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519Indian Journal of Clinical Practice, Vol. 22, No. 10, March 2012

Prevalence and Antibiotic Sensitivity Pattern ofBacteria Isolated from Nosocomial Infections in a

Surgical WardRAMA SIKKA*, JK MANN**, DEEP†, MG VASHIST‡, UMA CHAUDHARY¶, ANTRIKSH DEEP§

N

osocomial infections or healthcare-associatedinfections encompass all clinically evident

infections that do not originate from patient’soriginal admiing diagnosis.1 The incidence ofnosocomial infections is about 5-10% in most developednations while in India, one in four patients admiedinto hospital acquire nosocomial infection.2 Commonnosocomial infections in surgical patients includesurgical site infections (SSIs), urinary tract infections(UTIs), pneumonias and blood stream infections(BSIs). In 1986, NNIS report, the overall incidence ofnosocomial infections was 33.5 per 1,000 discharges,the range extended from 13.3 per 1,000 dischargesto 46.7 per 1,000 discharges in surgical patients.

*Professor**Resident†Senior Resident, Dept. of Microbiology‡Senior Professor, Dept. of Surgery¶Senior Professor and Head§Associate ProfessorDept. of MicrobiologyPt. BD Sharma PGIMS, Rohtak, HaryanaAddress for correspondenceDr Rama SikkaProfessor, Dept. of MicrobiologyPt. BD Sharma PGIMS, Rohtak, HaryanaE-mail: [email protected]

ABSTRACT

Background and Aims: Nosocomial infections among surgical patients are common and many are preventable. It is criticalto understand microbiology of these infections in order to create appropriate strategies to reduce this risk. This studywas planned to delineate the occurrence, microbiology and sensitivity paern of such infections among surgical patients.Subject and Methods: Various from 130 patients admied to the surgery ward were cultured, identied and antibiotic sensitivitywas performed by standard methods. Results: From 130 patients, 146 isolates were recovered. Of these 140 (95.9%) were

bacterial and six (4.1%) were of Candida spp. Most frequently observed nosocomial infections were SSIs (55.4%) followed byinfections of urinary tract (28.4%), respiratory tract infections (10.8%) and bacteremia was observed in only 5.4% patients. Thepredominant pathogen isolated from polymicrobial episodes were E. coli , S. aureus , K. pneumoniae , A. baumanii and P. aeruginosa.Resistance to b-lactams was high and carbapenems were found to be most eective drugs against GNBs. Conclusions: Gram-negative organisms are the predominant pathogens causing infections in surgical patients. The increasing trend of resistanceto b-lactams is posing a great problem. So for proper management of critically ill patients and patients undergoing variousoperative procedures and other medical interventions, hospital antibiotic policies need frequent revisions.

Keywords: Nosocomial infections, surgical site infections, antimicrobial resistance

The higher incidence of infections among surgicalpatients was largely aributable to SSIs.3 SSIs account

for approximately a quarter of all nosocomial infections.These infections can range from supercial woundinfections, which have minimal mortality rates but add

a considerable cost to patient care, to necrotizing sotissue infections, which are associated with prolonged

hospitalization, signicant healthcare expense and ahigh mortality rate.4 The incidence of infection varies

from surgeon-to-surgeon, from hospital-to-hospital,from one surgical procedure to another, and most

importantly from one patient to another. In cleansurgical procedures, in which the gastrointestinal,gynecologic and respiratory tracts have not been

entered, Staphylococcus aureus from the exogenousenvironment or the patient’s skin ora is the usual cause

of infection. In other categories of surgical procedures,including clean contaminated, contaminated and dirty,

the polymicrobial aerobic and anaerobic ora closelyresembling the normal endogenous microora of

the surgically resected organ are the most frequentlyisolated pathogens.5 Emmerson et al in 1996 reported

that surgical wound infections accounted for 12.3%of all hospital acquired infections.6 Basa et al in their

study observed that department of surgery had the

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Table 1. Site-wise Distribution of Various Isolates in

Nosocomial Infections among Surgical Patients

Type of isolate Site

Surgical Urine Respiratory

tract

Blood

E. coli 47 22 2 1

K. pneumoniae 8 4 4 1

Enterobacter spp. 5 4 3 -

P. aeruginosa 5 2 - 1

Citrobacter spp. 3 5 2 1

A. baumanii 4 1 3 1

P. vulgaris 2 - - -

S. aureus 7 - - 2

Candida spp. - 6 - -

Total 81 44 14 7

Table 2. Resistance Pattern of Gram-negative Bacteria other than P. aeruginosa from Surgical Patients (%age)

