Multidrug-resistant microorganisms and surgical antibiotic prophylaxis - prevalence at the University Hospital Centre Sestre Milosrdnice
Aim Emergence and spread of multidrug-resistant (MDR) microorganisms in healthcare settings, especially in Intensive Care Units (ICUs), cause concern worldwide. A particular problem is a lack of therapeutic options. One of the inducement factors for MDR microorganisms spread is antibiotic over- and wrong-prescribing. Surgical antibiotic prophylaxis is one of the misused antibiotic prescribing indications. The aims of our study were to determine the prevalence of five key MDR bacteria from blood and urine in order to establish surgical antibiotic prophylaxis compliance with the Croatian National Guidelines. Methods A point prevalence study was conducted. We present a laboratory-based WHO designed survey on MRSA, VRE, ESBL and CRE-producing Enterobacteriaceae, multi-resistant Acinetobacter spp., isolated from blood and urine of hospitalised patients. Surgical prophylaxis data were gathered from patients who had undergone operative procedures in the General Surgery Ward and Gynecology Ward. Results The prevalence of MRSA bloodstream infections was 1.64%, other MDR microorganisms were not isolated. The prevalence of urine MDR isolates was MRSA 0.07%, E. coli ESBL 1.43% (5.79% of overall E. coli isolates were ESBL producers), K. pneumonie 1.79% (26.3% of K. pneumoniae were ESBL producers) and Acinetobacter spp. 0.38%. The proportion of patients who continued surgical prophylaxis was 6.4%. Conclusion MDR microorganisms' prevalence in our institution is low, but the proportion of resistant strains within isolated species corresponds to European reports. Surgical antibiotic prophylaxis compliance with the Croatian National Guidelines is high. Constant and recent surveillance data are a significant guide for empiric antimicrobial therapy, an indicator for activities concerning the prevention of MDR microorganisms spread and proper antibiotic stewardship.
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