title: Antimicrobial resistance development following surgical site infections.
abstract: Surgical site infections (SSIs) determine an increase in hospitalization time and antibiotic therapy costs. The aim of this study was to identify the germs involved in SSIs in patients from the Clinical Emergency County Hospital of Craiova (SCJUC) and to assess their resistance to antimicrobials, with comparisons between surgical wards and the intensive care unit (ICU). The biological samples were subjected to classical bacteriological diagnostics. Antibiotic resistance was tested by disc diffusion. We used hierarchical clustering as a method to group the isolates based upon the antibiotic resistance profile. The most prevalent bacterial species isolated were Staphylococcus aureus (S. aureus; 50.72%), followed by Escherichia coli (E. coli; 17.22%) and Pseudomonas aeruginosa; 10.05%). In addition, at lower percentages, we isolated glucose-non-fermenting, Gram-negative bacteria and other Enterobacteriaceae. The antibiotic resistance varied greatly between species; the most resistant were the non-fermenting Gram‑negative rods. E. coli exhibited lower resistance to third generation cephalosporins, quinolones and carbapenems. By contrast, Klebsiella was resistant to many cephalosporins and penicillins, and to a certain extent to carbapenems due to carbapenemase production. The non-fermenting bacteria were highly resistant to antibiotics, but were generally sensitive to colistin. S. aureus was resistant to ceftriaxone (100%), penicillin (91.36%), amoxicillin/clavulanate (87.50%), amikacin (80.00%) and was sensitive to levofloxacin, doxycycline, gentamycin, tigecycline and teicoplanin. The Enterobacteriaceae resistance was only slightly higher in the ICU, particularly to carbapenems (imipenem, 31.20% in the ICU vs. 14.30% in the surgical wards; risk ratio = 2.182). As regards Staphylococcus species, but for non-fermenting bacteria, even if the median was almost the same, the antibiotic resistance index values were confined to the upper limit in the ICU. The data gathered from this study may help infection control teams to establish effective guidelines for antibiotic therapies in various surgical procedures, in order to minimize the risk of developing SSIs by the efficient application of the anti-infection armamentarium.
authors.affiliation: Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Călina
authors.affiliation: Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Anca Oana
authors.initials: AO
authors.lastname: Docea
authors.affiliation: Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Lucica
authors.initials: L
authors.lastname: Rosu
authors.affiliation: Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Zlatian
authors.affiliation: Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Alexandra Floriana
authors.initials: AF
authors.lastname: Rosu
authors.affiliation: Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Florin
authors.initials: F
authors.lastname: Anghelina
authors.affiliation: Department of Physiotherapy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Otilia
authors.initials: O
authors.lastname: Rogoveanu
authors.affiliation: Department of Pharmaceutical Microbiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
authors.forename: Andreea Letiția
authors.initials: AL
authors.lastname: Arsene
authors.affiliation: Department of Biochemistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
authors.forename: Alina Crenguța
authors.initials: AC
authors.lastname: Nicolae
authors.affiliation: Department of Biochemistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
authors.forename: Cristina Manuela
authors.initials: CM
authors.lastname: Drăgoi
authors.affiliation: Laboratory of Anatomy, Medical School of Heraklion, University of Crete, Heraklion 71003, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Tsiaoussis
authors.affiliation: Laboratory of Toxicology, Medical School, University of Crete, Heraklion 71003, Greece.
authors.forename: Aristides M
authors.initials: AM
authors.lastname: Tsatsakis
authors.affiliation: Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Greece.
authors.forename: Demetrios A
authors.initials: DA
authors.lastname: Spandidos
authors.affiliation: Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens 15771, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Drakoulis
authors.affiliation: Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Eliza
authors.initials: E
authors.lastname: Gofita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology*; D016000:Cluster Analysis; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000473:pathology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents