The Role of MDR-<i>Acinetobacter baumannii</i> in Orthopedic Surgical Site Infections

Helal, Soheir Fathy; AnanyMervat, El; GhaithDoaa,; RabeeaSamar,

doi:10.1089/sur.2014.187

Cited by 21 publications

(17 citation statements)

References 13 publications

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“…Among the etiologies, S. aureus was the most common constituting 37% of the overall isolates. This is in agreement with previous studies in Italy [25],Iran [26], Saudi Arabia [21], Egypt [27] and Kenya [28]. Similarly, previous studies in different parts of Ethiopia had also reported S. aureus as the most frequent isolate from SSIs [19,20,29].…”

Section: Discussionsupporting

confidence: 92%

Incidence and Bacterial Etiologies of Surgical Site Infections in a Public Hospital, Addis Ababa, Ethiopia

Kalayu¹,

Diriba²,

Girma³

et al. 2019

TOMICROJ

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Background: Surgical Site Infections (SSIs) are among the frequently reported healthcare-acquired infections worldwide. Successful treatment of SSIs is affected by the continuous evolvement of drug-resistant microbes. This study investigated the incidence of SSIs, identifying the major etiologic agents and their drug resistance patterns in Yekatit 12 Hospital, Ethiopia. Methods: A cross-sectional study was conducted on 649 patients who underwent surgery at Yekatit 12 hospital from April 2016 to April 2017. Socio-demographic and clinical data were collected from each patient on admission. After surgery, they were followed for SSI occurrence. SSI was initially diagnosed by a senior surgeon based on standard clinical criteria and then confirmed by culture. Isolates were tested for drug resistance according to the clinical and laboratory standards institute guideline. Results: Of the 649 study participants, 56% were females. Their age ranged from 9 months to 88 years with a median age of 37 years. The incidence of culture-confirmed SSI was 10.2% (66/649) where 73 isolates were recovered. About two-third of the isolates were Gram-positive bacteria. Staphylococcus aureus was the most frequently isolated (27/73, 37%) followed by Coagulase-negative staphylococci (18/73, 24.7%), Escherichia coli (11/73, 15.1%) and Klebsiella species (10/73, 13.7%). About 89% and 44% of S. aureus isolates were resistant to penicillin and trimethoprim-sulfamethoxazole, respectively. MRSA constituted 11% of the S. aureus isolates. All the Gram-negative isolates were resistant to ampicillin and trimethoprim-sulfamethoxazole but susceptible to amikacin and meropenem. Klebsiella species showed 70-100% resistance to ceftazidime, cefuroxime, augmentin, chloramphenicol, ciprofloxacin, cefepime and gentamicin. About 82% of E. coli isolates were resistant for chloramphenicol, cefepime, ceftazidime, augmentin, cefuroxime and 64% for gentamicin and ciprofloxacin. Conclusion: The incidence of surgical site infection in Yekatit 12 hospital is 10.2%. Most of the SSIs were due to Gram-positive bacteria. Gram-negative isolates showed high resistance to the most commonly prescribed drugs. No resistance was found for meropenem indicating the absence of carbapenem-resistant bacteria. SSI treatments should be guided by culture and drug resistance test. Better infection prevention practices and continuous surveillance of antimicrobial resistance in the hospital are recommended for better patient care.

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Section: Discussionsupporting

confidence: 92%

Incidence and Bacterial Etiologies of Surgical Site Infections in a Public Hospital, Addis Ababa, Ethiopia

Kalayu¹,

Diriba²,

Girma³

et al. 2019

TOMICROJ

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“…Invasive blood infection was detected among few percentage (6%)of hospitalized cancer patients during the 6-month study period ( Table 2). The rest of the isolates can be considered colonizers and might become potential pathogens for patients under certain condition, especially in association with the use of invasive procedures [23][24]. There is no significance difference in general demographic characteristics between male and female patients or their ages, whereas treatment with antibiotics showed increased significantly the chance of (P=0.033) colonization with A. baumanni.…”

