Jalalpour S, Roohakasrakermanshahi, Zarkesh-Esfahani H. Bacterial Spread Pattern in Blood, Urine and Skin Wounds Isolated from Nosocomial Infections in Iran. Biomed Pharmacol J 2011;4(2)

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Manuscript received on :October 06, 2011
Manuscript accepted on :November 15, 2011
Published online on: 04-12-2015

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Shila Jalalpour^1*, Roohakasrakermanshahi² and Hamid Zarkesh-Esfahani³

¹Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran.

²Professor of Microbiology, Department of Biology, Faculty of Sciences, Alzahra University, Tehran, Iran.

³Associate Professor of Immunology, Department of Biology, Faculty of Sciences, University of Isfahan, Isfahan, Iran.

Abstract

S.aureusis the most common gram positive bacterium causing nosocomial infection.E.coliand K.pneomoniaeis the most common gram negative bacterium, causing mainly urinary tract infections.P.aeruginosais also very common,chiefly causing lower respiratory tract infections.The aim of this search is comparative bacterial spread pattern in blood, urine and skin wounds isolated from nosocomial infections in Iran. Materials and MethodsThe research was laboratory based and performed during 2007-2008 years in Azzahrahospital in Isfahan, According to statistical formulaselected 100 blood, urine and skin wounds, in nosocomial infection.Bacterial identification was performed with microbiological methods.ResultsFrom 100 isolate pathogen Bacteria from nosocomial infection,frequency ofStaphylococcus spp.,Enterobacteriaceae and Pseudomonas sp.in blood infection respectively was 70%, 25% and 5%,in urine infection respectively was 45%, 50%, 5% and in skin wounds infectionwas 35%, 15% and 50% respectively. The result showed high frequency of gram positive coccus and gram negative bacilliinnosocomial infections.Commonreasons of nosocomial infections include:hospitals house large numbers of people who are sick and whose immune systems are often in a weakened state;Increased use of outpatient treatment means that people who are in the hospital are sicker on average;Medical staff move from patient to patient,providing a way for pathogens to spread;Manymedical procedures bypass the body’s natural protective barriers.

Keywords

Staphylococcus; Enterobacteriaceae; Pseudomonas; Nosocomial Infection

Introduction

Nosocomial infection also called hospitalacquired infection can be defined as: An infection acquired in hospital by a patient who was admitted for a reason other than that infection .An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility (Benenson, 1995; Girard et al., 2002). Patient ca
re is provided in facilities which range from highly equipped clinics and technologically advanced university hospitals to front-line units with only basic facilities. Despite progress in public health and hospital care, infections continue to develop in hospitalized patients, and may also affect hospital staff. Many factors promote infection among hospitalized patients: decreased immunity among patients; the increasing variety of medical procedures and invasive techniques creating potential routes of infection; and the transmission of drug-resistant bacteria among crowded hospital populations, where poor infection control practices may facilitate transmission. Nosocomial infections occur worldwide and affect both developed and resource-poor countries. Infections acquired in health care settings are among themajor causes of death and increased morbidity among hospitalized patients. They are a significant burden both for the patient and for public health. The most frequent nosocomial infections are infections of surgical wounds, urinary tract infections and lower respiratory tract infections.Hospital-acquired infections add to functional disability and emotional stress of the patient and may, in some cases, lead to disabling conditions that reduce the quality of life. Nosocomial infections are also one of the leading causes of death (Ponce, 1991; Girard et al., 2002). The economic costs are considerable (Plowman, 1999;Wenzel, 1995). The increased length of stay for infected patients is the greatestcontributor to cost (Kirkland, 1999; Girard et al., 2002). One study (Coella, 1993; Girard et al., 2002) showed that the overall increase in the duration of hospitalization for patients with surgical wound infections was 8.2 days, ranging from 3 days for gynaecology to 9.9 for general surgery and 19.8 for orthopaedic surgery (Girard et al., 2002).The most commonNIs are urinary tract infections, lower respiratory tract infections,surgical-site infections, and primary septicemia (Astagneau et al.,2001;Kampf  and Kramer 2004). They lead to additional days of treatment  (Foxman, 2002;Kampf  and Kramer, 2004;Piednoir et al.,2003). increase the risk of death (Astagneau et al.,2001; Garcia et al.,2001;KampfandKramer 2004)and increasetreatment (Jenneyet al.,200;Kampf  and Kramer, A 2004; Reilly et al.,2001). We have witnessed a cyclical parade of pathogens in hospitals. In Semmelweis’s era, group A streptococci created most nosocomial problems. For the next 50 to 60 years, gram-positive cocci, particularly streptococci and Staphylococcus aureus, were the hospital pathogens of major concern(Weinstein 1998). These problems culminated in the pandemic of 1940 to 1950, when S. aureus phage type 94/96 caused major nosocomial problems. In the 1970s, gram-negative bacilli, particularly Pseudomonas aeruginosa and Enterobacteriaceae, became synonymous with nosocomial infection (Weinstein, 1998). By the late 1980s and early 1990s, several different classes of antimicrobial drugs effective against gram-negative bacilli provided a brief respite. During this time, methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE) emerged, signaling the return of the blue bugs. In 1990 to 1996, the three most common gram-positive pathogens-S. aureus, coagulase-negative staphylococci, and enterococciaccounted for 34% of nosocomial infections, and the four most common gram-negative pathogens-Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiellapneumonia– accounted for 32% (Weinstein, 1998).Urinary trace infection This is the most common nosocomial infection; 80%of infections are associated with the use of an indwellingbladder catheter (Girard et al.,2002;Mayon, 1998). Surgical site infections are also frequent: the incidencevaries from 0.5 to 15% depending on the typeof operation and underlying patient status  (Girard et al.,2002;Reseau,1996). Nosocomial bacteraemiainfections represent a small proportion ofnosocomial infections (approximately 5%) but casefatalityrates are high more than 50% for somemicroorganisms (Girard et al.,2002).

