Biology Department, Education College, Salahaddin University, Erbil, Iraq.
Cell Mol Biol (Noisy-le-grand). 2020 Dec 31;66(8):20-25.
To analyze the occurrence of resistant bacterial infection in patients undergoing cardiac surgery hospitalized in the surgical specialty hospital, in Erbil city, Iraq. A prospective study was done on a total of 138 patients operated and hospitalized in an intensive care unit and surgical wards. Bacterial isolates identification was done according to cultural characteristics, microscopic examination, some biochemical tests, analytic Profile Index 20E& API Staph, confirmed with VITEK® 2 compact system (BioMérieux). Antimicrobial susceptibility for disc diffusion tested to 17 antimicrobial agents. Resistance isolates were confirmed phenotypically for carbapenemase by Rapidec Carba NP Test (bioMe´rieux SA, Marcy-l'E´toile, France) for ESBLs producers by ESBL screening test VITEK 2 system. Molecularly blaIMP blaTEM, blaKPC, AmpC and blaCTX-M were detected by PCR. In 134 patients, 28.3% of patients got infected post-operatively. The most frequent source of isolation was from ICU patients (75%). Isolated bacteria included gram-positive 29 (54.7%) and gram-negative bacteria 24 (45.3%). Most frequently: Staphylococcus aureus (24.4%), each of pseudomonas aeroginosa, Klebsiella pneumonia (15.1%), Streptococcus spp. (11.3%), Escherichia coli (9.4%). Whereas included Coagulase Negative Staphylococci species (CoNS) (13.2%) and Enterococci species (5.7) Statistical analysis showed significantly higher sensitive isolates as compared with resistance isolates. Resistance to Carbapenems calss was 18.9% and Cephalosporins class 41.5% of isolates. The antimicrobial resistance pattern indicated that MDR bacterial isolates (81.1%) were widespread. Of the 34 phenotypically ESBL positive isolates, the ESBL genes (AmpC, blaCTX-M, and blaTEM) were amplified in 7(20.6), 6(17.6) and 6(17.6) isolates respectively. Out of 8 K. pneumonia (37.5%) harboring both blaAmpC and bla-CTX-M genes, while 6(75%) carries blaTEM. The blaCTX-M gene was found in only 1 (12.5%) out of 8 isolates of P. aeruginosa. While blaAmpC genotyping revealed that 1(7.7%) out of 13 Staph. aureus isolates were harboring it. Finally, 3(60%) out of 5 E. coli isolates harboring both AmpC and bla-CTX-M genes. Cardiac surgery patients wound show increasingly emerging strains of ESBL-producing gram-negative bacteria K. pneumonia, P. aeruginosa and E. coli especially patients prolonged in the intensive care unit.
为了分析在伊拉克埃尔比勒市外科专科医院接受心脏手术的患者中发生耐药菌感染的情况，我们进行了一项前瞻性研究，共对 138 名在重症监护病房和外科病房接受手术和住院治疗的患者进行了研究。根据文化特征、显微镜检查、一些生化试验、分析谱指数 20E&API Staph 对细菌分离株进行鉴定，并通过 VITEK®2 紧凑型系统（生物梅里埃公司）确认。用纸片扩散法对 17 种抗菌药物进行了药敏试验。通过 Rapidec Carba NP 试验（生物梅里埃公司，马西-埃托勒，法国）对产碳青霉烯酶的耐药分离株进行表型确证，通过 VITEK 2 系统的 ESBL 筛选试验对产 ESBL 分离株进行表型确证。通过 PCR 检测 blaIMP、blaTEM、blaKPC、AmpC 和 blaCTX-M。在 134 名患者中，28.3%的患者术后发生感染。最常见的分离源是 ICU 患者（75%）。分离出的细菌包括革兰氏阳性菌 29 株（54.7%）和革兰氏阴性菌 24 株（45.3%）。最常见的是：金黄色葡萄球菌（24.4%）、铜绿假单胞菌、肺炎克雷伯菌（各 15.1%）、链球菌属（11.3%）、大肠埃希菌（9.4%）。而凝固酶阴性葡萄球菌（CoNS）（13.2%）和肠球菌（5.7%）的含量则相对较低。统计学分析显示，敏感分离株的敏感性明显高于耐药分离株。耐碳青霉烯类药物的分离株占 18.9%，头孢菌素类药物的分离株占 41.5%。抗菌药物耐药模式表明，MDR 细菌分离株（81.1%）广泛存在。在 34 株表型上产 ESBL 的阳性分离株中，7 株（20.6%）、6 株（17.6%）和 6 株（17.6%）分别扩增出 AmpC、blaCTX-M 和 blaTEM 基因。8 株肺炎克雷伯菌（37.5%）中同时携带 blaAmpC 和 bla-CTX-M 基因，而 6 株（75%）携带 blaTEM 基因。在 8 株铜绿假单胞菌中，仅发现 1 株（12.5%）携带 blaCTX-M 基因。blaAmpC 基因分型显示，13 株金黄色葡萄球菌中有 1 株（7.7%）携带该基因。最后，5 株大肠埃希菌中有 3 株（60%）同时携带 AmpC 和 bla-CTX-M 基因。心脏手术患者的伤口会出现越来越多的产 ESBL 的革兰氏阴性细菌，如肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌，尤其是在重症监护病房中长时间住院的患者。
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