PREVENTIVE MEDICINE - LABORATORY

Transcription

1 Rev. Med. Chir. Soc. Med. Nat., Iaşi 2014 vol. 118, no. 3 PREVENTIVE MEDICINE - LABORATORY ORIGINAL PAPERS CLINICAL EPIDEMIOLOGICAL STUDY ON THE INCIDENCE OF ESCHERICHIA COLI INFECTIONS IN THE CANCER PATIENTS ADMITTED TO SURGERY DEPARTMENT II OF THE IASI REGIONAL ONCOLOGY INSTITUTE IN 2013 Elenis Gabriela Manafu 1, Raluca Mihaela Filimon 2, Irina Jari 3, F.D. Petrariu 4, Alina Manole 5 Transylvania University, Brașov, Faculty of Medicine 1. Ph student 2. Iasi Regional Oncology Institute University of Medicine and Pharmacy Grigore T. Popa - Iași Faculty of Medicine 3. Discipline of Radiology 4. Discipline of Hygiene-Environmental Health 5. Discipline of Primary Health Care and Epidemiology CLINICAL EPIDEMIOLOGICAL STUDY ON THE INCIDENCE OF ESCHERICHIA COLI INFECTIONS IN THE CANCER PATIENTS ADMITTED TO SURGERY DEPARTMENT II OF THE IASI REGIONAL ONCOLOGY INSTITUTE IN 2013 (Abstract). The aim of study was to identify pathogens involved in hospital-acquired or community-acquired infections in patients suffering from various types of cancers. Material and methods. A clinical epidemiological study included a group of 355 cancer patients admitted and operated at the Surgery Department II of the Iasi Regional Oncology Institute in 2013 was performed using data from hospital statistical service and the surgery and laboratory records, then processed by epidemi o- logical and statistical methods. Results. In cancer patients the pathogen most commonly involved in infections was E. coli, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecalis, Enterobacter cloacae and Acinetobacter. Analysis of bacterial resistance to antibiotics of the pathogen most commonly involved revealed that of the 29 E. coli strains 22 were tested for resistance/sensitivity to ampicillin; of these, 19 strains showed resistance, and only 3 were sensitive; 14 E. coli strains of were resistant to cephalosporins and 8 sensitive; all strains tested were sensitive to carbapenems, imipenem or meropenem and polypeptides (colistin); the 10 tested strains showed resistance to monobactams (aztreonam). Conclusions. E. coli was incriminated in most urinary tract infections, the other pathogens being identified sporadically. Surgical wound infections were caused mostly by E. coli and Staphylococcus aureus, followed by Pseudomonas aeruginosa. In our study we encountered increased resistance of E. coli to penicillins, cephalosporins, monobactams (aztreonam), fluoro-quinolones and tetracyclines. Keywords: HOSPITAL-ACQUIRED INFECTION, CANCER, SURGERY, ESCHERICHIA COLI. The incidence of infections associated to diseases requiring hospital care varies highly in relation to many factors of which the peculiarities of the underlying disease and 796

2 Clinical epidemiological study on the incidence of Escherichia coli infections in the cancer patients admitted to surgery department ii of the Iasi Regional Oncology Institute in 2013 the presence of co morbidities rank first. Not always the medical act itself creates risks for infection. A number of causes or mechanisms may be involved, accounting for the pronounced epidemiological and clinical polymorphism of hospital-acquired infections, and implicitly for the major difficulties in their prevention and treatment. Many pathogens can cause infections in hospitalized patients, often highly susceptible due to immunosuppression, as often is the case of cancer patients. The origin of infection can be both endogenous, self-infection, the organisms responsible originating from the patient itself, and exogenous, through various ways and routes of transmission. Hospitalized patients, cancer patients included, are at high risk of infection which can be acquired both during hospital stay, when it occurs some time after admission or after a short or longer period of time after discharge, depending on the incubation period. The pathogens capable of causing infections in cancer patients are most often bacteria resistant and multi-resistant to antibiotics. Colonization of patients during medical-surgical procedures occurs due to unhygienic lifestyle and as a result of longterm multiple investigations or treatments. MATERIAL AND METHODS This clinical epidemiological study included a group of 355 cancer patients admitted and operated at the Surgery Department II of the Iasi Regional Oncology Institute in 2013, of which 53 (14.92%) were detected to have hospital-acquired (43: 12.11%) and community-acquired infections (10: 2.8%). Data were obtained through cooperation with the hospital statistical service, and the study of the surgery and laboratory records. The results were processed and interpreted by epidemiological and statistical methods. RESULTS AND DISCUSSION In the 53 cancer patients with infections, the laboratory investigations done on various pathological samples identified 18 bacterial species involved in infectious episodes (tab. I, fig. 1). In the 53 patients with infection, 93 identifications were obtained because some patients had multiple co-infections and some infections were caused by several pathogens. In cancer patients the pathogen most commonly involved in infections was E. coli, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecalis, Enterobacter cloacae and Acinetobacter. The underlying disease of the patients who contracted hospital-acquired infections with E. coli varied widely, the most common being cancers of the rectum (4 cases), lung (3), colon (2), and ovary, uterus, skin, sarcoma, liver, stomach one each. Surgical wound infections were most often caused by E. coli and Staphylococcus aureus, 9 identifications each, followed, in order, by Pseudomonas aeruginosa (7 identifications), Klebsiella pneumoniae (6), Acinetobacter (4), Enterococcus faecalis (4), Enterobacter cloacae (3). E. coli was incriminated in most urinary tract infections (14 % patients of the 22 patients from whom urine samples were collected had urinary infection with E. coli), the other pathogens being identified sporadically. E. coli, pathogen with an increasing frequency, was found in 9 of the 49 examined wound secretions, equaling S. aureus. Of the nine wound samples, 7 were superficial and 2 deep. 797

