa: occurrence rate, antimicrobial susceptibility pattern and molecular typing in the global sentry antimicrobial surveillance program 1997-1999. Clinic Infect Dis. 2001;32:146-55.

Van Eldere J. Multicentre surveillance of Pseudomonas aeruginosa susceptibility patterns in nosocomial infections. J Antimicrob Chemother. 2003;51:347-52.

Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin. Microbiol. Rev. 2001;14:933-51.

Livermore DM. Woodford. The beta-lactamase threat in Enterobacteriaceae, Pseudomonas and Acinetobacter. Trends Microbiol. 2006;14:413-20.

Dhillon RH, Clark J. ESBLs: a clear and present danger?. Critical care research and practice. 2012;2012.

Thakuria B, Lahon K. The Beta Lactam Antibiotics as an Emperical Therapy in a Developing Country: An Update on Their Current Status and recommendations to Counter the Resistance against Them. J of Cli and Diag Resear. 2013;7:1207-14.

Gupta N, Limbago B, Patel JB, Kallen AJ. Carbapenem-Resistant Enterobacteriaceae: Epidemiology and Prevention. Clinical Infectious Disease. 2011;53:60-67.

Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infection Control & Hospital Epidemiology. 2013 Jan;34(1):1-4.

Andrade SS, Jones RN, Gales AC, Sader HS. Increasing prevalence of antimicrobial resistance among Pseudomonas aeruginosa isolates in Latin American medical centres: 5 year report of the SENTRY Antimicrobial Surveillance Program (1997-2001). J Antimicrob Chemother. 2003;52:140-41.

Kallen AJ, Hidron AI, Patel J, Srinivasan A. Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp Epidemiol. 2010;31:528-31.

Falagas ME, Koletsi PK, Bliziotis IA. The diversity of deﬁnitions of multidrug-resistant (MDR) and pandrug-resistant (PDR) Acinetobacter baumannii and Pseudomonas aeruginosa. J Med Microbiol. 2006;55:1619-29.

Gould IM. The epidemiology of antibiotic resistance. Int J Antimicrob Agents. 2008;32:2-9.

Giske CG, Monnet DL, Cars O, Carmeli Y. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrobial agents and chemotherapy. 2008 Mar 1;52(3):813-21.