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Antibiotic-resistant Staphylococcus epidermidis in patients undergoing cardiac surgery
Abstract:
Staphylococcus epidermidis isolates containing subpopulations resistant to 100 microgram of methicillin per ml were found on the chests of only 3 of 80 (4%) patients before cardiac surgery, whereas these highly resistant staphylococci were isolated from the chest wounds of 43 of 80 (54%) patients 5 days postoperatively. The percentage of patients colonized with methicillin-resistant S. epidermidis increased with time postoperatively. Methicillin-resistant postoperative isolates also contained organisms resistant to other antibiotics frequently used during these patients' hospitalizations. The percentages of patients with organisms resistant to various antibiotics were: nafcillin (100%), penicillin (100%), cephalothin (93%), cefamandole (80%), streptomycin (67%), and gentamicin (20%). Preoperative methicillin-susceptible isolates were generally susceptible to other antibiotics. Two patients with S. epidermidis prosthetic valve endocariditis caused by multiple antibiotic-resistant isolates were among the study patients. Antibiotic susceptibility patterns of each isolate from these two patients were identical to those of postoperative chest isolates from the same patient.
Insights
Methicillin-resistant Staphylococcus epidermidis (MRSE) colonization increased significantly after cardiac surgery. Postoperative MRSE strains exhibited resistance to multiple antibiotics, posing a risk for surgical site infections.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Surgical Site Infections
Background:
- Staphylococcus epidermidis is a common cause of healthcare-associated infections.
- Antibiotic resistance in S. epidermidis is a growing concern, particularly in surgical patients.
- Methicillin resistance in S. epidermidis (MRSE) can complicate treatment and increase morbidity.
Purpose of the Study:
- To investigate the prevalence and antibiotic resistance patterns of Staphylococcus epidermidis colonization in patients before and after cardiac surgery.
- To determine the risk factors associated with the development of methicillin-resistant S. epidermidis (MRSE) postoperatively.
- To assess the potential for MRSE to cause serious infections, such as prosthetic valve endocarditis.
Main Methods:
- Prospective study involving 80 patients undergoing cardiac surgery.
- Collection of S. epidermidis isolates from patient chests preoperatively and from surgical wounds postoperatively.
- Antimicrobial susceptibility testing of all isolates against various antibiotics, including methicillin.
Main Results:
- Preoperative MRSE colonization was low (4%), increasing significantly to 54% by 5 days postoperatively.
- Postoperative MRSE isolates demonstrated high resistance rates to multiple antibiotics, including nafcillin (100%), penicillin (100%), cephalothin (93%), and cefamandole (80%).
- Two patients developed S. epidermidis prosthetic valve endocarditis caused by multidrug-resistant isolates with identical susceptibility patterns to their postoperative chest isolates.
Conclusions:
- Cardiac surgery is associated with a substantial increase in MRSE colonization.
- Postoperative MRSE strains are frequently multidrug-resistant, necessitating careful antibiotic stewardship.
- The findings highlight the importance of infection control measures to prevent MRSE transmission and subsequent infections in surgical settings.