The aims of this search were study and comparative bacteria spread pattern in blood, urine and skin wounds isolated from nosocomial infections in Iran.

Material and Methods

Clinical Isolates

A total of 100 consecutive non-repeat culture isolates ofStaphylococcuaureus, S.epidermidis, S. saprophitycus,Pseudomonas,Escherichia coli and Klebsiellapneumoniae were obtained from different clinical specimens such as urine, skin wounds and blood nosocomial infections, over a period of 24 months (2007-2008).

The isolates were identified on the basis of conventional microbiological procedures.(Koneman et al.,2006)

Bacterial strains

Identification bacteria was performed with microbiological methods e.g Gram stains and biochemical tests with the BioMerieux database system and use of differential culture medium. In first step specimen grows on sheep blood and EMB agars then incubated at 37°C under aerobic conditions (Jalalpooretal., 2009a; Washington etal., 2006).

Results

From 100 isolate pathogen Bacteria from nosocomial infection, frequency of Staphylococcus spp., Enterobacteriaceae and Pseudomonas sp. in blood infection was 70%, 25% and 5%, in urine infection was 45%, 50%, 5% and in skinwounds infection was 35%, 15% and 50% respectively(Diag 1, 2).

Diagram. 1 Comparative Frequency of bacteria in skin wounds, urinary and blood nosocomial infections Click here to View figure

Diagram. 2  Frequency of bacteria species in nosocomial infections Click here to View figure

According to result,Staphylococcus spp. andEnterobacteriaceaehave highly frequency in urinary nosocomial infection and blood nosocomial infections. In urinary nosocomial infections, E. coli and K. pneumonia consist 50% all of isolated bacteria, in skin wounds nosocomial infections, Pseudomonas consist 50% all of isolated bacteria and in blood nosocomial infections Staphylococcusconsist 70% all of isolated bacteria (Diag 1).

Conclusion

According result of present paper, Staphylococcus sp. and Enterobacteriaceae consist of the more bacteria isolated of nosocomial infections samples.According previous study in Iran, Staphylococcus sp. and Enterobacteriaceae have highly frequency in hospital biotic and abiotic condition.