Section: Discussionmentioning

confidence: 97%

Occurrence and molecular characterization of metallo-β-lactamases (MBLs) among Acinetobacter baumannii isolates from cancer patients

qouzah

Hawari²,

Abu-Qatouseh

et al. 2018

int. arab. j antimicrob. agents

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Background: During the last decade, the prevalence of carbapenem-resistant infection associated with multidrug resistant (MDR) Acinetobacter baumanniiin patients has been continuously increasing. This prospective study aimed to determine the occurrence and molecular characterization of metallo-β-lactamases (MBLs) and carbapenem hydrolyzing oxacillinases among A. baumannii isolates from cancer patients over a period of 6-month. Methods:Antimicrobial susceptibility profile of 70 randomly collected A. baumannii isolates was first determined using disc diffusion test, and second, the MICs of 45 representative multidrug resistant (MDR) isolates were tested to useful drugs in treatment of their infections using E-test. PCR assays were used to detect the common four types of class D carbapenem hydrolyzing oxacillinases, two types of class A carbapenemases, four types of class B metallo-β –lactamases, and prevalence of Class 1 Integron among MDR isolates. Results: All 70 isolates were MDR, including 100% resistance to meropenom, aztreonem, piperacillin/tazobactum and 99% to carbapenem. All isolates carried blaOXA-23 and blaOXA-51, but none carried a blaOXA-24 like or blaOXA-58. The isolates also were positive for NDM-1, NDM, VIM, GES, KPC and SPM at the rates of 29%, 20%, 29%,19%,7% and 2%, respectively. Class 1 Integron was positive in 82% of A. baumanniiisolates. The clonal relationship of 42 MDR A. baumanniiisolates using ERIC-PCR and constructed dendrogram showed 3 major genotype clusters of genetically related isolates. These include 4 genotype groups, each composed of 2 isolates with 100 % similarity of DNA bands. Conclusion:This study demonstrates that A. baumannii colonize frequently cancer patients in association with antibiotic treatment. The organism is mostly carrying wide spectrum of antibiotic resistance genetic factors, especially many types of ESBLs and MBLs and Class 1 Integron. This fact should be considered when therapy is selected for treatment of patients infected with MDR A. baumannii. Key words. Acinetobacter baumannii, ESBLs, MBLs, Class 1 Integron, Jordanian cancer patients.

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“…It is speculated that the axillary and inguinal skin sites, which are moist and rich in apocrine glands, may represent microbial niches that are particularly favorable for long-term colonization with MDROs. 4,8 CHG bathing can decrease the bioburden of bacteria and yeasts on patients, the hospital environment, and the hands of health care workers. 29 Our study demonstrated that the implementation of CHG decolonization policy was associated with significant reduction of overall risk of surgical site infection after surgery in the SICU from 24% to 15%.…”

Section: Discussionmentioning

confidence: 99%

“…All SSI cases had drained pus from the deep incision in addition to one or more of the following criteria: 1) A deep incision that impulsively dehisced or is purposely opened by a surgeon and was culture-positive; and 2) plus one of the following signs or symptoms: fever (>38°C), localized pain, or tenderness. 4,6 Causative organisms of SSI were predominated by gram negative MDROs as shown by the unit antibiogram and phase I collected data. Therefore, screening for colonization with OXA-48-type (CPE) and screening for colonization with A. baumannii using Chromagars were done according to the manufacturer's instructions as shown in Figures 1 and 2 respectively.…”

Section: Methodsmentioning

confidence: 99%

“…2 As previous studies in our institute showed alarming predominance of OXA 48 producing Enterobacteriaceae colonization in intensive care units and infections with MDR-Acinetobacter baumannii in SSI. [2][3][4] A recently published study used the national healthcare associated-infections surveillance data from 2011 to 2017 in the Egyptian intensive care units showed that 54.1% of Enterobacteriaceae were carbapenem resistant (CRE) dominated by Klebsiella spp. 5 Thereby, this study used a systemic care bundle that encompassed 5-S evidencebased preventive measures across the phases of perioperative care to assess the effectiveness of care bundles to reduce SSI at the acute surgical intensive care unit of Cairo University Emergency Hospital.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt</p>

Wassef¹,

Mukhtar²,

Nabil³

et al. 2020

IDR

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Introduction: Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance. Purpose: We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University. Patients and Methods: Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection. Results: Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p<0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd's ratio (OR's ratio = 0.3) confidence interval (95% CI 0.14-0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%). Conclusion: Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.

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The Role of MDR-Acinetobacter baumannii in Orthopedic Surgical Site Infections

Abstract: Staphylococcus aureus was the main causative organism of orthopedic SSI (44.4%), whereas A. baumannii represented only (16.67%) of the causative organisms. MDR Acinetobacter CHROMagar reduced the turnaround time for screening of MDR-AB.

Cited by 21 publications

References 13 publications

Incidence and Bacterial Etiologies of Surgical Site Infections in a Public Hospital, Addis Ababa, Ethiopia

Incidence and Bacterial Etiologies of Surgical Site Infections in a Public Hospital, Addis Ababa, Ethiopia

Occurrence and molecular characterization of metallo-β-lactamases (MBLs) among Acinetobacter baumannii isolates from cancer patients

<p>Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt</p>

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