Bacteriological profile with phenotypic detection of MDR isolates in surgical site infections of Nishtar Hospital, Multan
DOI:
https://doi.org/10.55629/pakjpathol.v35i3.840Abstract
Objective: To determine bacteriological profile with phenotypic detection of MDR isolates in surgical site infections.
Materials and Methods: This cross-sectional descriptive study determined the frequency of bacteria causing surgical site infections in patients admitted at Nishtar Hospital, Multan. A total of 175 wound samples were collected and processed in the laboratory. All bacterial strains were characterized, and multidrug resistant strains were identified by an antibiotic susceptibility test. Moreover, modified carbapenem inactivation method, combine disc diffusion, and double disc synergy methods were employed to identify carbapenemases, metallo beta-lactamases, and extended spectrum beta-lactamases production among gram negative bacilli, respectively. Likewise, Cefoxitin-disc diffusion method was employed to identify S. aureus strains as methicillin-resistant staphylococcus aureus.
Results: In this study, P. aeruginosa (40%), E. coli (19.4%), Proteus spp. (8.6%), K. pneumoniae (6.3%), Enterobacter (2.9%), and A. baumannii (2.2%) made up the majority of the detected Gram-Negative Bacilli, while S. aureus (20.6%) was the only isolated Gram-Positive Cocci. A significant proportion of Gram-Negative Bacilli showed resistance to amoxicillin/clavulanic acid, ampicillin, ceftriaxone, trimethoprim/sulfamethoxazole, ciprofloxacin, amikacin, piperacillin/tazobactam, and meropenem, while Gram Positive Cocci showed resistance to ampicillin, amoxicillin/clavulanic acid, cefoxitin, and ceftriaxone. In this study, among 139 identified Gram-Negative Bacilli, 111 (79.9%) strains were CP (+), 122 (87.8%) strains were MBL (+), and 62 (44.6%) strains were ESBL (+). Likewise, 36 isolated strains of S. aureus were analyzed, out of which 30 (83.3%) were Methicillin-Resistant Staphylococcus Aureus (+).
Conclusion: our study will help in surveillance of resistance patterns of antibiotics and provide a cornerstone for the appropriate therapeutic strategy against multidrug-resistant infection.
Keywords: Carbapenemases, ESBLs, MBLs, methicillin-resistant staphylococcus aureus, surgical site infections
References
Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A, et al. Surgical site infection following abdominal surgery: A prospective cohort study. Can J Surg. 2019; 62(2): 111-7. DOI: https://doi.org/10.1503/cjs.004818
Kolasiński W. Surgical site infections–review of current knowledge, methods of prevention. Pol J Chir. 2019; 91(4): 41-7.
DOI: https://doi.org/10.5604/01.3001.0012.7253
Liu Z, Liu H, Yin H, Rong R, Cao G, Deng Q. Prevention of surgical site infection under different ventilation systems in operating room environment. Front Environ Sci Eng. 2021; 15: 36.
DOI:https://doi.org/10.1007/s11783-020-1327-9
Wall RT, Datta S, Dexter F, Ghyasi N, Robinson AD, Persons D, et al. Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures: a post-implementation prospective case-cohort study. J Clin Anesth. 2022; 77: 110632.
DOI:https://doi.org/10.1016/j.jclinane.2021.110632
ALhlale MF, Humaid A, Saleh AH, Alsweedi KS, Edrees WH. Effect of most common antibiotics against bacteria isolated from surgical wounds in Aden Governorate hospitals, Yemen. Uni J Pharm Res. 2020 Mar 8; 5(1): 21-4.
DOI: https://doi.org/10.22270/ujpr.v5i1.358
Hemmati H, Hasannejad-Bibalan M, Khoshdoz S, Khoshdoz P, Kalurazi TY, Ebrahim-Saraie HS, et al. Two years study of prevalence and antibiotic resistance pattern of Gram-negative bacteria isolated from surgical site infections in the North of Iran. BMC Res Notes. 2020; 13 (1): 383.
DOI: https://doi.org/10.1186/s13104-020-05223-x
Puca V, Marulli RZ, Grande R, Vitale I, Niro A, Molinaro G, et al. Microbial species isolated from infected wounds and antimicrobial resistance analysis: Data emerging from a three-years retrospective study. Antibiotics. 2021; 10(10): 1162.
DOI:https://doi.org/10.3390%2Fantibiotics10101162
Liston J, Bayles A. Surgical site infections. Surgery (Oxford). 2023 Feb 1; 41(2): 65-70.
Pal S, Sayana A, Joshi A, Juyal D. Staphylococcus aureus: A predominant cause of surgical site infections in a rural healthcare setup of Uttarakhand. J Family Med Prim Care. 2019; 8(11): 3600-6.
DOI: https://doi.org/10.4103/jfmpc.jfmpc_521_19
Sisay M, Worku T, Edessa D. Microbial epidemiology and antimicrobial resistance patterns of wound infection in Ethiopia: a meta-analysis of laboratory-based cross-sectional studies. BMC Pharmacol Toxicol. 2019 Dec; 20: 1-9. DOI: https://doi.org/10.1186/s40360-019-0315-9
Hrynyshyn A, Simões M, Borges A. Biofilms in surgical site infections: Recent advances and novel prevention and eradication strategies. Antibiotics. 2022; 11(1): 69.
