Deka Sangeeta, Kalita Deepjyoti, Mahanta Putul, Baruah Dipankar
Medical Microbiology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, IND.
Medical Microbiology, All India Institute of Medical Sciences, Rishikesh, IND.
Cureus. 2020 Dec 21;12(12):e12208. doi: 10.7759/cureus.12208.
Background and objective Surgical site infections (SSI) are the most common healthcare-associated infections in low- and middle-income countries associated with substantial morbidity and mortality and impose heavy demands on healthcare resources. We aimed to study the microbiological profile of SSI pathogens and their antibiotic-resistant patterns in a tertiary care teaching hospital serving mostly rural population Methods A prospective, hospital-based cross-sectional study on pathogen profile and drug resistance was conducted from January 2015 to December 2016. Study subjects were the patients who developed signs of SSI after undergoing surgical procedures at three surgical wards (General Surgery, Orthopedics, and Obstetrics & Gynecology). The selection of the patients was based on CDC Module. Standard bacteriological methods were applied for isolation of pathogens and antibiotic-susceptibility testing based on CLSI (Clinical Laboratory Standard Institute) guidelines. Results Out of 518 enrolled subjects, 197 showed growth after aerobic culture yielding 228 pathogen isolates; 12.2% of samples showed polymicrobial growth. (22.4%) and Klebsiella species (20.6%) were the predominant isolated bacteria followed by Staphylococcus species (18.4%), Pseudomonas species (12.3%), and Enterococcus species (6.6%). Gram-negative bacteria (GNB) were highly resistant to ampicillin (90.1%) and cefazolin (85.9%). High resistance was also observed to mainstay drugs like ceftriaxone (48.4%), cefepime (61%), amoxycillin-clavulanic acid (43.4%), and ciprofloxacin/levofloxacin (37.7%). Among the Gram-positive cocci, showed 85-96% resistance to penicillin and 65-74% to ampicillin. But GPCs were relatively less resistant to quinolones (16-18%) and macrolides (21.5%). was 100% sensitive to vancomycin and clindamycin but vancomycin-resistant Enterococci was encountered in 3/15 (20%) isolates. Conclusion GNBs were responsible for more than two-thirds of aerobic-culture positive SSI and showed high resistance to the commonly used antibiotics thus leaving clinicians with few choices. This necessitates periodic surveillance of causative organisms and their antibiotic-susceptibility pattern to help in formulating hospital antibiotic policy. The antibiotic stewardship program is yet to be adopted in our hospital.
手术部位感染（SSI）是低收入和中等收入国家最常见的医疗相关感染，与严重的发病率和死亡率相关，对医疗资源造成沉重负担。我们旨在研究一家主要服务农村人口的三级护理教学医院中SSI病原体的微生物学特征及其抗生素耐药模式。方法：于2015年1月至2016年12月进行了一项基于医院的前瞻性横断面研究，以了解病原体特征和耐药情况。研究对象为在三个外科病房（普通外科、骨科和妇产科）接受手术后出现SSI迹象的患者。患者的选择基于美国疾病控制与预防中心（CDC）的标准。采用标准细菌学方法分离病原体，并根据美国临床实验室标准化协会（CLSI）指南进行抗生素敏感性测试。结果：在518名登记受试者中，197人在需氧培养后有细菌生长，共分离出228株病原体；12.2%的样本显示为多微生物生长。大肠埃希菌（22.4%）和克雷伯菌属（20.6%）是主要分离细菌，其次是葡萄球菌属（18.4%）、假单胞菌属（12.3%）和肠球菌属（6.6%）。革兰阴性菌（GNB）对氨苄西林（90.1%）和头孢唑林（85.9%）高度耐药。对头孢曲松（48.4%）、头孢吡肟（61%）、阿莫西林-克拉维酸（43.4%）和环丙沙星/左氧氟沙星（37.7%）等主要药物也观察到高耐药性。在革兰阳性球菌中，对青霉素的耐药率为85 - 96%，对氨苄西林的耐药率为65 - 74%。但革兰阳性球菌对喹诺酮类（16 - 18%）和大环内酯类（21.5%）的耐药性相对较低。屎肠球菌对万古霉素和克林霉素100%敏感，但在15株分离株中有3株（20%）为耐万古霉素肠球菌。结论：革兰阴性菌占需氧培养阳性SSI的三分之二以上，对常用抗生素表现出高耐药性，这使得临床医生选择有限。因此有必要定期监测病原体及其抗生素敏感性模式，以帮助制定医院抗生素政策。我们医院尚未采用抗生素管理计划。
