Antimicrobial Resistance Pattern of Nosocomial Infections at a Referral Teaching Hospital
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Abstract
Background: The choice of appropriate antibiotics to treat nosocomial infections requires knowledge of antibiotic resistance pattern in the hospitals. The aim of this study was to determine antimicrobial resistance patterns of common pathogens of nosocomial infections (pneumonia, UTI, bloodstream infection, wound infection) in a referral teaching hospital.
Methods: This cross-sectional study was conducted over a 6-month period. The pathogens isolated from biological samples of hospitalized patients with nosocomial pneumonia, UTI, bloodstream infection, or wound infection underwent antibiotic susceptibility testing by Kirby-Bauer method (disk diffusion test).
Results: Over the study period, 442 cases of infection were recorded. Pneumonia (n = 204, 46.2%) and UTI (n = 118, 26.7%) showed the most frequency followed by BSI (n = 71, 16.1%) and wound infection (n = 49, 11%). Acinetobacter baumannii was the most common pathogen of nosocomial pneumonia infection that showed the most susceptibility to colistin (100%). Escherichia coli, the most common pathogen of urinary tract infections, showed the highest sensitivity to colistin (100%). Staphylococcus epidermidis was the most common bloodstream infection pathogen that showed the most sensitivity to vancomycin (100%). Enterococcus spp., the most common pathogens of wound infection, had the most susceptibility to linezolid (100%).
Conclusion: Nosocomial infections in our hospital have high rate of resistance to antibiotics representing the importance of improvement in antibiotic use and infection control.
1. Georgia A. National Nosocomial infectious surveillance (NNIS) system Reports, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32(8):470-85.
2. Revelas A. Healthcare - associated infections: A public health problem. Niger Med J 2012;53(2):59-64.
3. Gastmeier P, Geffers C, Schwab F, Fitzner J, Oblanden M. Development of surveillance system for nosocomial infections, the component for neonatal intensive care units in Germany. J Hosp Infect 2004;57(2):126-31.
4. Phu VD, Wertheim HF, Larsson M, et al. Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units. PLoS One 2016;11(1):e0147544
5. Fanders SA. Collard HR. Saint S. Nosocomial pneumonia: state of the science. Am J Infect Control 2006;34(2):84-93.
6. Kaoutar B, Joly C, Heriteau FL, Barbut F, et al. Noscoomial infections and hospital mortality: a multicenter epidemiological study. J Hosp Infect 2004;58(4):268-75.
7. Sahu MK, Siddharth B, Choudhury A, et al. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit. Ann Card Anaesth 2016;19(2):281-7.
8. Klevens RM, Edwards JR, Richards CL, et al. Estimation healthcare associated infections and deaths in U.S. hospitals 2002. Public Health Rep 2007;122(2):160-6.
9. Jeong SH, Bae IK, Kwon SB. Investigation of a nosocomial outbreak in ICU. J Hosp Infect 2005:59(3):242-8.
10. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309-32.
11. Clinical and Laboratory Standards Institute. M100: Performance standards for antimicrobial susceptibility testing, 27th edition [pamphlet]. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute; 1998.
12. Mohammadimehr M, Feizabadi MM, Bahadori O, Khosravi M. Study of prevalence of gram-negative bacteria caused nosocomial infections in ICU in Besat hospital in Tehran and detection of their antibiotic resistance pattern-year 2007. Iranian Journal of Medical Microbiology 2009;3(2):47-54.
13. Cook PP1, Catrou PG, Christie JD, Young PD, Polk RE. Reduction in broad spectrum antimicrobial use associalted with no improvementin hospital antibiogram. J Antimicrob Chemother 2004;53(5):853-9.
14. Fish DN, Ohlinger MJ. Antimicrobial resistance: factors and outcomes. Crit Care Clin 2006;22(2):291-311.
15. Yates RR. New intervention strategies for reducing antibiotic resistance. Chest 1999;115(3 Suppl):24S-27S.
16. File TM Jr. Overview of resistance in the 1990s. Chest 1999;115(3 Suppl):3S-8S.
17. Zamani S, Nasiri MJ, Khoshgnab BN, Ashrafi A, Abdollahi A. Evaluation of antimicrobial resistance pattern of nosocomial and community bacterial pathogens at a teaching hospital in Tehran, Iran. Acta Med Iranica 2014;52(3):182-6.
18. Rajabi M, Esmaeili M, Rafiei H, Aflatoonia MR, Esmaeili R. Nosocomial Infections and Epidemiology of Antibiotic Resistance in Teaching Hospitals in South East of Iran. Glob J Health Sci 2016;8(2):190-197.
19. Van der Zwet WC, Kaiser AM, van Elburg RM, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005;61:300-11.
20. Soltani R, Khalili H, Abdollahi A, Rasoolinejad M, Dashti-khavidaki S. Nosocomial Gram-positive antimicrobial teaching hospital in Tehran, Iran. Future Microbiol 2012;7(7):903-910.
