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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2020

01-12-2020 | Escherichia Coli | Research article

High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

Authors: Aiman El-Saed, Hanan H. Balkhy, Majid M. Alshamrani, Sameera Aljohani, Asim Alsaedi, Wafa Al Nasser, Ayman El Gammal, Saad A. Almohrij, Ziyad Alyousef, Sara Almunif, Mohammad Alzahrani

Published in: BMC Infectious Diseases | Issue 1/2020

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Abstract

Background

Despite being largely preventable, surgical site infections (SSIs) are still one of the most frequent healthcare-associated infections. The presence of resistant pathogens can further augment their clinical and economic impacts. The objective was to estimate the distribution and resistance in SSI pathogens in Saudi Arabia and to compare them to the US National Healthcare Safety Network (NHSN) hospitals.

Methods

Targeted SSI surveillance was prospectively conducted on several surgical procedures done between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of SSI and bacterial resistance were based on NHSN.

Results

A total 492 pathogens causing 403 SSI events were included. The most frequent pathogens were Staphylococcus aureus (22.8%), Pseudomonas aeruginosa (20.1%), Klebsiella spp. (12.2%), and Escherichia coli (12.2%), with marked variability between surgeries. Approximately 30.3% of Staphylococcus aureus was methicillin-resistant (MRSA), 13.0% of Enterococcus spp. was vancomycin-resistant (VRE), and 5.5% of Enterobacteriaceae were carbapenem resistant (CRE). The highest multidrug-resistant (MDR) GNPs were Acinetobacter spp. (58.3%), Klebsiella spp. (20.4%) and Escherichia coli (16.3%). MRSA was significantly less frequent while cephalosporin-resistant Klebsiella spp., MDR Klebsiella spp., and MDR Escherichia coli were significantly more frequent in our hospitals compared with NHSN hospitals.

