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Received: 25 May 2020 / / Accepted: 03 June 2020 / Published online: 30 June 2020
DOI 10.34689/SH.2020.22.3.013 UDC 616-053.2+612.17
ANTIBIOTIC RESISTANCE SURVEILLANCE IN A PEDIATRIC CARDIAC SURGERY
Nelya M. Bissenova 1, http://orcid.org/0000-0001-8722-0398 Aigerim S. Yergaliyeva 1, http://orcid.org/0000-0003-2111-9888
1JSC National Scientific Medical Research Center, Laboratory of Microbiology, Nur-Sultan, Republic of Kazakhstan
Background. The aim of this study was to identify etiological organisms and antibiotic resistance rates of bacterial infection in Department of pediatric cardiac surgery.
Methods. Our database consisted of 2816 consecutive samples from pediatric patients who underwent cardiac surgery between January 2011 and December 2019 at a single center. Identification of isolates and antibiotic susceptibility testing were performed by Vitek-2 automated system.
Results: The most frequently isolated microorganisms in our Department of pediatric cardiac surgery were as follows: Psedomonas aeruginosa 19.7%, Klebsiella pneumoniae 16%, Staphylococcus aureus 13.2%, and Acinetobacter baumannii 8.8%. During study period there is tendency increasing the percentage of detection Ps.aeruginosa from 16.1% to 30.2% (p=0.048) and K.pneumoniae from 7.5% to 19.3% (p=0.014). There are tendency of increasing resistance to 3rd generation cephalosporins, carbapenems and quinolones.
Conclusion. Based on our results, we report that respiratory tract infection was found to be the most common site for bacterial infection and P.aeruginosa and K. pneumoniae were the most frequent pathogens with high level of resistance. Our findings are posing necessitates for improvement preventive measures, including microbiological monitoring, good hygiene, and well-designed hospital infection control strategy.
Key words: bacterial infection, antibiotic resistance, microbiologic monitoring.
Резюме
ИССЛЕДОВАНИЕ РЕЗИСТЕНТНОСТИ К АНТИБИОТИКАМ В ОТДЕЛЕНИИ ДЕТСКОЙ КАРДИОХИРУРГИИ
Неля М. Бисенова 1, http://orcid.org/0000-0001-8722-0398
Айгерим С. Ергалиева 1, http://orcid.org/0000-0003-2111-9888
1 АО «Национальный научный медицинский центр», Микробиологическая лаборатория, г Нур-Султан, Республика Казахстан.
Целью настоящего исследования явилось определение бактериальной структуры и уровня антибиотикорезистентности основных возбудителей инфекционных осложнений после проведенных операций на сердце и крупных сосудах в отделении детской кардиохирургии.
Методы: Проведено проспективное микробиологическое исследование 2816 клинических образцов (культуры крови, раневое отделяемое, респираторный тракт, центральный венозный катетер, катетер из трахеобронхиального дерева и др.), полученные от пациентов отделения детской кардиохирургии в период с 2010 по 2019 годы. Идентификацию выделенных изолятов и их антибиотикочувствительность проводили на микробиологическом автоматическом анализаторе Vitek 2 - Compact.
Результаты: За исследуемый период часто встречающимися патогенами были: Pseudomonas aeruginosa -19,7%, Klebsiella pneumoniae - 16%, Staphylococcus aureus - 13,2%, Acinetobacter baumannii- 8,8% от общего количества выделенных микроорганизмов. В динамике отмечается увеличение частоты обнаружения Ps.aeruginosa с 16,1% до 30,2% (p=0,048), K.pneumoniae с 7,5% до 19,3% (p=0,014). Данные штаммы показывают тенденцию достоверного увеличения резистентности к цефалоспоринам III-IV поколения, к хинолонам и карбапенемам.
Заключение: Результаты исследования показывают что P.aeruginosa и K. pneumoniae были наиболее частыми возбудителями бактериальных инфекций в отделении детской кардиохирургии, высокий уровень резистентности которых побуждают необходимость улучшения профилактических мер, включая микробиологический мониторинг, хорошо разработанную стратегию борьбы с нозомиальными инфекциями.
