Antimicrobial resistance development following surgical site infections

Călina,Daniela; Docea,Anca Oana; Rosu,Lucica; Zlatian,Ovidiu; Rosu,Alexandra Floriana; Anghelina,Florin; Rogoveanu,Otilia; Arsene,Andreea Letiția; Nicolae,Alina Crenguța; Drăgoi,Cristina Manuela; Tsiaoussis,John; Tsatsakis,Aristides M.; Spandidos,Demetrios A.; Drakoulis,Nikolaos; Gofita,Eliza

doi:10.3892/mmr.2016.6034

Antimicrobial resistance development following surgical site infections

Authors:
- Daniela Călina
- Anca Oana Docea
- Lucica Rosu
- Ovidiu Zlatian
- Alexandra Floriana Rosu
- Florin Anghelina
- Otilia Rogoveanu
- Andreea Letiția Arsene
- Alina Crenguța Nicolae
- Cristina Manuela Drăgoi
- John Tsiaoussis
- Aristides M. Tsatsakis
- Demetrios A. Spandidos
- Nikolaos Drakoulis
- Eliza Gofita
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Affiliations: Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Physiotherapy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Pharmaceutical Microbiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Biochemistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania, Laboratory of Anatomy, Medical School of Heraklion, University of Crete, Heraklion 71003, Greece, Laboratory of Toxicology, Medical School, University of Crete, Heraklion 71003, Greece, Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Greece, Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens 15771, Greece
Published online on: December 13, 2016 https://doi.org/10.3892/mmr.2016.6034
Pages: 681-688
Copyright: © Călina et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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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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