Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2016; 4(3): 63-70
Published online Mar 16, 2016. doi: 10.12998/wjcc.v4.i3.63
Health care associated infections, antibiotic resistance and clinical outcome: A surveillance study from Sanandaj, Iran
Jafar Soltani, Bahman Poorabbas, Neda Miri, Jalal Mardaneh
Jafar Soltani, Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran
Bahman Poorabbas, Jalal Mardaneh, Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz 7193711351, Iran
Neda Miri, Besat Tertiary Hospital, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran
Author contributions: Soltani J, Poorabbas B, Miri N and Mardaneh J contributions to conception and design, acquisition of data, analysis and interpretation of data; Poorabbas B and Mardaneh J acquisition of data, laboratory performances and interpretation of laboratory data; all authors participated in drafting the article and they critically reviewed the manuscript and approved the final manuscript as submitted.
Supported by Kurdistan University of Medical Sciences and Professor Alborzi Clinical Microbiology Research Center affiliated to Shiraz University of Medical Sciences supported the whole study.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Professor Alborzi Clinical Microbiology Research Center, Shiraz, Iran. Once again, the study was reviewed and approved by the Institutional Review Board of Research Committee of the Medical Faculty and Research committee of the Kurdistan University of Medical Sciences, Sanandaj, Iran.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors of the paper declare any conflicting interests (including but not limited to commercial, personal, political, intellectual or religious interests) that are related to the work submitted for consideration of publication.
Data sharing statement: The technical annex, statistical code, and dataset are available from the corresponding author at soltanjaf@gmail.com. The participants gave informed consent for the data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jafar Soltani, MD, Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Pasdaran Street, Sanandaj 6617713446, Iran. soltanjaf@muk.ac.ir
Telephone: +98-918-8723979 Fax: +98-87-33288199
Received: August 4, 2015
Peer-review started: August 6, 2015
First decision: October 16, 2015
Revised: November 9, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 16, 2016
Processing time: 219 Days and 18.8 Hours
Abstract

AIM: To study the antibiotic susceptibility patterns of gram-negative healthcare associated bacterial infections at two tertiary hospitals in the Sanandaj city, Kurdistan Province, Iran.

METHODS: From January 2012 to December 2012, all positive cultures from potentially sterile body fluids were gathered. They sent to professor Alborzi clinical microbiology center in Shiraz for further analysis and susceptibility testing. The antibiotic susceptibility was determined using the Kirby-Bauer method (disk diffusion technique). The Results were interpreted according to Clinical and Laboratory Standards Institute guidelines against a series of antimicrobials. World Health Organization definitions for Healthcare associated infections were followed.

RESULTS: Seven hundred and thirty-two positive cultures were reported from both hospitals. Seventy-nine isolates/patients fulfilled the study criteria for health-care associated gram-negative infections. The most frequent bacterial cultures were from the pediatric wards (52%). Serratia marcescens (S. marcescens) (38%) Escherichia coli (E. coli) (19%), Klebsiella pneumoniae (K. pneumoniae) (19%), Acinetobacter baumannii (6%), Enterobacter species (6%), Serratia odorifera (4%) and Pseudomonas species (5%) were the most frequently isolated organisms. The susceptibility pattern of common isolates i.e., S. marcescens, E. coli and K. pneumoniae for commonly used antibiotics were as follows: Ampicillin 3.3%, 6.7%, 20%; gentamicin 73.3%, 73.3%, 46.7%; ceftazidim 80%, 73.3%, 33.3%; cefepim 80%, 86.7%, 46.7%; piperacillin/tazobactam 90%, 66.7%, 86.7%; ciprofloxacin 100%, 73.3%, 86.7%; imipenem 100%, 100%, 100%, respectively.

CONCLUSION: The most effective antibiotics against gram-negative healthcare associated infections are imipenem followed by ciprofloxacin. The resistance rate is high against ampicillin and cephalothin. The high mortality rate (46.1%) associated with S. marcescens is alarming.

Keywords: Escherichia coli; Klebsiella pneumoniae; Serratia marcescens; Extended-spectrum beta-lactamase; Nosocomial infections; Antibiotic susceptibility

Core tip: To investigate the antibiotic susceptibility patterns of gram-negative healthcare associated bacterial infections a study was conducted in tertiary hospitals in Sanandaj (a large city in the west of Iran). World Health Organization guidelines for hospital-acquired infections were followed. The results were interesting and provided important information concerning antibiotic resistance, making some antibiotics such as cephalothin almost useless. According to our study, gram-negative health care associated infections are challenging especially in pediatric wards. The most effective antibiotics against gram-negative healthcare associated infections were imipenem followed by ciprofloxacin. The high mortality rate (46.1%) associated with Serratia marcescens was alarming.