Change of Antibiotic Resistance to the Causative Organisms of Pelvic Wound Infection for Recent 5 Years

Yoo Seok Kim; Soon Ki Kim; In-Chang Cho; Jin Soo Ko; Gyeong In Lee; Seung Ki Min

doi:10.14777/uti.2015.10.02.112

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

Original Article

Urogenit Tract Infect 2015;10(2):112-119.

Published online: 19 October 2015

DOI: https://doi.org/10.14777/uti.2015.10.02.112

Change of Antibiotic Resistance to the Causative Organisms of Pelvic Wound Infection for Recent 5 Years

Yoo Seok Kim, Soon Ki Kim, In-Chang Cho, Jin Soo Ko¹, Gyeong In Lee², Seung Ki Min

Departments of Urology

¹Plastic Surgery

²Laboratoy Medicine, National Police Hospital, Seoul, Korea

Correspondence to: Seung Ki Min http://orcid.org/0000-0002-9638-9668 Department of Urology, National Police Hospital, 123 Songi-ro, Songpa-gu, Seoul 05715, Korea Tel: +82-2-3400-1263, Fax: +82-2-3400-1264 E-mail: drmsk@korea.com

Received 10 October 2015 Revised 22 October 2015 Accepted 22 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pelvic infection, Wound infection, Drug resistance, Methicillin

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Fig. 1.

Incidence of causative organisms of pelvic wound infection for 5 years.

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 (%)
Organism	Year	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 (%)
Organism	Year	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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