DOI:https://doi.org/10.3390%2Fantibiotics11010069
Mihai MM, Preda M, Lungu I, Gestal MC, Popa MI, Holban AM, et al. Nanocoatings for chronic wound repair—modulation of microbial colonization and biofilm formation. Int J Mol Sci. 2018 Apr 12; 19(4): 1179.
DOI: https://doi.org/10.3390/ijms19041179
Gaynes R. The discovery of penicillin—new insights after more than 75 years of clinical use. Emerg Infect Dis. 2017; 23(5): 849-53.
DOI: https://doi.org/10.3201%2Feid2305.161556
Gajdács M, Spengler G. The role of drug repurposing in the development of novel antimicrobial drugs: non-antibiotic pharmacological agents as quorum sensing-inhibitors. Antibiotics. 2019 Dec 17; 8(4): 270.
DOI: https://doi.org/10.3390/antibiotics8040270
Raouf M, Ghazal T, Kassem M, Agamya A, Amer A. Surveillance of surgical-site infections and antimicrobial resistance patterns in a tertiary hospital in Alexandria, Egypt. J Infect Dev Ctries. 2020; 14(03): 277-83.
DOI: https://doi.org/10.3855/jidc.12124
Ahmed EF, Rasmi AH, Darwish AM, Gad GF. Prevalence and resistance profile of bacteria isolated from wound infections among a group of patients in upper Egypt: A descriptive cross-sectional study. BMC Res Notes. 2023; 16(1): 106.
DOI: https://doi.org/10.1186/s13104-023-06379-y
Ashoobi MT, Asgary MR, Sarafi M, Fathalipour N, Pirooz A, Jafaryparvar Z, et al. Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross‐sectional study. Int Wound J. 2023; 20(7): 2640-8.
DOI: https://doi.org/10.1111/iwj.14137
Ali A, Gebretsadik D, Desta K. Incidence of surgical site infection, bacterial isolate, and their antimicrobial susceptibility pattern among patients who underwent surgery at De surgical site infection Comprehensive Specialized Hospital, Northeast Ethiopia. SAGE Open Med. 2023; 11: 20503121231172345.
DOI:https://doi.org/10.1177%2F20503121231172345
Dan M, Hora S, Peshattiwar P, Vijay A. Assessing the bacteriological profile and antibiotic susceptibility pattern of surgical site infections in a tertiary care hospital. Int J Acad Med Pharm. 2023; 5(3): 579-82.
DOI: https://doi.org/10.47009/jamp.2023.5.3.121
Mukagendaneza MJ, Munyaneza E, Muhawenayo E, Nyirasebura D, Abahuje E, Nyirigira J, et al. Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study. Patient Saf Surg. 2019; 13: 10.
DOI: https://doi.org/10.1186/s13037-019-0190-8
Hogle NJ, Cohen B, Hyman S, Larson E, Fowler DL. Incidence and risk factors for and the effect of a program to reduce the incidence of surgical site infection after cardiac surgery. Surg Infect. 2014; 15(3): 299-304.
DOI: https://doi.org/10.1089/sur.2013.048
Maab H, Ali SA, Akmal M. Antibiotic susceptibility profile of bacterial isolates from post-surgical wounds of patients in tertiary care hospitals of Peshawar, Pakistan. J Pak Med Assoc. 2018; 68: 1517-20.
Alebel M, Mekonnen F, Mulu W. Extended-spectrum β-lactamase and carbapenemase producing gram-negative bacilli infections among patients in intensive care units of felegehiwot referral hospital: A prospective cross-sectional study. Infect Drug Resist. 2021: 391-405.
DOI: https://doi.org/10.2147%2FIDR.S292246
Jose LR, Gogi S. Increasing trend of antimicrobial resistance among Gram Negative organisms isolated from blood samples with special reference to ESBL and MBL producers, A study from a tertiary care center in the rural areas of Wayanad. IOSR J Dental Medical Sci. 2020; 19(5): 59-62.
DOI: http://dx.doi.org/10.9790/0853-1905065962
Metwally W, Aamir R. Prevalence and antimicrobial resistance patterns of nosocomial pathogens causing surgical site infections in an Egyptian University hospital. Microbes Infect Dis. 2020; 1(3): 226-37.
DOI:https://doi.org/10.21608/mid.2020.45255.1069
Lutgring JD, Limbago BM. The problem of carbapenemase-producing-carbapenesm-resistant -Enterobacteriaceae detection. J Clin Microbiol. 2016; 54(3): 529-34.
DOI: https://doi.org/10.1128%2FJCM.02771-15
Algammal AM, Hetta HF, Elkelish A, Alkhalifah DH, Hozzein WN, Batiha GE, et al. Methicillin-Resistant Staphylococcus aureus (methicillin-resistant staphylococcus aureus): One health perspective approach to the bacterium epidemiology, virulence factors, antibiotic-resistance, and zoonotic impact. Infect Drug Resist. 2020: 3255-65.
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