3 Elena Gabriela Manafu et al. TABLE I Bacterial species involved in the infections detected in cancer patients No. Bacterial species No. of infections % infections 1. Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Enterobacter cloacae Acinetobacter Coagulase-negative staphylococcus Morganela morganii Candida albicans Enterococcus faecium Proteus mirabilis Haemophilus spp Providencia stuartii Streptococcus pyogenes Streptococcus viridans Citrobacter freundii Clostridium difficile 1 1,09 E. coli % 35 31,18 Klebsiella pneumoniae ,2 Pseudomonas aeruginosa Stafilococus aureus Enterococus faecalis Enterobacter cloacae Acinetobacter ,75 9,67 5,37 5,37 4,3 2,15 2,15 2,15 2,15 1,07 1,07 1,07 1,07 1,07 1,07 1,07 Stafilococ coagulazoneg. Enterococus faecium Morganela morganii Candida albicans Fig. 1. Frequency of bacterial species involvement in causing infections 798

4 Clinical epidemiological study on the incidence of Escherichia coli infections in the cancer patients admitted to surgery department ii of the Iasi Regional Oncology Institute in 2013 E. coli caused a total of 29 hospitalacquired infections, being also isolated from blood cultures, bile culture, peritoneal fluid, and catheter. Analysis of bacterial resistance to antibiotics of the pathogen most commonly involved in infections in our cancer patients revealed the following (tab. III): of the 29 E. coli strains 22 were tested for resistance/sensitivity to ampicillin; of these, 19 strains showed resistance, and only 3 were sensitive; 14 E. coli strains of were resistant to cephalosporins and 8 sensitive; all strains tested were sensitive to carbapenems, imipenem or meropenem and polypeptides (colistin) (22 to carbapenems and 19 to colistin, respectively); the 10 tested strains showed resistance to monobactams (aztreonam). The 2012 antibiotic use report of the Institute of Public Health, based on data obtained by IMS Health and published on its website, E. coli resistance to cephalosporins (in agreement with the result of our study), fluoroquinolones and aminoglycosides is mentioned. In our study, the strains circulating in the Iasi Regional Cancer Institute showed sensitivity to aminoglycosides. TABLE III Analysis of bacterial sensitivity to antibiotics Antibiotic Tested strains Sensitive strains E. coli of E. coli No. % Ampicillin 22 3 Cephalosporins 22 8 Carbapenems imipenem, meropenem Monobactams - Aztreonam 10 0 Gentamicin Tetracycline/doxycycline 21 8 Ciprofloxacin Colistin Sulfamethoxazole

5 Elena Gabriela Manafu et al. Legend Ampicillin - AM Cephalosporins -Csp Imipenem - IMI Aztreonam -AZT Gentamicin - G Tetracycline/doxycycline - Te Ciprofloxacin - CIP Colistin - CS Sulfamethoxazole STX Fig. 2. Sensitivity to antibiotics of E. coli strains isolated from cancer patients with infections CONCLUSIONS Our research showed that the pathogen most commonly involved in nosocomial infections in the studied cancer patients was E. coli, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Enterobacter cloacae, and Acinetobacter. E. coli was incriminated in most urinary tract infections, the other pathogens being identified sporadically. Surgical wound infections were caused mostly by E. coli and Staphylococcus aureus, followed by Pseudomonas aeruginosa. In our study, we encountered increased resistance of E. coli to penicillins, cephalosporins, monobactams (aztreonam), fluoro-quinolones and tetracyclines. The tested E. coli strains were 100% susceptible to carbapenems and polypeptides. Of the 22 E. coli strains tested for resistance/ sensitivity to aminoglycosides, 16 were sensitive to gentamicin, and 6 exhibited resistances to it, but showed sensitivity to amikacin. 800 REFERENCES 1. Sabău M. Colibaciloza. In: Tratat de epidemiologie a bolilor transmisibile. A. Ivan (red.). Edit. Polirom, Iași, 2002, Neguț M. Identificarea genului Escherichia Shigella. In: Tratat de microbiologie clinică. Buiuc D, Neguț M (red.), Edit. Medicală, București, 1999, Sack RB. Escherichia coli infection. In: Infection diseases. Gorbach SL, Bartlett JG, Blacklow NR (coord.), Saunders Co., Philadelphia, 1998, Wong CS, Jelacic SB, Habeeb RL, et al. The risk of hemolytic uremic syndrome adter antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med 2000; 342, Doyle MP, Padhye VV. Escherichia coli. In: Foodborne bacterial pathogens. Marcel Dekker Inc., New York, 1998, Mac Donald KL, O Leary MJ, Cohen MJ, et al. Escherichia coli O157:H7, an emergent gastrointestinal pathogens. Results of a one year, perspective, populational-based study. JAMA 1998; 259, Azoicăi D. Infecțiile nosocomiale. In: Tratat de epidemiologie a bolilor transmisibile. A. Ivan (red.). Edit. Polirom, Iași, 2002, Buiuc D. Particularități ale relației microb-gazdă în mediul de spital. Colonizarea de spital și infecția nosocomială. Rev Med Chir Soc Nat Iași 1981, 1,