Ключевые слова: бактериальные инфекции, резистентность к антибиотикам, микробиологический мониторинг.
Тушндеме
БАЛАЛАР КАРДИОХИРУРГИЯЛЫК Б0Л1М1НДЕГ1 БАКТЕРИЯЛАРДЫН Т¥РАКТЫЛЫГЫ
Неля М. Бисенова 1, http://orcid.org/0000-0001-8722-0398
Айгерим С. Ергалиева 1, http://orcid.org/0000-0003-2111-9888
1АК «¥лттык гылыми медициналык орталык», Микробиология зертханасы, Нур-Султан каласы, Казакстан Республикасы
Осы зерттеудщ максаты балалар кардиохирургиясы бвлiмшесiнде жYрекке ж8не ipi тамырларга ота жYргiзiлгеннен кейiнгi инфекциялык аскынулардыщ Heri3ri козды^ыштарыныч бактериалдык курылымын ж8не антибиотикке твзiмдiлiгiнiи деигейiн аныктау болып табылады.
Эдiстер: 2010 мен 2019 жылдар аралы^ында балалар кардиохирургиясы бвлшшесЫщ пациенттерiнен алынган 2816 клиникалык Yлriлердщ (кан культурасы, жара бвлiндiсi, тыныс жолдары, орталык веноздык катетер, трахеобронхиалды агаштан алынган катетер жэне т.б.) проспективт микробиологиялык зерттеуi жYргiзiлдi. Окшауланган изоляттардыщ аныктау жэне олардыщ антибиотиктерге сезiмталдыFын аныктау Vitek 2 - Compact автоматты микробиологиялык анализаторында жYргiзiлдi.
Нэтижелер: Зерттеу бойынша кезечiндегi жи коздырFыштар аныкталды: окшауланFан микроорганизмдердщ жалпы санынан Pseudomonas aeruginosa - 19,7%, Klebsiella pneumoniae - 16%, Staphylococcus aureus - 13,2%, Acinetobacter baumannii - 8,8% курады. Динамикада Ps.aeruginosa Yшiн 16,1% -дан 30,2% ^а дейЫ (p = 0.048), K.pneumoniae Yшiн 7,5% -дан 19,3% -ке дейЫ (p = 0.014) аныктау житИнщ жоFарылауы белгiленедi. Бул штаммдар III-IV буынды цефалоспориндерге, хинолондар мен карбапенемдерге карсы твзiмдiлiгiнiи ед8уiр артуы тенденциясын кврсетедi.
Корытынды: балалар кардиохирургиясы бвлiмшесiнде Ps.aeruginosa ж8не K.pneumoniae штамдарыныщ аныкталу жиiлiгi мен олардыщ твзiмдiлiпнщ артуы медициналык персоналдыщ тиiстi гигиенасын, микробиологиялык мониторинг пен ауруханаiшiлiк бакылауды косатын жаксы курастырылFан инфекциялык бакылау стратегиясын жасау кажет етедi де, бул нозокомиялдык инфекцияларFа шалдыFу каупЫ азайтуFа мYмкiндiк бередi.
TYÜiHdi свздер: бактериалдык инфекциялар, бактериялардыц турактылыт, микробиологиялык мониторинг.
Bibliographic citation:
Бисенова Н.М., Ергалиева А.С. Исследование резистентности к антибиотикам в отделении детской кардиохирургии // Наука и Здравоохранение. 2020. 3(Т.22). С. 105-110. doi 10.34689/SH.2020.22.3.013
Bissenova N.M., Yergaliyeva A.S. Antibiotic resistance surveillance in a pediatric cardiac surgery // Nauka i Zdravookhranenie [Science & Healthcare]. 2020, (Vol.22) 3, pp. 105-110. doi 10.34689/SH.2020.22.3.013
Бисенова Н.М., Ергалиева А.С. Балалар кардиохирургиялык бвлiмiндегi бактериялардыщ турактылы^ы // Гылым ж8не Денсаулык сактау. 2020. 3 (Т.22). Б. 105-110. doi 10.34689/SH.2020.22.3.013
Introduction
Patients with pediatric cardiac surgery operations (congenital heart defects and heart diseases a child gets after birth) are at high risk of bacterial infections [1-2]. There are a number of factors contribute to this risk, including younger age of patients (especially neonates and infants), higher complexity of surgery and limited choice of treatment. Therefore, bacterial infection are the cause of frequent complication in these patients and responsible for ICU admissions [3]. Nevertheless, of the improvements and recent advances in treatments in critical care, mortality remains high, particularly caused by health care associated infections [4-5].
As is known, the rate of bacterial infections related to multidrug resistance bacteria in pediatric cardiac surgery patients is widespread globally and are the basic cause of morbidity and mortality. Moreover, treatment options are limited for choice of antibiotic for virulent nosocomial strains in these departments [6-7]. Reserve antibiotics, such as carbapenems are antibiotics of choice for infections caused
ESBL-producing Klebsiella pneumonia and E.coli, but not appropriate for infections caused Stenotrophomonas maltophilia, Burkholderia cepacia, or Acinetobacter baumannii, Pseudomonas aeruginosa, for which resistance rates to carbapenems increasing constantly [8-10].
With this background in mind, we decided to study etiological organisms and antibiotic resistance rates of bacterial infection in our Department of pediatric cardiac surgery.
Materials and Methods
Study design
This was a prospective study of microbial landscape and antibiotic resistance rates of strains conducted in the Department of pediatric cardiac surgery of tertiary hospital in Central Kazakhstan during the study period 2010-2019.
Data collection
Data were collected from newborns and children of the first three years hospitalized in Department of pediatric cardiac surgery undergoing cardiac surgery (surgery on the heart and major blood vessels). All patients were monitored
for bacterial infection at body sites for a period at least one month. Strains analyzed by infection site and pathogen type.
Bloodstream strains were collected from patient with either two or more positive blood cultures. Respiratory tract specimens included nasopharyngeal swabs and sputum. Other types of specimens obtained from the patients were: swabs from cardiac surgical wounds, bronchoalveolar lavage, central venous catheter (CVC), aspiration catheter, tracheostomy, pleural cavity, peritoneal fluid. All specimens were collected at the bed site, transported to the Laboratory of Microbiology and were inoculated on proper culture media within two hours according to the guidelines.
Samples cultivation
Clinical specimens were inoculated onto 5% sheep blood agar, Mannitol salt agar, Endo agar, Sabouraund dextrose agar (Himedia, India). Plates were incubated at 37°C for 18-24 hours.
Identification of isolates
Methods used for confirmation of identification included test of colonial morphology, haemolytic activity on appropriate agar media, Gram strain, rapid tests (coagulase, oxidase, catalase, indole) and use of automated identification system Vitek 2 - Compact (bioMerieux, Marcy I'Etoile, France).
Antibiotic susceptibility testing
Isolates reported from
The percentages of most frequently isolated microorganisms in our Department of pediatric cardiac surgery were as follows: Ps.aeruginosa 19.7% (554), K.pneumoniae 16% (451), Staphylococcus aureus 13,2% (372) and A.baumannii 8.8% (248). During study period, the rate of positive hemocultures was increased from 1.5% to 22.3% in the mean of 18.8%. The most frequent pathogens from blood samples were K.pneumoniae (19.2%) and Burkholderia cepacia (16.7%).
For antimicrobial susceptibility testing, we used the following antibiotics: amoxicillin/clavulanic acid, ceftazidime, ceftriaxone, cefepime, meropenem, imipenem, amikacin, gentamicin, ciprofloxacin, levofloxacin. Susceptibility tests were performed with broth microdilution method (Vitek 2 -Compact (bioMerieux, Marcy I'Etoile, France) according to the manufacturer's guideline recommendations. Colonies from 18-24 hours culture were used to inoculate the microdilution cards.
All data analyzed by using Microsoft Access and Excel. Trends over time of antibiotic resistance rates determined by linear regression with the yearly data. A p value of < 0.05 considered statistically significant.
Results
During study period (from January 2010 to December 2019) 2816 isolates from 7712 clinical samples (bloodstream, wound samples, respiratory tract, tracheobronchial tree, and central venous catheter) were included to the study. Respiratory tract were most frequent isolates 54.3% (1530), followed by tracheobronchial tree 25.6% (721), wound samples 8.5% (240), bloodstream infections (BSI) 5.7% (161) and CVC 3.9% (112). The causative organisms for bacterial infection in our patients, is as shown in (Table 1). The percentage of Gram-negative bacilli 53.1% (1498), Gram-positive cocci was 33.5% (944), and fungi 9% (253).
Table 1.
In tracheobronchial tree site Ps.aeruginosa (24.4%), was the most commonly pathogen, which was followed by K.pneumoniae (14.8%). Wound and CVC infections mostly caused by coagulase-negative staphylococci (36.6% and 35.7% respectively); more than 19% S.aureus isolates reported from respiratory tract.
During study period there is tendency increasing the percentage of detection Ps.aeruginosa from 16.1% to 30.2% (p=0.048), K.pneumoniae from 7.5% to 19.3%
jediatnc cardiac intensive care unit according to the site of infection.
Microorganism Bloodstream Tracheo bronchial aspirte Respiratory tract Surgical site Central venous catheter Urinary tract Others1 Total
n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)
Staphylococcus aureus 6 (3.7) 32 (4.4) 300(19.6) 25 (10.4) 6 (5.3) 0 3(13.6) 372 (13.2)
CN2-staphylococci 25 (15.5) 100 (14.4) 0 88 (36.6) 40(35.7) 2(2.6) 0 259 (9.2)
Enterococcus faecalis 2 (1.2) 30 (4.1) 61 (3.9) 24 (10) 8(7.1) 7 (23.3) 6 (27.2) 138 (4.9)
Escherichia coli 1 (0.6) 28 (3.8) 129 (8.4) 11 (4.5) 0 4 (13.3) 2 (9) 175 (6.2)
Enterobacter cloacae 5(3.1) 18 (2.4) 64 (3.5) 8 (3.3) 7 (6.25) 0 0 92 (3.3)
Klebsiella pneumoniae 31(19.2) 107 (14.8) 275(17.9) 12 (5) 16 (14.2) 5 (16.6) 5 (22.7) 451 (16)
Pseudomonas aeruginosa 16 (9.9) 176 (24.4) 321(20.9) 27 (11.2) 11 (9.8) 1 (3.3) 2 (9) 554 (19.7)
Acinetobacter baumannii 12 (7.4) 91 (12.6) 123 (8) 17 (7) 4 (3.5) 1 (3.3) 0 248 (8.8)
Stenotrophomonas maltophilia 8 (4.9) 55 (7.6) 31 (2) 4(1.6) 3 (2.6) 0 2 (9) 103 (3.7)
Burkholderia cepacia 27 (16.7) 13 (1.8) 3 (0.9) 3(1.2) 4 (3.5) 0 0 50 (1.8)
Candida albicans 25 (15.5) 49 (6.7) 153 (10) 8 (3.3) 8(7.1) 8 (26.6) 2 (9) 253 (9)
Other 3 (1.8) 18 (2.4) 80 (5.2) 13 (5.4) 5 (4.4) 2 (6.6) 0 121 (4.3)
Total 161 721 1530 240 112 30 22 2816
1 Aspiration catheter, tracheostomy, pleural cavity, peritoneal fluid
2 Coagulase-negative
(p=0.014), A.baumannii from 3.2% to 13.6% (p=0.059). At the same time, there is decreasing percentage of Enterococcus faecalis from 8.6% to 1.9% (p=0.007) and Candida albicans from 10.7% to 6.6% (p=0.002).
Gram-negative bacilli are frequently associated with bacterial infections in pediatric cardiac surgery patients. Ps.aeruginosa showed high proportion and increasing of
resistance against to cephalosporins (ceftazidime from 26.6% to 76.7% p=0.001, cefepime from 13.3% to 81.1% p=0.001), to aminoglycosides (gentamicin from 6.6% to 63.5% p<0.001, amikacin from 0% to 64.1% p=0.002) and to carbapenems (meropenem from 0% to 67.9% p<0.0001) (Table 2). Not found resistance to colistin.
Antibiotic resistance of surgery.
Table 2.
Pseudomonas aeruginosa isolated from infections in Department of pediatric cardiac
Antibiotic 2010 n=15 2011 n=21 2012 n=8 3 2 O II 2n 2014 n=78 2015 n=89 2016 n=69 2017 n=38 2018 n=65 2019 n=159 P-value*
Ceftazidime 4 (26.6) 6 (28.5) 1 (12.5) 1 (8.3) 31 (39.7) 63 (70.7) 46 (66.6) 23 (60.5) 55 (84.6) 122 (76.7) 0.001
Cefepime 2 (13.3) 10 (47.6) 2 (25) 3 (25) 22 (28.2) 49 (55) 50 (72.4) 21 (55.2) 57 (87.6) 129 (81.1) 0.001
Meropenem 0 0 1 (12.5) 3 (25) 29 (31.1) 50 (56.1) 52 (75.3) 26 (68.4) 58 (89.2) 108 (67.9) 0.000
Imipenem 1 (6.6) 1 (4.7) 2 (25) 4 (33.3) 32 (41) 53 (59.5) 53 (76.8) 27 (71) 58 (89.2) 106 (66.6) 0.000
Amikacin 0 6 (28.5) 1 (12.5) 1 (8.3) 14 (17.9) 56 (62.9) 57 (82.6) 23 (60.5) 56 (86.1) 102 (64.1) 0.002
Gentamicin 1 (6.6) 6 (28.5) 1 (12.5) 1 (8.3) 19 (24.3) 47 (52.8) 47 (68.1) 25 (65.7) 57 (87.6) 101 (63.5) 0.000
Ciprofloxacin 3 (20) 1 (4.7) 1 (12.5) 1 (8.3) 8 (10.2) 15 (16.8) 43 (62.3) 22 (57.8) 56 (86.1) 104 (65.4) 0.002
Levofloxacin 3 (20) 2 (9.5) 0 1 (8.3) 22 (28.2) 14 (15.7) 43 (62.3) 24 (63.1) 53 (81.5) 103 (64.7) 0.001
' Linear regression
K.pneumoniae isolates showed tendency of increasing resistance to 3rd generation cephalosporins (ceftriaxone from 35.7% to 79.4% (p=0.011) to cefepime from 28.5% to
78.4% (p=0.0001) and aminoglycosides (amikacin from 7.1% to 14.7% (p=0.0001) and gentamicin from 7.1% to 65.6% (p=0.002) (Table 3).
Table 3.
Antibiotic resistance of Klebsiella pneumoniae isolated from infections in Department of pediatric cardiac surgery.
Antibiotic 2011 n=14 2012 n=12 2013 n=21 2014 n=61 2015 n=88 2016 n=63 2017 n=39 2018 n=44 2019 n=102 P-value*
Amoxicillin/ clavulanic acid 7 (50) 5 (41.6) 9 (42.8) 39 (63.9) 52 (59) 53 (84.1) 35 (89.7) 37 (84) 88 (86.2) 0.001
Ceftazidime 5 (35.7) 4 (33.3) 10 (47.6) 37 (60.6) 63 (71.5) 39 (61.9) œ 3 J) 1x0 30 (68.1) 78 (76.4) 0.000
Ceftriaxone 5 (35.7) 5 (41.6) 12 (57.1) 44 (72.1) 66 (75) 54 (85.7) 8 3 J) xo 29 (65.9) 81 (79.4) 0.011
Cefepime 4 (28.5) 4 (33.3) 11 (52.3) 36 (59) 65 (73.8) 44 (69.8) 31 (79.4) 29 (65.9) 80 (78.4) 0.000
Meropenem 0 0 0 1 (1.6) 2 (2.2) 0 1 (2.5) 1 (2.2) 0 0.172
Amikacin 1 (7.1) 1 (8.3) 2 (9.5) 4 (6.5) 8 (9) 7 (11.1) 5 (12.8) 6 (13.6) 15 (14.7) 0.000
Gentamicin 1 (7.1) 1 (8.3) 11 (52.3) 18 (29.5) 38 (43.1) 29 (46) 23 (58.9) 27 (61.3) 67 (65.6) 0.002
Ciprofloxacin 2 (14.2) 2 (16.6) 7 (33.3) 18 (29.5) 18 (20.4) 16 (25.3) 11 (28.2) 11 (25) 30 (29.4) 0.364
Levofloxacin 2 (14.2) 2 (16.6) 6 (28.5) 19 (31.1) 16 (18.1) 14 (22.2) 9 (23) 9 (20.4) 20 (19.6) 0.734
' Linear regression
Antibiotic resistance patterns of A.baumannii isolates are shown in Table 4; statistically significant increasing resistance was to all tested antibiotics with the higher
resistance to carbapenems, more than 63% quinolones, 66%. Not found resistance to colistin.
and
Table 4.
Antibiotic resistance of Acinetobacter bumannii isolated from infections in Department of pediatric cardiac surgery.
Antibiotic 2011 2014 2015 2016 2017 2018 2019 p-
n=13 n=39 n=89 n=69 n=38 n=65 n=159 value*
Meropenem 0 11 (28.2) 7 (33.3) 9 (34.6) 15 (39.4) 11 (42.3) 45 (62.5) 0.003
Imipenem 0 10 (25.6) 9 (42.8) 10 (38.4) 16 (42.1) 11 (42.3) 46 (63.8) 0.008
Amikacin 0 11 (28.2) 7 (33.3) 9 (34.6) 14 (36.8) 10 (38.4) 34 (47.2) 0.014
Gentamicin 0 4 (10.2) 3 (14.2) 8 (30.7) 14 (36.8) 9 (34.6) 30 (41.6) 0.000
Tobramycin 0 0 0 2 (7.6) 4 (10.5) 5 (19.2) 22 (30.5) 0.009
Ciprofloxacin 0 12 (30.7) 7 (33.3) 11 (42.3) 15 (39.4) 12 (46.1) 47 (65.2) 0.004
Levofloxacin 0 11 (28.2) 8 (38) 9 (34.6) 13 (34.2) 11 (42.3) 48 (66.6) 0.009
* Linear regression
Discussion
There is a lack of studies with pediatric cardiac surgery patients hospitalized in the ICU with multi-drug resistance infections. Nonetheless, from many different studies around the world, bacterial infections in pediatric cardiac surgery represent a great problem caused of increasing morbidity, mortality and prolonged hospital stays. Prevalence of bacterial infection in pediatric cardiac surgery is necessary to determine prevalent pathogens and resistance rates for better use the effective antibiotics. It is important to known that bacterial agents that affect each different unit were variable among hospitals. For example, in our study the most common systems affected were respiratory tract (54.3%) followed surgical site infections (8.5%) and bloodstream infection (5.7%). The distribution of bacterial infection was more or less similar to that of Sahu et al. [11] (respiratory infection 44.2% followed by SSI 11.6%, BSI 7.5%, and UTI 6.9%. In most of other studies are the commonest infection affected by respiratory tract followed urinary tract infection [12-13]. These results are different of other studies in which bloodstream infection was the common type of bacterial infection [14-17]. In the present study, we found small number of infection related to the central venous catheter (3.9%) it was similar with the study conducted by Sahu et al. [11], (<1%), but contrary to the others studies including Michalopoulos et al. [18] with 22.4%. We found a low incidence of urinary tract catheter infection-associated infection. The rational use of urinary catheters was the major factor accounting for this low incidence.
Our study determined a predominance of Gramnegative bacilli (53.1%) from the culture results, witch comparable with study reported by Sahu et al. [11] and Silva et al. [19], whereas Gram-positive cocci were the most prevalent group of patients studied by Michalopoulos et al. [18] and Lola et al. [16] noted equal level of both group organisms.
In the present study, the most frequently isolated pathogens were P.aeruginosa (19.7%), K.pneumoniae (16%), and A.baumannii (8.8%). In the same study P.aeruginosa are the most common pathogen in Italy reported by Valera et al. [20]. Moreover, we found statistically increasing rates of frequency P.aeruginosa from 16.1% to 30.2% (p=0.048), Kpneumoniae from 7.5% to 19.3% (p=0.014), and A.baumannii from 3.2% to 13.6% (p=0.059). In our study, P.aeruginosa was responsible for respiratory tract infection 20.9%, tracheobronchial aspirate 24.4% that was comparable with previous study [21]. We also found that K.pneumoniae was responsible for most of
the BSIs (19.2%) in our study that was comparable with other studies [11, 22]. We found CoNS (36.6%) as prevalent pathogen of SSI that was comparable with similar study [23], whereas Sahu et al. [11] documented that S.aureus was the most common pathogen for SSI (58%).
The most common isolated P.aeruginosa was found with dramatically increasing resistance to all tested antibiotics6 especially to meropenem from 0% to 67.9% (p=0.0001), ceftazidime from 26.6% to 76.7% (p=0.001). In 2018 was found to be highest resistance to meropenem and imipenem 89.2%, to ceftazidime 84.6%, which is much higher, compared to Chinese report [24] with 50% and 33.3% respectively, also to levofloxacin 81.1% and ciprofloxacin 86.1%, which is less in India (86-96% respectively) report [11].
In our study, we found higher levels of ESBL-producing K.pneumoniae isolates (72.7%) and statistically significant increasing resistance to aminoglycosides, whereas we not report about carbapanemases producers isolates and higher resistance to quinolones, both these group of antibiotics are the most effective for treatment K.pneumoniae associated infections.
A.baumannii was responsible for more than 8.5% of bacterial infection with statistically significant increasing frequency (p=0.059), it is important to note because it contrary to our previous study [21]. Moreover, we report increasing resistance to all tested antibiotics, especially to meropenem 62.5%, ciprofloxacin 65.2% and amikacin 47.2% which more or less similar to other studies [11,25]. As is known, this Gram-negative bacterium becoming is serious hurdle, because there are limited choice of available antibiotics.
Conclusion
In this paper, we report characteristics of microbial landscape and resistance rates of bacterial infections in a postoperative pediatric cardiac surgical facility in tertiary hospital in Kazakhstan. Respiratory tract infection was found to be the most common site for bacterial infection and P.aeruginosa and K. pneumoniae were the most frequent pathogens with high level of resistance. Our findings are posing necessitates for improvement preventive measures, including microbiological monitoring, good hygiene, and well-designed hospital infection control strategy.
Compliance with ethical standards
Declaration of Conflicting Interests: The authors declare that they have no conflict of interest.
Financial Disclosure: No financial support was received.
References:
1. Agarwal H.S., Wolfram K.B., Saville B.R., Donahue B.S., Bichell D.P. Postoperative complications and association with outcomes in pediatric cardiac surgery // Journal Thoracic Cardiovascular Surgery. 2014.148(2):609-16
2. Levy I., Ovadia B., Erez E., Rinat S., Ashkenazi S., Birk E. Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors // Journal Hospital Infections. 2003.53:111-116.
3. Urrea M., Pons M., Serra M., Latorre C., Palomeque A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit // Pediatric Infectious Diseases Journal. 2003.22:490-494.
4. Guardia Cami M.T, Jordan G.I, Urrea A.M. Nosocomial infections in pediatric patients following cardiac surgery // Annual Pediatrics. 2008.69:34-38.
5. Holzmann-Pazgal G, Hopkins-Broyles D, Recktenwald A, Hohrein M, Kieffer P, Huddleston C. Case-control study of pediatric cardiothoracic surgical site infections // Infection Control Hospital Epidemiology. 2008.29:76-79
6. Nateghian A., Taylor G., Robinson J.L. Risk factors for surgical site infections following open-heart surgery in a Canadian pediatric population // American Journal Infection Control. 2004.32:397-401
7. Lex D.J, Toth R., Cserep Z., Breuer T. et al. Postoperative differences between colonization and infection after pediatric cardiac surgery-a propensity matched analysis // Journal of Cardiothoracic Surgery. 2013.166. doi .org/10.1186/1749-8090-8-166
8. Barker G.M., O'Brien S.M., Welke K.F., Jacobs M.L., Jacobs J.P., Benjamin D.K., et al. Major infection after pediatric cardiac surgery: at risk estimation model // Annual Thoracic Surgery. 2010.89(3):843-850.
