Journal List > Urogenit Tract Infect > v.10(2) > 1084182

Kim, Kim, Cho, Ko, Lee, and Min: Change of Antibiotic Resistance to the Causative Organisms of Pelvic Wound Infection for Recent 5 Years

Abstract

Purpose:

We researched microbial profiles and the antimicrobial resistance profile of wound infection of the pelvic area in Korea for the recent 5 years in order to provide useful information on the choice of adequate drugs in the treatment of pelvic wound infection.

Materials and Methods:

We retrospectively analyzed 211 pelvic wound culture samples and their antimicrobial resistance in 198 in- or outpatients of the Urology and Plastic surgery department from January 2010 to December 2014.

Results:

Of the total samples, Staphylococcus aureus was isolated most frequently (35.3%), followed by Escherichia coli (15.1%), Staphylococcus epidermidis (12.6%), Staphylococcus haemolyticus (12.6%), Staphylococcus lugdunensis (8.4%), Pseudomonas aeruginosa (6.7%), Enterococcus spp. (4.2%), and Streptococcus spp. (3.3%). There were no notable changes of bacterial distribution for 5 years. For Gram-positive isolates, the oxacillin resistance rate for Gram-positive bacteria was 42.6% and showed an increasing tendency for the recent 5 years. Piperacillin, rifampicin, and vancomycin had low resistance for Gram-positive bacteria. Carbapenems, piperacillin/tazobactam had low resistance for Gram-negative bacteria. The Gram-positive organisms were more sensitive to many antibiotics in contrast to the Gram-negative organisms.

Conclusions:

Of varied causative organisms and susceptibility of the pelvic wound site, the most frequently infected organisms of the pelvic area were S. aureus, followed by E. coli. The methicillin resistive S. aureus (MRSA) incidence showed a tendency to increase yearly, thus selection or early change of antibiotics considering MRSA is recommended if the antibiotic response is poor. Gram-negative bacteria has a higher resistance rate compared with Gram-positive bacteria and had carbapenems and piperacillin/tazobactam.

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Fig. 1.
Incidence of causative organisms of pelvic wound infection for 5 years.
uti-10-112f1.tif
Table 1.
Distribution of mixed wound infection
Year 1 Organism 2 Organisms Total
2010 21 (87.5) 3 (12.5) 24
2011 17 (89.5) 2 (10.5) 19
2012 20 (90.9) 2 (9.1) 22
2013 23 (88.5) 3 (11.5) 26
2014 25 (89.3) 3 (10.7) 28
Total 106 13 119

Values are presented as number (%) or number only.