Bacterial isolates Am G Ak Cf Gf Ac Cp Ca Cps Ce Cpm Pt Ao Nt Mr

E. coli (72) 98.6 95.8 58.3 93.1 88.8 84.7 98.6 91.6 80.5 94.4 91.6 66.6 98.6 93.1 4.2

K. pneumoniae (17) 100 94.1 76.4 88.2 94.1 88.2 100 100 94.1 94.1 82.3 76.4 100 94.1 0

Enterobacter spp. (12) 100 100 91.6 100 91.6 83.3 100 100 83.3 100 83.3 75 100 91.6 25

Citrobacter spp. (11) 100 81.8 72.7 81.8 72.7 81.8 100 72.7 72.7 100 90.9 90.9 90.9 81.8 18.2

Acinetobacter spp. (9) 100 100 100 100 100 100 100 88.8 77.7 100 100 77.7 100 88.8 22.2

P. vulgaris (2) 100 100 50 50 100 0 100 100 100 100 100 100 100 100 0

Table 3. Resistance Pattern of P. aeruginosa Isolates obtained from Various Clinical Specimens

Antibiotics Pus (n = 5) Urine (n = 2) Blood (n = 1) Total (n = 8)

(n) (%) (n) (%) (n) (%) (n) (%)

Ceftazidime 5 100 2 100 0 0 7 87.5

Cefepime 5 100 1 50 1 100 7 87.5

Ceftriaxone 5 100 1 50 1 100 7 87.5

Ceftizoxime 5 100 0 0 1 100 6 75

Gentamicin 5 100 2 100 1 100 8 100

Amikacin 5 100 0 0 1 100 6 75

Netilmicin 5 100 1 50 1 100 7 87.5

Aztreonam 5 100 2 100 1 100 8 100

Imipenem 0 0 0 0 0 0 0 0

Piperacillin/Tazobactam 3 60 1 50 0 0 4 50

Ooxacin 5 100 1 50 1 100 7 87.5

the most common isolate was E. coli (50%) and Candidawas the second most common isolate. K. pneumoniae(9.9%) was the most commonly isolated organism fromsputum sample (Table 1). The predominant pathogenisolated from polymicrobial episodes were E. coli ,S. aureus , K. pneumoniae , A. baumanii and P. aeruginosa ,Enterobacter spp., Citrobacter spp. and P. vulgaris wereobserved only in single episode each.

Antimicrobial Susceptibility Pattern

On performing antimicrobial susceptibility testingof GNBs other than P. aeruginosa showed highfrequency of resistance to b-lactams, quinolones aswell as b-lactam- b-lactamase inhibitor was observed.Resistance to aztreonam was also found to be very high(90-100%). However, least resistance was observed tocarbapenems with maximum resistance being observed

in 25% isolates of Enterobacter spp. (Table 2).

About 85-100% urinary isolates were also resistantto noroxacin but resistance against nitrofurantoinwas relatively low (35-75%). Isolates of P. aeruginosashowed high level of resistance to cephalosporins

and aztreonam. Although, no isolate from urinesample was resistant to amikacin but they were resistantto gentamicin. Imipenem was the most eectivedrug as no isolate was resistant to it (Table 3).

Am: Amoxycillin; G: Gentamicin; Ak: Amikacin; Cf:Ciprooxacin; Gf: Gatioxacin; Ac: Amoxycillin/clavulanic acid; Cp: Cephalexin; Ca: Ceftazidime;

Cps: Cefoperazone/Sulbactam; Ce: Cefotaxime; Cpm: Cepime Pt: Piperacillin/Tazobactam; Ao: Aztreonam; Nt: Netilmicin; Mr: Meropenem.

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resistance to multiple antibiotics continues to worsenas demonstrated by various studies including thepresent study. However, the current situation is theresult of ineective infection control measures andantibiotic policies. So for proper management of

critically ill patients and patients undergoing variousoperative procedures and other medical interventions,hospital antibiotic policies need frequent revisions.Hospital wide antibiograms may mask unit-specicsusceptibility paern. These unit-specic antibiogramsmay help surgeon in selection of empirical therapy insurgical patients.

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