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. 2017 Feb;15(2):681-688.
doi: 10.3892/mmr.2016.6034. Epub 2016 Dec 13.

Antimicrobial resistance development following surgical site infections

Daniela Călina  1 , Anca Oana Docea  2 , Lucica Rosu  3 , Ovidiu Zlatian  3 , Alexandra Floriana Rosu  4 , Florin Anghelina  5 , Otilia Rogoveanu  6 , Andreea Letiția Arsene  7 , Alina Crenguța Nicolae  8 , Cristina Manuela Drăgoi  8 , John Tsiaoussis  9 , Aristides M Tsatsakis  10 , Demetrios A Spandidos  11 , Nikolaos Drakoulis  12 , Eliza Gofita  2
Affiliations

Antimicrobial resistance development following surgical site infections

Daniela Călina et al. Mol Med Rep. 2017 Feb.

Abstract

Surgical site infections (SSIs) determine an increase in hospitalization time and antibiotic therapy costs. The aim of this study was to identify the germs involved in SSIs in patients from the Clinical Emergency County Hospital of Craiova (SCJUC) and to assess their resistance to antimicrobials, with comparisons between surgical wards and the intensive care unit (ICU). The biological samples were subjected to classical bacteriological diagnostics. Antibiotic resistance was tested by disc diffusion. We used hierarchical clustering as a method to group the isolates based upon the antibiotic resistance profile. The most prevalent bacterial species isolated were Staphylococcus aureus (S. aureus; 50.72%), followed by Escherichia coli (E. coli; 17.22%) and Pseudomonas aeruginosa; 10.05%). In addition, at lower percentages, we isolated glucose-non-fermenting, Gram-negative bacteria and other Enterobacteriaceae. The antibiotic resistance varied greatly between species; the most resistant were the non-fermenting Gram‑negative rods. E. coli exhibited lower resistance to third generation cephalosporins, quinolones and carbapenems. By contrast, Klebsiella was resistant to many cephalosporins and penicillins, and to a certain extent to carbapenems due to carbapenemase production. The non-fermenting bacteria were highly resistant to antibiotics, but were generally sensitive to colistin. S. aureus was resistant to ceftriaxone (100%), penicillin (91.36%), amoxicillin/clavulanate (87.50%), amikacin (80.00%) and was sensitive to levofloxacin, doxycycline, gentamycin, tigecycline and teicoplanin. The Enterobacteriaceae resistance was only slightly higher in the ICU, particularly to carbapenems (imipenem, 31.20% in the ICU vs. 14.30% in the surgical wards; risk ratio = 2.182). As regards Staphylococcus species, but for non-fermenting bacteria, even if the median was almost the same, the antibiotic resistance index values were confined to the upper limit in the ICU. The data gathered from this study may help infection control teams to establish effective guidelines for antibiotic therapies in various surgical procedures, in order to minimize the risk of developing SSIs by the efficient application of the anti-infection armamentarium.

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Figures

Figure 1.
Figure 1.
Prevalence of bacterial species involved in surgical site infections.
Figure 2.
Figure 2.
(A) The antibiotic resistance index of the isolated species; (B) comparison of the antibiotic resistance index of the isolated species isolated from ICU and surgical wards. ICU, intensive care unit.
Figure 3.
Figure 3.
Antibiotics resistance profile of (A) Staphylococcus aureus, (B) Escherichia coli, (C) Klebsiella pneumoniae and (D) non-fermenting Gram-negative rods (non-fermenters). AK, amikacin; AMC, amoxicillin/clavulanate; AMP, ampicillin; AZT, aztreonam; AX, amoxicillin; CES, cefoperasone sulbactam; CIP, ciprofloxacin; CLR, clarithromycin; COL, colistin; CPO, cefpirome; CRO, ceftriaxone; CXM, cefuroxime; CZO, cefazoline; DO, doxycycline; E, erythromycin; ETP, ertapenem; FEP, cefepim; FOS, fosfomycin; GEN, gentamycin; IMP, imipenem; LEV, levofloxacin, LZD, linezolid; MEM, meropenem; OX, oxacillin; P, penicillin; RIF, rifampin; SXT, trimethoprim/sulfamethoxazole; TEC, teicoplanin; TCC, ticarcillin/clavulanate; TGC, tigecycline; TOB, tobramycin; TPZ, piperacillin-tazobactam; VAN, vancomycin.
Figure 4.
Figure 4.
Antibiotics resistance profile of (A) non-fermenting Gram negative rods (non-fermenters) and (B) Klebsiella pneumoniae in surgery and ICU wards. AK, amikacin; AMC, amoxicillin/clavulanate; AZT, aztreonam; CES, cefoperasone sulbactam; CIP, ciprofloxacin; COL, colistin; CPO, cefpirome; CRO, ceftriaxone; CXM, cefuroxime; CZO, cefazoline; ETP, ertapenem; FEP, cefepim; IMP, imipenem; MEM, meropenem; PIP, piperacillin; SXT, trimethoprim/sulfamethoxazole; TCC, ticarcillin/clavulanate; TGC, tigecycline; TOB, tobramycin; TPZ, piperacillin-tazobactam.
Figure 5.
Figure 5.
Hierarchical cluster analysis of resistance of Staphylococcus aureus strains (Ward's minimum variance method).
Figure 6.
Figure 6.
Hierarchical cluster analysis of resistance of Escherichia coli and Klebsiella pneumoniae strains (Ward's minimum variance method).
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