Table 2.
Changes of antibiotics resistance for gram-positive organisms
Organism Year Drug resistance (%)
OX AM AX/C AN CFZ CFT CTX CFP CIP CC IPM EM PIP SXT TC RA VCM
Staphylococcus aureus 2010 13.3 32.1 75.4 11.2 69.5 45.8 2 38.4 22.3 32.7 11.6 32.5 12.2 0.0 25.1 0.0 0.0 0.0
2011 26.6 21.6 78.9 0.0 100.0 43.7 2 37.6 26.6 37.4 11.7 33.7 22.5 0.0 12.5 11.1 - -
2012 50.0 24.3 85.6 14.2 75.3 45.2 2 40.2 25.8 35.6 13.3 36.7 21.4 0.0 0.0 0.0 - -
2013 53.2 21.1 87.3 11.1 63.4 46.4 2 40.1 27.2 35.1 12.9 38.2 31.1 0.0 0.0 0.0 - 0.0
2014 62.8 32.0 91.3 12.7 62.7 50.4 2 42.0 27.3 38.5 13.8 39.5 24.7 0.0 0.0 0.0 0.0 0.0
Total 45.2 26.8 84.6 12.1 65.3 47.2 2 39.9 26.5 36.7 12.7 37.4 23.9 0.0 10.6 2.2 0.0 0.0
Staphylococcus epidermidis 2010 76.2 25.2 57.4 14.2 73.2 31.4 2 28.2 24.2 35.6 13.3 11.2 21.4 0.0 0.0 - 0.0 0.0
2011 100.0 27.2 60.1 11.1 100.0 55.6 3 45.1 36.7 35.1 12.5 0.0 31.1 0.0 0.0 - - -
2012 50.0 26.0 71.8 12.7 50.0 44.8 2 36.0 24.3 38.5 13.8 - 24.7 0.0 0.0 - - -
2013 0.0 26.9 62.6 12.1 26.3 21.7 2 22.9 25.5 36.7 12.7 18.3 23.9 0.0 5.6 - - 0.0
2014 33.3 30.7 52.8 11.2 27.9 26.2 2 26.2 25.6 32.7 12.6 21.4 12.2 0.0 10.1 - 0.0 0.0
Total 74.6 28.1 58.1 11.4 48.3 39.8 2 37.6 24.6 37.4 11.7 10.7 22.5 0.0 3.5 - 0.0 0.0
Staphylococcus haemolyticus 2010 50.0 16.1 36.7 21.4 25.3 0.0 1 27.1 12.3 35.1 11.1 39.7 0.0 0.0 - - - 0.0
2011 - 11.1 38.2 31.1 26.2 0.0 1 26.3 12.1 39.3 - - 0.0 0.0 - - - -
2012 54.1 15.6 39.5 24.7 26.4 0.0 1 26.6 16.5 38.4 - - 14.1 0.0 - - - -
2013 50.0 21.2 37.4 23.9 27.1 5.6 1 26.5 15.9 39.7 0.0 12.7 0.0 0.0 - - - 0.0
2014 50.0 17.3 12.7 11.2 27.3 12.7 1 27.5 14.7 38.7 - - 0.0 12.7 - - 0.0 0.0
Total 52.1 18.4 30.2 24.6 26.5 2.5 1 26.8 15.2 38.6 2.6 1.5 2.4 2.5 - - 0.0 0.0
Staphylococcus lugdunensis 2010 0.0 21.3 22.3 0.0 18.3 21.8 3 - 32.3 37.2 35.3 28.2 0.0 0.0 - - 0.0 0.0
2011 50.0 27.0 20.1 0.0 25.2 23.2 3 - 33.2 38.4 33.0 26.4 0.0 - - - - -
2012 100.0 31.7 19.8 0.0 27.4 21.6 3 0.0 31.4 34.6 26.7 21.1 0.0 - - - - -
2013 50.0 35.2 19.2 0.0 26.5 24.3 3 0.0 36.7 32.1 24.8 23.7 0.0 0.0 - - - 0.0
2014 0.0 32.8 18.8 12.7 32.7 22.9 3 12.7 38.4 31.1 32.4 24.9 - - - - 0.0 0.0
Total 30.0 32.2 19.6 2.5 28.4 22.9 3 2.5 34.1 33.8 32.5 24.8 2.5 0.0 - - 0.0 0.0
Streptococcus spp. 2010 - 11.2 11.2 11.2 11.2 22.8 2 11.2 22.3 32.7 11.6 32.5 12.2 0.0 25.1 11.1 0.0 0.0
2011 - - - - - - - - - - - - - - - - -
2012 - 11.4 0.0 10.0 - 22.4 2 22.4 23.4 36.7 12.5 28.4 15.3 0.0 24.6 0.0 - -
2013 - 0.0 12.3 11.4 32.5 31.8 2 21.4 22.5 38.1 11.4 34.1 15.2 0.0 24.2 0.0 - -
2014 - 0.0 11.4 10.2 22.3 30.8 2 26.7 21.8 35.6 12.7 29.4 16.1 0.0 25.4 11.1 0.0 0.0
Total - 3.4 7.8 8.4 26.4 27.7 2 21.5 21.1 36.3 11.4 28.5 15.0 0.0 24.3 5.8 0.0 0.0
Enterococcus spp. 2010 - 9.7 15.2 22.3 53.1 42.4 1 26.2 19.4 46.7 0.0 34.2 42.5 - 21.3 0.0 0.0 0.0
2011 - 4.3 16.7 25.8 53.0 39.1 1 25.1 19.8 76.8 - 40.1 43.6 - 22.7 0.0 - -
2012 - - - - - - - - - - - - - - - - -
2013 - 0.0 11.2 22.3 52.6 38.2 2 27.3 21.2 56.9 0.0 42.2 43.7 0.0 22.8 0.0 - 0.0
2014 - 13.3 13.4 41.2 57.4 42.3 2 29.7 24.7 75.2 0.0 32.8 48.9 0.0 24.1 0.0 9.2 0.0
Total - 7.1 12.3 36.2 54.1 40.3 2 25.9 23.1 68.1 0.0 37.2 45.9 0.0 23.0 0.0 3.1 0.0
Total 2010 21.3 19.0 50.6 31.6 52.2 33.2 3 43.2 32.1 33.9 34.1 43.2 36.5 0.0 22.1 4.6 0.0 0.0
2011 70.7 18.6 51.2 38.3 46.2 39.7 4 43.1 43.5 35.1 35.6 42.3 33.8 0.0 23.7 4.8 - -
2012 22.4 18.0 51.1 27.4 48.3 56.4 3 43.5 34.1 38.9 35.9 40.7 32.4 0.0 19.2 0.0 - -
2013 32.1 17.9 52.6 41.2 47.6 48.3 2 45.6 24.7 40.3 38.2 40.8 33.6 0.0 21.3 0.0 - 0.0
2014 35.6 16.0 53.8 26.9 44.4 41.1 3 46.1 37.8 41.1 41.4 38.4 30.2 12.7 20.5 4.4 9.2 0.0
Total 42.6 17.3 52.5 32.3 46.8 45.1 44.4 3 35.1 37.8 38.2 41.1 34.3 2.5 22.7 2.6 3.1 0.0

OX: oxacillin, AM: ampicillin, AX/C: amoxicillin/clavulanic acid, AN: amikacin, CFZ: cefazolin, CFT: cefotetan, CTX: ceftriaxone, CFP: cefepime, CIP: ciprofloxacin, CC: clindamycin, IPM: imipenem, EM: erythromycin, PIP: piperacillin, SXT: trimethoprim/sulfamethoxazole, TC: tetracyclin, RA: rifampicin, VCM: vancomycin.

Table 3.
Changes of antibiotics resistance for gram-negative organisms
Organism Year Drug resistance (%)
AM AZT AN CFZ CFT CTX CFP CIP IPM MPM GM PIP/T SXT TiC/K RA VCM
Escherichia coli 2010 80.1 21.3 33.2 75.3 45.2 30.2 25.8 35.6 13.3 36.7 21.4 0.0 55.6 - - -
2011 81.2 31.6 34.1 63.4 46.4 30.1 27.2 35.1 12.9 38.2 31.1 0.0 41.3 - - -
2012 82.1 20.2 33.7 62.7 50.4 32.0 27.3 38.5 13.8 39.5 24.7 0.0 56.7 - - -
2013 82.0 29.8 36.1 65.3 47.2 29.9 26.5 36.7 12.7 37.4 23.9 0.0 58.2 - - -
2014 82.4 23.6 48.2 69.5 45.8 28.4 22.3 32.7 11.6 32.5 12.2 0.0 51.4 - - -
Total 81.5 27.2 36.7 71.3 43.7 27.6 26.6 37.4 11.7 33.7 22.5 0.0 53.4 - - -
Pseudomonas aeruginosa 2010 73.3 16.7 62.7 38.4 34.2 21.1 16.1 55.1. 16.1 0.0 0.0 0.0 51.7 - - -
2011 72.9 18.2 71.4 44.4 31.6. 17.4 15.3 52.3 17.3 - 0.0 0.0 49.8 - - -
2012 73.8 19.5 68.7 46.8 41.7 16.2 10.2. 61.3 18.6 - 14.1 0.0 55.8 - - -
2013 75.7 17.4 63.9 40.5 37.8 16.0 11.6 50.2 5.3 0.0 0.0 8.7 54.9 - - -
2014 80.0 22.7 - 0.0 37.3 15.4 15.3 54.3 25.8 - 0.0 0.0 59.2 - - -
Total 75.6 20.5 65.7 43.4 36.4 16.3 13.4 54.0 22.1 0.0 2.4 1.8 55.4 - - -
Total 2010 72.8 29.1 42.2 65.2 38.2 18.0 20.1 45.2 6.3 5.0 44.4 0.0 56.3 - - -
2011 74.0 25.4. 43.1 58.3 38.6 19.1 22.4 46.1 9.1 5.2 42.7 0.0 54.1 - - -
2012 76.2 23.7 48.7 59.4 41.3 21.3 25.3 45.1 6.9 4.9 43.7 0.0 56.5 - - -
2013 77.9 19.6 46.8 54.9 42.6 22.1 25.1 43.8 4.6 4.8 46.1 8.7 56.8 - - -
2014 81.1 26.7 49.6 56.4 42.5 22.2 19.1 44.2 7.5 6.1 43.9 0.0 55.1 - - -
Total 77.4 24.9 48.9 57.5 40.7 22.8 22.6 44.6 6.8 5.3 44.3 1.8 54.1 - - -

AM: ampicillin, AZT: aztreonam, AN: amikacin, CFZ: cefazolin, CFT: cefotetan, CTX: ceftriaxone, CFP: cefepime, CIP: ciprofloxacin, IPM: imipenem, MPM: meropenem, GM: gentamicin, PIP/T: piperacillin/tazobactam, SXT: trimethoprim/sulfamethoxazole, TiC/K: ticarcillin/K clavulanic acid, RA: rifampicin, VCM: vancomycin.

Table 4.
Surgical site and likely infective wound pathogens
Surgical site Staphylococcus aureus Coagulase-negative Staphylococci Gram-negative bacilli Streptococci Anaerobes Other
Cardiac - - - -
Neurosurgery - - - -
Breast - - - -
Ophthalmic - -
Orthopaedic - - -
Vascular - - - -
Gastroduodenal - - - Oropharyngeal anaerobes
Biliary - - - -
Colorectal - - - -
Head and neck - - - Oropharyngeal anaerobes
Obstetric and gynaecological - - - Enterococci, group B Streptococci
Urological foreign material - - -
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