21. Giacometi A, Cirioni O, Schimizzi AM, et al. Epidemiology and microbiology of surgical wound infections. J Clin Microbiol 2000;38(2):918-22
22. Sader HS, Jones RN, Gales AC, et al. Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: analysis of results from the SENTRY Antimicrobial Surveillance Program (1997). Diagn Microbiol Infect Dis 1998;32(4):289-301.
23. Pfaller MA, Jones RN, Doern GV, Sader HS, Kugler KC, Beach ML. Survey of bloodstream infections attributable to Gram positive cocci: frequency of occurrence and antimicrobial susceptibility of isolates collected in 1997 in the United States, Canada and Latin America from the SENTRY. Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis 1999;33(4):283-97.
24. Soltani R, Ehsanpoor M, Khorvash F, Shokri D. Antimicrobial susceptibility pattern of extended spectrum β lactamase producing bacteria causing nosocomial urinary tract infections in an Iranian referral teaching hospital. J Res Pharm Pract 2014;3(1):6-11.
25. Talebi Taher M, Golestanpour A. Symptomatic nosocomial urinary tract infection in ICU patients: Identification of antimicrobial resistance pattern. Iranian Journal of Clinical Infectious Diseases 2009;4(1);25 29.
26. Saffar MJ, Enayti AA, Abdolla IA, Razai MS, Saffar H. Antibacterial susceptibility of uropathogens in 3 hospitals, Sari, Islamic Republic of Iran, 2002 2003. East Mediterr Health J 2008;14(3):556-63.
27. Gaynes R, Edwards JR, National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram negative bacilli. Clin Infect Dis 2005;41(6):848-54.
28. Bouza E, San Juan R, Muñoz P, et al. A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI 003 study). European Study Group on Nosocomial Infections. Clin Microbiol Infect 2001;7(10):523-31.
29. Tankhiwale SS, Jalgaonkar SV, Ahamad S, Hassani U. Evaluation of extended spectrum beta lactamase in urinary isolates. Indian J Med Res 2004;120(6):553-6.
30. Soltani R, Khalili H, Abdollahi A, Rasoolinejad M, Gholami KH. Antimicrobial Susceptibility Pattern of Staphylococcus aureus Strains Isolated from Hospitalized Patients in Tehran, Iran. Iranian Journal of Pharmaceutical Sciences 2010;6(2):125-132.
31. Diekema DJ, Pfaller MA, Jones RN, et al. Survey of bloodstream infections due to gram-negative bacilli: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY antimicrobial surveillance program, 1997. Clin Infect Dis 1999;29(3):595-607.
32. Schmitz FJ, Lindenlauf E, Hofmann B, et al. The prevalence of low- and high-level mupirocin resistance in staphylococci from 19 European hospitals. J Antimicrob Chemother 1998;42(4):489-95.
33. Sabzghabaee A, Abedi D, Fazeli H, et al. Antimicrobial resistance pattern of bacterial isolates from burn wounds in an Iranian university hospital. J Res Pharm Pract 2012;1(1):30-3.
34. Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. Changing trends in bacteriology of burns in the burns unit, Delhi, India. Burns 2003;29(2):129-32.
35. Ozumba UC, Jiburum BC. Bacteriology of burn wounds in Enugu, Nigeria. Burns 2000;26(2):178-80.
2. Revelas A. Healthcare - associated infections: A public health problem. Niger Med J 2012;53(2):59-64.
3. Gastmeier P, Geffers C, Schwab F, Fitzner J, Oblanden M. Development of surveillance system for nosocomial infections, the component for neonatal intensive care units in Germany. J Hosp Infect 2004;57(2):126-31.
4. Phu VD, Wertheim HF, Larsson M, et al. Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units. PLoS One 2016;11(1):e0147544
5. Fanders SA. Collard HR. Saint S. Nosocomial pneumonia: state of the science. Am J Infect Control 2006;34(2):84-93.
6. Kaoutar B, Joly C, Heriteau FL, Barbut F, et al. Noscoomial infections and hospital mortality: a multicenter epidemiological study. J Hosp Infect 2004;58(4):268-75.
7. Sahu MK, Siddharth B, Choudhury A, et al. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit. Ann Card Anaesth 2016;19(2):281-7.
8. Klevens RM, Edwards JR, Richards CL, et al. Estimation healthcare associated infections and deaths in U.S. hospitals 2002. Public Health Rep 2007;122(2):160-6.
9. Jeong SH, Bae IK, Kwon SB. Investigation of a nosocomial outbreak in ICU. J Hosp Infect 2005:59(3):242-8.
10. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309-32.
11. Clinical and Laboratory Standards Institute. M100: Performance standards for antimicrobial susceptibility testing, 27th edition [pamphlet]. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute; 1998.
12. Mohammadimehr M, Feizabadi MM, Bahadori O, Khosravi M. Study of prevalence of gram-negative bacteria caused nosocomial infections in ICU in Besat hospital in Tehran and detection of their antibiotic resistance pattern-year 2007. Iranian Journal of Medical Microbiology 2009;3(2):47-54.
13. Cook PP1, Catrou PG, Christie JD, Young PD, Polk RE. Reduction in broad spectrum antimicrobial use associalted with no improvementin hospital antibiogram. J Antimicrob Chemother 2004;53(5):853-9.
