DİRENÇLİ BAKTERİ KOLONİZASYONU TARAMASI YAPILMASININ CERRAHİ ALAN ENFEKSİYONU AÇISINDAN ÖNEMİ

Öz

Cerrahi alan enfeksiyonları sağlık hizmeti ilişkili enfeksiyonların yaklaşık %20’sini oluşturmakta ve hastalarda artmış morbidite ile mortaliteye neden olmaktadır. Tarama amaçlı yapılan rektal sürüntü kültürlerinde ise hastaların dirençli bakteriler ile kolonize olduğunun anlaşılması yatış sürecindeki enfeksiyon riskini anlamlı olarak arttırmaktadır. Çalışmamızda hastanemiz Genel Cerrahi bölümü tarafından son beş yılda ameliyat edilen 3228 hastada gelişen 102 cerrahi alan enfeksiyonu (%3.16) verisini değerlendirdik. Çalışma süresince 86 hastada 168 etken ürediği ve sekiz hastada (%9.3) etkenin dirençli mikroorganizmalar olduğu görüldü. 16 hastada (%15.7) ise kültür için hiç örnek alınmadığı saptandı. Cerrahi alan enfeksiyonu gelişen hastaların 4 tanesinde dirençli bakteri tarama kültürü yapıldığı ve bu hastalardan birinde karbapenemaz üreten Gram negatif bakteri pozitifliği saptandığı anlaşıldı. Bu hastanın total gastrektomi sonrası gelişen karın içi apse kültüründe de yine karbapenemaz üreten Gram negatif bakteri, Escherichia coli üremesi oldu. Bu sonuçlar ile hastanemizde cerrahi alan enfeksiyonlarının önlenmesi için, tarama kültürü gibi önemli bir fırsatın yeteri kadar iyi kullanılamadığı sonucuna vardık. Etkin bir tarama ile daha fazla kolonize hastaya ulaşmamız mümkün olsa bu hastalarda izolasyon, yakından izlem ve cerrahi alan enfeksiyonu gelişmesi durumunda ise daha etkin bir tedavi planlama şansımız olacaktı. Sonuçta çalışmamız Genel Cerrahi tarafından ameliyat edilen hastalarda gerçekleştirilmesi gereken dirençli bakteri kolonizasyonu taraması konusunda önemli eksikliklerimiz olduğunu göstermiş ve cerrahi alan enfeksiyonu etkenlerinin saptanması konusunda da gelişim alanlarımız olduğunu belirlemiştir.

Anahtar Kelimeler

• Cerrahi alan enfeksiyonu
• Çoklu dirençli bakteriler
• Dirençli bakteri kolonizasyonu taraması
• Karbapenemaz üreten Gram negatif bakteri

Impact of Multidrug-resistant Bacteria Colonisation Screening on Surgical Site Infections

Öz

Surgical site infections constitute approximately 20% of healthcare-associated infections and increase morbidity and mortality rates. In the rectal swab cultures for multidrug-resistant bacteria colonization screening, colonized patients with resistant bacteria have a significantly increased risk of infection during their hospitalization period. Our study evaluated 102 surgical site infections (3.16%) developed in 3228 patients operated by the General Surgery team in the last five years. During the study period, 168 microorganisms were reported in 86 patients, and the causative microorganism in eight patients (9.3%) were multi-drug resistant. It was shown that no samples were taken for culture in 16 patients (15.7%). Multidrug-resistant bacteria colonization screening cultures were performed in 4 patients with surgical site infections, and carbapenemase producing Gram negative bacteria was found in one of them. That patient, who underwent total gastrectomy, had a postoperative intra-abdominal abscess, and a carbapenemase producing Gram negative bacteria, Escherichia coli, was reported in his abscess culture. With these results, we concluded that a significant opportunity, such as a screening culture, could not be used well enough to prevent surgical site infections in our hospital. If we reach more colonized patients with adequate screening, we would have the chance to plan timely isolation, close monitoring and more effective treatment in case of surgical site infection. As a result, our study showed that we have essential deficiencies in screening resistant bacteria colonization that should be performed in patients operated by General Surgery and determined that we have room for improvement in diagnosing surgical site infection causative microorganisms.

Anahtar Kelimeler

• Carbapenemase producing Gram negative bacteria
• Multidrug-resistant bacteria
• Multidrug-resistant bacteria colonization screening
• Surgical site infections

Kaynakça

1. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, ve ark. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e276-e287.
2. Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, ve ark. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288-e303.
3. Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, ve ark. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59-74.
4. Bar-Yoseph H, Hussein K, Braun E, Paul M. Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis. J Antimicrob Chemother. 2016;71(10): 2729–39. pmid:27317444.
5. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, ve ark. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91.
6. Foschi D, Yakushkina A, Cammarata F, Lamperti G, Colombo F, Rimoldi S, ve ark. Surgical site infections caused by multi-drug resistant organisms: a case-control study in general surgery. Updates Surg. 2022 Oct;74(5):1763-1771.
7. Freire MP, Song ATW, Oshiro ICV, Andraus W, D’Albuquerque LAC, Abdala E. Surgical site infection after liver transplantation in the era of multidrug-resistant bacteria: what new risks should be considered? Diagn Microbiol Infect Dis. 2021;99:115220
8. Klevens RM, Edwards JR, Richards CL, Horan TC, Gaynes RP, Pollock DA, ve ark. Estimating health care‐associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160-6.

9. Kolasinski W. Surgical site infections - review of current knowledge, methods of prevention. Pol Przegl Chir. 2018;91:41e7.
10. Manges AR, Steiner TS, Wright AJ. Fecal microbiota transplantation for the intestinal decolonization of extensively antimicrobial-resistant opportunistic pathogens: a review. Infect Dis (Lond). 2016;48(8): 587-92.
11. Rasa K, Kilpatrick C. Implementation of World Health Organization Guidelines in the Prevention of Surgical Site Infection in Low- and Middle-Income Countries:What We Know and Do Not Know. Surg Infect (Larchmt). 2020;21(7):592-8.
12. Righi E, Mutters NT, Guirao X, Del Toro MD, Eckmann C, Friedrich AW, ve ark. ESCMID/EUCIC clinical practice guidelines on perioperative antibiotic prophylaxis in patients colonized by multidrug-resistant Gram-negative bacteria before surgery. Clin Microbiol Infect. 2023;29(4):463-79.
13. Seika P, Marz S, Geffers C, Adam T, Feldbrügge L, Jara M, Pratschke J, Rau B. The Clinical Importance of Preoperative Rectal Swabs in Patients after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Visc Med. 2022;38(6):376-83.
14. Sganga G, Baguneid M, Dohmen P, Giamarellos-Bourboulis EJ, Romanini E, Vozikis A, ve ark. Management of superficial and deep surgical site infection: an international multidisciplinary consensus. Updates Surg. 2021;73:1315e25.
15. Souverein D, Euser SM, Herpers BL, Kluytmans J, Rossen JWA, Den Boer JW. Association between rectal colonization with highly resistant Gram-negative rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: a one year historical cohort study. PLOS ONE. 2019;14:e0211016.
16. Tacconelli E, Mazzaferri F, de Smet AM, Bragantini D, Eggimann P, Huttner BD, ve ark. ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin Microbiol Infect. 2019;25:807e17.
17. Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis. 2015;15:1429e37.