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Multidrug-resistant microorganisms and surgical antibiotic prophylaxis – prevalence at the University Hospital Centre Sestre milosrdnice

Aim. To determine the prevalence of five key Gram positive and Gram negative multidrug-resistant microorganisms from blood and urinary specimens. To establish the proportion of patients who continue surgical antibiotic prophylaxis following their operation in absence of any infections, either surgical or non-surgical, and to ascertain the reasons for prophylaxis prolongation and to describe the types of antibiotic prophylaxis prescribed.

Methods. Laboratory-based WHO designed survey during one week (21-28 March 2014) was conducted at the Department of Microbiology, Parasitology and Hospital Infection at the University Hospital Centre Sestre milosrdnice (Zagreb, Croatia). Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) , extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae, carbapenem resistant Enterobacteriaceae (CRE) and multi-resistant Acinetobacter spp (MRAB) isolated from blood culture and urine (mid-stream or catheter specimen) of hospitalised patients routinely submitted to the microbiology laboratory, excluding copy strains, were registered in electronic form.

Surgical prophylaxis data were gathered using a WHO designed survey with a ‘closed-question’ questionnaire by hospital infection control professionals on a single day (27 March 2014) from patients hospitalised in the General Surgery and Gynecology wards at the Clinic for Tumours at the University Hospital Centre Sestre milosrdnice. Data were collected from patient records (and by asking clinical ward staff if necessary) on all patients who underwent surgery in the previous three consecutive working days (excluding the day of survey).

Results. The prevalence of MRSA bloodstream infections was 1.64%. Other MDR microorganisms were not isolated from blood cultures. The urine MDR isolates prevalence was 0.07% MRSA, 1.43% E. coli ESBL (5.79% of overall E. coli isolates were ESBL producers), 1.79% K. pneumonie (26.3% K. pneumoniae were ESBL producers) and 0.38% Acinetobacter baumannii. The proportion of patients who continued surgical prophylaxis was 6.4% following departmental guidelines. The duration was no longer than one day.

Conclusion. The prevalence of multidrug resistant microorganisms in our institution is low, but the proportion of resistant strains within isolated species corresponds to European reports. Prolongation of surgical antibiotic prophylaxis exists, but the prevalence is low and with short duration.

This data will support healthcare workers in their efforts to better manage patient infections and care, as well as to mitigate costs by using cost-free tools such as hand hygiene and the rational prescribing of antibiotics.

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