The characteristics of the microflora species composition and its antibiotic resistance in adult patients at cardiac surgery department
The most important component of the prevention of infectious complications (IС) in patients undergoing cardiac surgery is the determination of the carrier state of opportunistic pathogenic microflora (OPM) from the admission and the identification of risk factors and comorbidity. For effective antibiotic prophylaxis, it is necessary to take into account the levels of natural resistance and the continuous growth of the acquired resistance of the OPM, especially the Enterobacter spp., producing ESBL (extended spectrum beta-lactamases).
Purpose of the study – determine the features of the species composition of the microflora of the mucous membranes and their antibiotic resistance in adults at the admission to the cardiac surgery department.
Material and methods. 109 patients treated in GI “CPCCC MHC in Ukraine” during the period from April to June 2018 were performed blood cultures.
Results and discussion. The results of performed bacteriological studies showed that in most cases in samples of biological materials of the respiratory tract were identified Staphylococcus aureus. The second place were taken by Staphylococcus epidermidis – 57 (26.0%), Staphylococcus haemolyticus – 15 (6.1%). Among catalase-negative cocci, the most common were Streptococcus spp. – 40 (18.3%) and Enterococcus spp. – 5 (2.3%). Also the next strains of microorganisms were cultured: the gram-positive rods Corynebacterium spp. – 2 (0.9%) and Bacillus spp. – 3 (1.4%). From the 10 tested antibiotics, cefuroxime (II generation cephalosporin) demonstrated the lowest activity against Klebsiella pneumoniae strains with resistance of 81.8% (95%, CI 47.7–96.8).
Conclusions. Our analysis shows that the preoperative detection of the patient’s microflora and the determination of antibacterial sensitivity could prevent the development of infectious complications and reduce the level of methicillin-resistant forms of microorganisms. The analysis of the etiological structure showed that staphylococci are the most common pathological agents in the upper respiratory tract.
2. European Centre for Disease Prevention and Control. Rapid risk assessment: carbapenem-resistant Enterobacteriacae, first update. Stockholm: ECDC; 2018. Available from: https://ecdc.europa.eu/sites/portal/files/documents/RRA-Enterobacteriaceae-Carbapenems-EuropeanUnion-countries.pdf
3. Filonenko GV, Talalaev OS, Kyryk DL, Kovalenko NN, Skorohod IN, Salamanina AA.Single center study of ESBL-related strains of Enterobacteriaceae collected from clinical specimens of infants with congenital heart disease using multiplex PCR amplification. Biopolym. Cell. 2017; 33(2):92–101.
4. Filonenko HV, Salamanina AO, Kyryk DL. Monitorynh mikrobiolohichnoho peizazhu u ditei z vrodzhenymy vadamy sertsia. Visnyk sertsevo-sudynnoi khirurhii. 2016; 1(24):86–88.
5. Sobkova ZhV, Filonenko HV, Surmasheva OV, Rosada MO. Vyvchennia vydovoho skladu mikroorhanizmiv v bioplivkakh na sudynnykh ta sechovykh kateterakh u bahatoprofilnomu statsionari. Scientific Journal «Science Rise: Biological Science». 2017; 2 (5): 38–42.
6. Cluzet VC, Gerber JS, Nachamkin I, Metlay JP, Zaoutis TE, Davis MF et al. Duration of colonization and determinants of earlier clearance of colonization with methicillin - resistant Staphylococcus aureus. Scientific Journal ”Clin Infect Dis”. 2015; 60:1489–1496.
7. Anderson DJ, Podgorny K, Berrнos-Torres SI. Strategies to prevent surgical site infections in acute care hospitals. 2014; 35:605.
8. Bratzler DW, Dellinger EP, Olsen KM. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013; 70:195.
9. Rodriguez-Bano J, Gutierrez-Gutierrez B, Machuca I, Pascual A. Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae. ClinMicrobiol Rev. 2018; 14(2): 31.
10. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, et al. Antimicrobial-resistant pathogens associated with health care - associated infections. Summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention. Infect Control HospEpidemiol. 2013; 34 (1):1–14.
11. Stьrenburg E, Mack D. Extended - spectrum Я-lactamases: Implications for the clinical microbiology laboratory, therapy and infection control. J Infect. 2003; 47(4): 73-95.
12. Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. DiabetesCare. 2009; 32:287.
13. David K McCulloch, Rodney AHayward. A Screening for type 2 diabetes mellitus. UpTodade. 2017.
14. Park C, Guallar E, Linton JA, Lee DC, Jang Y, Son DK,et al. Fasting glucose level and the risk of incident atherosclerotic cardiovascular diseases. Diabetes Care. 2013; 36: 7–11.
15. Krykunov OA, Buriak RV, Koltunova HB, Spysarenko SP, Pustovalova HO, Khmelevskyi AM. Analiz antybiotykorezystentnosti zbudnykiv aktyvnoho klapannoho infektsiinoho endokardytu. Visnyk sertsevo-sudynnoi khirurhii. 2017; 3 (29):48–52.
16. Thomas L Holland, Larry MBaddour, Arnold S Bayer, Bruno Hoen, Jose MMiro and Vance G.Infective endocarditis. Scientific Journal“Primer”. 2016; 4:2–4.
17. Lemaignen A, Birgand G, Ghoodhbane W, Alkhoder A, Lolom I, Belorgey S. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation. Scientific Journal ”Clinical Microbiology and Infection”. 2015; 7: 2–3.