9. Alten J.A., Rahman A.F., Zaccagni H.J. et al. The Epidemiology of health-care associated infections in pediatric cardiac intensive care units // Pediatric Infectious Diseases Journal. 2018.37(8):768-772
10. Abramczyk M.L., Carvalho W.B., Carvalho E.S., Medeiros E.A. Nosocomial infection in a pediatric intensive care unit in a developing country // Brazilian Journal Infectious Diseases. 2003.7(6): 44-49
11. Sahu M.K., Siddhart B., Choudhary A. et al. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume cardiac surgical intensive care unit // Annals of Cardiac Anaesthesia. 2016.19(2):281-287
12. Porto J.P., Mantese O.C., Arantes A. et al. Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance // Revista da Sociedade Brasileira de Medicina Tropical. 2012. 45: 475-479.
13. Becerra M.R., Tantalean J.A, Suarez V.J. et al. Epidemiologic surveillance of nosocomial infections in a
Pediatric Intensive Care Unit of a developing country // BMC Pediatrics. 2010. 10:66-72
14. Wang Z., Xia Z. What we can do? The risk factors for multidrug resistant infection in pediatric intensive care unit: case-control study // Italian Journal of Pediatrics. 2020. 46(17):66-69
15. Elbarbary M., Alsarhani W., Alotaibi M. Central line associated blood stream infection in a pediatric cardiac intensive care unit: Incidence, risk factors, and outcome // Journal of the Saudi Heart Association. 2017. 29(4):318-19
16. Lola I., Levidiotou S., Petrou A. et al. Are there independent predisposing factors for postoperative infections following open-heart surgery? // Journal of Cardiothoracic Surgery. 2011. 6:151
17. Garcia H., Cervantes-Luna B., Gonzalez-Cabello H., Miranda-Novales G. Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease // Pediatrics and Neonatology. 2018. 59(4):404-09
18. Michalopoulos A., Geroulanos S., Rosmarakis E.S., Falagas M.E. Frequency, characteristics, and predictors of microbiologically documented nosocomial infection after cardiac surgery // European Journal Cardiothoracic Surgery. 2006. 29:456-60
19. Araujo da Silva A.R., Henriques C.T., Werneck L.S. Healthcare associated infections by multidrug resistant organisms in pediatric intensive care: Analysis of four years // International Journal of Infection Control. 2014. doi:10.3396/IJIC.v10i3.019.14
20. Valera M., Scolfaro C., Cappello N., Gramaglia E., et al. Nosocomial infections in pediatric cardiac surgery, Italy // Infection Control Hospital Epidemiology. 2001. 22(12):771-75
21. Bissenova N., Yergaliyeva A. Patterns of Antimicrobial Resistance in a Pediatric Cardiac Intensive Care Unit: Five Years' Experience // Journal of Microbiology and Infectious Diseases. 2017. 7(3):132-138
22. Lakshmi K.S., Jayashree M., Singhi S., Ray P. Study of nosocomial primary bloodstream infections in a pediatric intensive care unit // Journal of Tropical Pediatrics. 2006. 53(2): 87-91
23. Murray M.T., Krishnamurthy G., Corda R. et al. Surgical site infections and bloodstream infections in infants after cardiac surgery // Journal of Thoracic and Cardiovascular Surgery. 2014. 148(1):259-65
24. Wang L.J., Sun Y., Song W.L., Zhang Z.J., Liu C.F. Changes of drug-resistance of Pseudomonas aeruginosa in pediatric intensive care unit // Chinese Journal of Pediatrics. 2012. 50(9):657-663.
25. Mathai A.S., Oberoi A., Madhavan S., Kaur P. Acinetobacter infections in a tertiary level intensive care unit in northern India: Epidemiology, clinical profiles and outcomes // Journal of Infection and Public Health. 2012. 5:145-52
Correspondence:
Yergaliyeva Aigerim - microbiologist of Laboratory of Microbiology. JSC National Scientific Medical Reserch Center. NurSultan, Kazakhstan
Mailing Address: JSC National Scientific Medical Research Center, Laboratory of Microbiology. 42 av.Abylaikhan, NurSultan, 010000
Email: [email protected]
Phone: +8(7172) 577652, mob: 87752031270
