title: Resistance Pattern of Antibiotics in Patient Underwent Open Heart Surgery With Nosocomial Infection in North of Iran.
abstract: BACKGROUND
  Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens.
  
  
  OBJECTIVE
  The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014.
  
  
  METHODS
  In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used.
  
  
  RESULTS
  Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR).
  
  
  CONCLUSIONS
  We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and ESBL bacteria is increasing in our region.
authors.forename: Alireza
authors.initials: A
authors.lastname: Davoudi
authors.forename: Narges
authors.initials: N
authors.lastname: Najafi
authors.forename: Shahriar
authors.initials: S
authors.lastname: Alian
authors.forename: Atefe
authors.initials: A
authors.lastname: Tayebi
authors.affiliation: Antimicrobial Resistance Research Center, Department of Infectious Diseases, Mazandaran university of medical sciences, Sari, Iran. fkani63@gmail.com.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ahangarkani
authors.forename: Samaneh
authors.initials: S
authors.lastname: Rouhi
authors.forename: Amirhosein
authors.initials: A
authors.lastname: Heydari
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors