ABSTRACT
OBJECTIVE: The present study aims to analyse the risk factors involvement in the cross infectious pathology determined by multiresistant Enterobacteriaceae, in hospitalised patients in the Intensive Care Unit at the County Emergency Clinical Hospital in Timisoara. MATERIAL AND METHOD: We carried out a case-control study with 3 groups of adult inpatients--200 patients with no superadded infectious pathology, 100 patients infected with Enterobacteriaceae strains resistant to 3 classes of antibacterial chemotherapeutic agents and 100 infected with multiresistant strains. Identification of bacterial germs was performed using API ID 20 E manual galleries (BioMérieux) and the inclusion in the resistance phenotypes was done using the Osiris Evolution (BioRad) analyser. RESULTS: Subjects infected with multiresistant strains are mostly male, (p=0.020, OR=1.8 [1.06-3.07], RR=1.49, [1.05-2.11]), with the mean age younger than that of the control group (p=0.011). The mean Charlson Comorbidity Index was 3.34 in Group III and 4.06 in Group I (p=0.027). The logistic regression application keeps as well as independent risk factors for multiresistance--the mechanical ventilation, consciousness impairment, prolonged hospitalization and the higher number of days of antibiotherapy. CONCLUSIONS: In this study, the nosocomial factors and basic pathology prevail to the detriment of other intrinsic risk factors.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/isolation & purification , Anti-Bacterial Agents/pharmacology , Case-Control Studies , Cross Infection/drug therapy , Cross Infection/microbiology , Disk Diffusion Antimicrobial Tests , Drug Resistance, Multiple, Bacterial/drug effects , Enterobacteriaceae/drug effects , Female , Humans , Intensive Care Units , Logistic Models , Male , Regression Analysis , Risk FactorsABSTRACT
PURPOSES: The aim of our study was to determine the prevalence of multiresistant germs with nosocomial potential and their main resistance phenotype and genotype patterns in surgical departments. METHODS: Identification of germs was performed by the API system (BioMerieux France) and susceptibility tests by disk-diffusion tests, (CLSI standards) with automatic reading methods (Osiris-Bio Rad Laboratories). ESBL producing E. coli and Klebsiella pneumoniae strains have been also genotyped. RESULTS: From 190 samples (urines, wound secretions, blood, etc.); we isolated 106 microbial strains with nosocomial potential. 56 (52.83%) from these strains were represented by enterobacteria, 26 (24.52%) by Gram negative non-fermentative rods, and 24 (22.64%) by Gram positive cocci. CONCLUSIONS: We noticed a high prevalence of multidrug resistant germs (ESBL, MRSA, etc). The majority of them were involved in nosocomial surgical site and urinary tract infections.
Subject(s)
Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Gram-Negative Bacteria/genetics , Gram-Positive Bacteria/genetics , Surgery Department, Hospital , Surgical Wound Infection/microbiology , Urinary Tract Infections/microbiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Drug Resistance, Multiple, Bacterial/drug effects , Escherichia coli/isolation & purification , Genotype , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Humans , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests , Phenotype , Prevalence , Romania/epidemiology , Surgical Wound Infection/drug therapy , Surgical Wound Infection/epidemiology , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiologyABSTRACT
From 1911 outpatients, who addressed a Timisoara private clinical laboratory, from January to December 2005, we collected 1,889 urine cultures, 431 being positive. Bacteria identification was generally done using morphological, cultural, biochemical characters and pathogenicity tests. Sensitivity testing to antimicrobial medical drugs was done by using the classical diffusion Kirby-Bauer method and the automatic analyzer Osiris, also. The main bacteria involved in the etiology of these infections were represented by Enterobacteriaceae, head of the list being Escherichia coli (81.21%), followed by Klebsiella pneumoniae (8.35%) and Proteus mirabilis (3.02%). We also isolated Gram positive cocci (in a much smaller proportion), mainly represented by Enterococcus faecalis (1.16%), Staphylococcus aureus (0.93%), Streptococcus agalactiae, and also Gram negative non-fermentative bacilli, such as Pseudomonas aeruginosa (0.93%) or Acinetobacter baumanii (0.23%). As soon as we performed the sensitivity tests, we divided them in resistance phenotypes: Most of the Enterobacteriaceae were integrated in the wild phenotype, followed by the penicillinase producing phenotype. An E. coli strain (0.29%) and 3 Klebsiella pneumoniae strains (8.33%) were integrated in the large spectrum, multidrug resistant, beta-lactamase producing phenotype, also associated with resistance to fluoroquinolones and aminoglycosides; Non-fermentative bacilli did not present special resistance problems, the four Pseudomonas aeruginosa strains were integrated in the wild phenotype (secreting induced chromosomal cephalosporinase). As for Staphylococcus aureus it was identified a strain having fluoroquinolone resistance, two strains secreting penicillinase and having a K (Nm) phenotype and a strain secreting penicillinase only. Antibiotic resistance represents a major concern for patients, physicians, healthcare managers, and policymakers. The use of antibiotics is closely linked with the development of acquired antibiotic resistance.