Conclusion

GNPs in a tertiary care setting in Saudi Arabia are responsible for more than 60% of SSI with more resistant patterns than Western countries. This information may be critical to secure resources and ensure support for caregivers and healthcare leaders in implementing antimicrobial stewardship programs and evidence-based SSI preventive practices.
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Literature
1.
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–41.CrossRef
2.
Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96(1):1–15.CrossRef
3.
Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101–14.CrossRef
4.
Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011;89(10):757–65.CrossRef
5.
6.
Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM, Gans S, Wallert ED, Wu X, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288–303.CrossRef
7.
Campbell RS, Emons MF, Mardekian J, Girgenti D, Gaffney M, Yu H. Adverse clinical outcomes and resource utilization associated with methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections after elective surgery. Surg Infect. 2015;16(5):543–52.CrossRef
8.
Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, Kallen A, Limbago B, Fridkin S. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34(1):1–14.CrossRef
9.
Weiner LM, Webb AK, Limbago B, Dudeck MA, Patel J, Kallen AJ, Edwards JR, Sievert DM. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol. 2016;37(11):1288–301.CrossRef
10.
Khairy GA, Kambal AM, Al-Dohayan AA, Al-Shehri MY, Zubaidi AM, Al-Naami MY, AlSaif FA, Al-Obaid OA, Al-Saif AA, El-Farouk OY, et al. Surgical site infection in a teaching hospital: a prospective study. J Taibah Univ Med Sci. 2011;6(2):114–20.
11.
Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Maghrabi A, Altaf A, Aljiffry M. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62(2):111–7.CrossRef
12.
Al-Mulhim FA, Baragbah MA, Sadat-Ali M, Alomran AS, Azam MQ. Prevalence of surgical site infection in orthopedic surgery: a 5-year analysis. Int Surg. 2014;99(3):264–8.CrossRef
13.
El-Kholy AA, Elanany MG, Sherif MM, Gad MA. High prevalence of VIM, KPC, and NDM expression among surgical site infection pathogens in patients having emergency surgery. Surg Infect. 2018;19(6):629–33.CrossRef
14.
Davoudi A, Najafi N, Alian S, Tayebi A, Ahangarkani F, Rouhi S, Heydari A. Resistance pattern of antibiotics in patient underwent open heart surgery with nosocomial infection in north of Iran. Glob J Health Sci. 2015;8(2):288–97.CrossRef
15.
Rosenthal VD, Richtmann R, Singh S, Apisarnthanarak A, Kübler A, Viet-Hung N, Ramírez-Wong FM, Portillo-Gallo JH, Toscani J, Gikas A, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005–2010. Infect Control Hosp Epidemiol. 2013;34(6):597–604.CrossRef
16.
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.CrossRef
17.
18.
19.
20.
21.
Irek EO, Amupitan AA, Obadare TO, Aboderin AO. A systematic review of healthcare-associated infections in Africa: an antimicrobial resistance perspective. Afr J Lab Med. 2018;7(2):796.CrossRef
22.
El-Saed A, Noushad S, Tannous E, Abdirizak F, Arabi Y, Al Azzam S, Albanyan E, Al Jahdalil H, Al Sudairy R, Balkhy HH. Quantifying the Hawthorne effect using overt and covert observation of hand hygiene at a tertiary care hospital in Saudi Arabia. Am J Infect Control. 2018;46(8):930–5.CrossRef
23.
McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999;12(1):147–79.CrossRef
24.
Zhang Z, Chen M, Yu Y, Pan S, Liu Y. Antimicrobial susceptibility among gram-positive and gram-negative blood-borne pathogens collected between 2012-2016 as part of the Tigecycline evaluation and surveillance trial. Antimicrob Resist Infect Control. 2018;7:152.CrossRef
25.
Chiang CH, Pan SC, Yang TS, Matsuda K, Kim HB, Choi YH, Hori S, Wang JT, Sheng WH, Chen YC, et al. Healthcare-associated infections in intensive care units in Taiwan, South Korea, and Japan: recent trends based on national surveillance reports. Antimicrob Resist Infect Control. 2018;7:129.CrossRef
26.
Nazeer A, Al-Tawfiq JA. Methicillin-resistant Staphylococcus aureus metrics for patients in Saudi Arabia. J Infect Dev Ctries. 2012;6(3):223–33.CrossRef
27.
Yezli S, Shibl AM, Livermore DM, Memish ZA. Antimicrobial resistance among gram-positive pathogens in Saudi Arabia. J Chemother. 2012;24(3):125–36.CrossRef
28.
Abdallah M, Al-Saafin M. Overview of prevalence, characteristics, risk factors, resistance, and virulence of vancomycin-resistant Enterococci in Saudi Arabia. Microb Drug Resist. 2019;25(3):350–358.
29.
Bhardwaj N, Khurana S, Kumari M, Malhotra R, Mathur P. Pattern of antimicrobial resistance of gram-negative bacilli in surgical site infections in in-patients and out-patients at an apex trauma center: 2013–2016. J Lab Physicians. 2018;10(4):432–6.CrossRef
30.
Zaman TU, Alrodayyan M, Albladi M, Aldrees M, Siddique MI, Aljohani S, Balkhy HH. Clonal diversity and genetic profiling of antibiotic resistance among multidrug/carbapenem-resistant Klebsiella pneumoniae isolates from a tertiary care hospital in Saudi Arabia. BMC Infect Dis. 2018;18(1):205.CrossRef
31.
Balkhy HH, El-Saed A, Al Johani SM, Francis C, Al-Qahtani AA, Al-Ahdal MN, Altayeb HT, Arabi Y, Alothman A, Sallah M. The epidemiology of the first described carbapenem-resistant Klebsiella pneumoniae outbreak in a tertiary care hospital in Saudi Arabia: how far do we go? Eur J Clin Microbiol Infect Dis. 2012;31(8):1901–9.CrossRef
32.
Uz Zaman T, Albladi M, Siddique MI, Aljohani SM, Balkhy HH. Insertion element mediated mgrB disruption and presence of ISKpn28 in colistin-resistant Klebsiella pneumoniae isolates from Saudi Arabia. Infect Drug Resist. 2018;11:1183–7.CrossRef
33.
Zowawi HM, Sartor AL, Sidjabat HE, Balkhy HH, Walsh TR, Al Johani SM, AlJindan RY, Alfaresi M, Ibrahim E, Al-Jardani A, et al. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolates in the Gulf Cooperation Council States: dominance of OXA-23-type producers. J Clin Microbiol. 2015;53(3):896–903.CrossRef
34.
Alghoribi MF, Gibreel TM, Farnham G, Al Johani SM, Balkhy HH, Upton M. Antibiotic-resistant ST38, ST131 and ST405 strains are the leading uropathogenic Escherichia coli clones in Riyadh, Saudi Arabia. J Antimicrob Chemother. 2015;70(10):2757–62.CrossRef
Metadata
Title
High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi Arabia, 2007–2016
Authors
Aiman El-Saed
Hanan H. Balkhy
Majid M. Alshamrani
Sameera Aljohani
Asim Alsaedi
Wafa Al Nasser
Ayman El Gammal
Saad A. Almohrij
Ziyad Alyousef
Sara Almunif
Mohammad Alzahrani
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2020
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-020-4939-6

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