14. Fish DN, Ohlinger MJ. Antimicrobial resistance: factors and outcomes. Crit Care Clin 2006;22(2):291-311.
15. Yates RR. New intervention strategies for reducing antibiotic resistance. Chest 1999;115(3 Suppl):24S-27S.
16. File TM Jr. Overview of resistance in the 1990s. Chest 1999;115(3 Suppl):3S-8S.
17. Zamani S, Nasiri MJ, Khoshgnab BN, Ashrafi A, Abdollahi A. Evaluation of antimicrobial resistance pattern of nosocomial and community bacterial pathogens at a teaching hospital in Tehran, Iran. Acta Med Iranica 2014;52(3):182-6.
18. Rajabi M, Esmaeili M, Rafiei H, Aflatoonia MR, Esmaeili R. Nosocomial Infections and Epidemiology of Antibiotic Resistance in Teaching Hospitals in South East of Iran. Glob J Health Sci 2016;8(2):190-197.
19. Van der Zwet WC, Kaiser AM, van Elburg RM, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005;61:300-11.
20. Soltani R, Khalili H, Abdollahi A, Rasoolinejad M, Dashti-khavidaki S. Nosocomial Gram-positive antimicrobial teaching hospital in Tehran, Iran. Future Microbiol 2012;7(7):903-910.
21. Giacometi A, Cirioni O, Schimizzi AM, et al. Epidemiology and microbiology of surgical wound infections. J Clin Microbiol 2000;38(2):918-22
22. Sader HS, Jones RN, Gales AC, et al. Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: analysis of results from the SENTRY Antimicrobial Surveillance Program (1997). Diagn Microbiol Infect Dis 1998;32(4):289-301.
23. Pfaller MA, Jones RN, Doern GV, Sader HS, Kugler KC, Beach ML. Survey of bloodstream infections attributable to Gram positive cocci: frequency of occurrence and antimicrobial susceptibility of isolates collected in 1997 in the United States, Canada and Latin America from the SENTRY. Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis 1999;33(4):283-97.
24. Soltani R, Ehsanpoor M, Khorvash F, Shokri D. Antimicrobial susceptibility pattern of extended spectrum β lactamase producing bacteria causing nosocomial urinary tract infections in an Iranian referral teaching hospital. J Res Pharm Pract 2014;3(1):6-11.
25. Talebi Taher M, Golestanpour A. Symptomatic nosocomial urinary tract infection in ICU patients: Identification of antimicrobial resistance pattern. Iranian Journal of Clinical Infectious Diseases 2009;4(1);25 29.
26. Saffar MJ, Enayti AA, Abdolla IA, Razai MS, Saffar H. Antibacterial susceptibility of uropathogens in 3 hospitals, Sari, Islamic Republic of Iran, 2002 2003. East Mediterr Health J 2008;14(3):556-63.
27. Gaynes R, Edwards JR, National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram negative bacilli. Clin Infect Dis 2005;41(6):848-54.
28. Bouza E, San Juan R, Muñoz P, et al. A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI 003 study). European Study Group on Nosocomial Infections. Clin Microbiol Infect 2001;7(10):523-31.
29. Tankhiwale SS, Jalgaonkar SV, Ahamad S, Hassani U. Evaluation of extended spectrum beta lactamase in urinary isolates. Indian J Med Res 2004;120(6):553-6.
30. Soltani R, Khalili H, Abdollahi A, Rasoolinejad M, Gholami KH. Antimicrobial Susceptibility Pattern of Staphylococcus aureus Strains Isolated from Hospitalized Patients in Tehran, Iran. Iranian Journal of Pharmaceutical Sciences 2010;6(2):125-132.
31. Diekema DJ, Pfaller MA, Jones RN, et al. Survey of bloodstream infections due to gram-negative bacilli: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY antimicrobial surveillance program, 1997. Clin Infect Dis 1999;29(3):595-607.
32. Schmitz FJ, Lindenlauf E, Hofmann B, et al. The prevalence of low- and high-level mupirocin resistance in staphylococci from 19 European hospitals. J Antimicrob Chemother 1998;42(4):489-95.
33. Sabzghabaee A, Abedi D, Fazeli H, et al. Antimicrobial resistance pattern of bacterial isolates from burn wounds in an Iranian university hospital. J Res Pharm Pract 2012;1(1):30-3.
34. Singh NP, Goyal R, Manchanda V, Das S, Kaur I, Talwar V. Changing trends in bacteriology of burns in the burns unit, Delhi, India. Burns 2003;29(2):129-32.
35. Ozumba UC, Jiburum BC. Bacteriology of burn wounds in Enugu, Nigeria. Burns 2000;26(2):178-80.
| Files | ||
| Issue | Vol 8, No 1 (Winter 2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v8i1.2744 | |
| Keywords | ||
| Nosocomial Infections Urinary Tract Infections Pneumonia Bloodstream Infections Wound infections; Microbial Drug Resistance | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Soltani R, Khorvash F, Pazandeh F. Antimicrobial Resistance Pattern of Nosocomial Infections at a Referral Teaching Hospital. J Pharm Care. 2020;8(1):26-34.