About importance staff hands and hospital surfaces in NIs, there is consensus that control bacterial population in these sources, lead to control these bacteria in hospital (Boyce et al.2002; Jalalpoor et al.2007;Sehulster et al.,2003).According result previous study in Iranian hospital, Staphylococcussp. 101 consist of isolated bacteria from hospital surfaces and 28 consist of isolated bacteria from hands of staff and according to Acidimetric test results respectively 73 species of Staphylococcus isolated from hospital surfaces and 19 species of Staphylococcus isolated from hands of staff was resistance to beta lactame antibiotics(Jalalpooretal., 2009b, 2010a, b, 2011a,b).According previous study 83.33% of Staphylococcus spp. isolated from nosocomial infection in iran was resistance to beta lactame antibiotics (Jalalpooretal., 2009a, 2011c). According result another study in Iran, 61.9% of bacteria isolated from biotic condition in hospital was resistance to beta lactame antibiotics, respectively was in Staphylococcus spp., Bacillus spp. and Enterobacteriaceae 71%, 64.72% and 50%, According another study in Iran 77.94% of bacteria isolated from abiotic condition in hospital was resistance to beta lactame antibiotics, respectively was in Staphylococcus spp., Bacillus spp. and Enterobacteriaceae 82.7%, 68.4% and 80.35% (Jalalpooretal., 2009b, 2010a, b, 2011a).

NIs remain a major global concern. Approximately2 million NIs occur annually in the United States (Kampf and Kramer,2004). Overallnational prevalence rates have been described as ranging between3.5 and 9.9% (Kampf and Kramer, 2004), but they vary significantly between departments,patient groups, types of surgical procedures, and the use ofindwelling medical devices, etc(Anonymous2002, Kampf andKramer 2004).They lead to additional days of treatment, increase the risk of death and increase treatment costs. Staff hands and hospital surfaces have important role in NIs (Astagneau et al.,2001; Garcia et al.,2001; Hollenbeak et al.,2002; Orsi et al.,2002). Bacteria on hospital surfaces have low potential to spread. Staff hands are more sources to transmission bacteria in hospital. Increase staff hand and hospital surfaces hygiene has been considered the most important toolin control of NIs (Boyce et al.,2002; Jalalpoor et al.,2007,2008,2010c,d;Sehulster et al.,2003).

The overall financial burden incurred by NIs has been estimatedto be $4.5 billion per year in the United States alone, approximately one-third of all NIs are regarded as preventable(Kampf and Kramer, 2004).Studies throughout the world document thatnosocomial infections are a major cause ofmorbidity and mortality (Girard et al., 2002).A high frequency ofnosocomial infections is evidence of a poor qualityof health service delivery, and leads to avoidablecosts. Many factors contribute to the frequency ofnosocomial infections: hospitalizedpatients areoften immune compromised, they undergo invasiveexaminations and treatments, and patient care practicesand the hospital environment may facilitate thetransmission of microorganisms among patients.Prevention of nosocomial infections is the responsibility of all individuals and services providinghealth care. Everyone must work cooperatively to reduce the risk of infection for patients and staff. This includes personnel providing direct patient care, management and physical plant, provision of materials and products, and training of health workers. Infection control programmes(Gaynes, 1998; Girard et al., 2002) are effective provided they are comprehensive and include surveillance and prevention activities, as well as staff training. There must also be effective support at the national and regional levels. The nosocomial infection rate in patients in a facility is an indicator of quality and safety of care. The development of a surveillance process to monitor this rate is an essential first step to identify local problems and priorities, and evaluate the effectiveness of infection control activity. Surveillance, by itself, is an effective process to decrease the frequency of hospital-acquired infections (Girard et al., 2002).

Acknowledgments

This article was written according result of the thesis “Study of Production of beta lactamase and Surface layer, Nano Structure in some of Isolated Pathogen Bacteria from Clinical and Environmental Hospital Samples”. This thesis has been introduced as the top country, microbiology thesis in 2009 defended among the defended thesis during of 2004 to 2008 years in Islamic Republic of Iran.

Author would like their subspecialty Alzahra Hospital Management, Isfahan University, Management of science research lab of Isfahan university, journals manager of  Isfahan University of Medical Sciences, Azzahra Hospital Infection control committee, DrRoohaKasraKermanshahi, Dr Ashraf Sadat Noohi, Dr Hamid ZarkeshEsfahani, Dr.ArdeshirTalebi, Dr. MehrdadMemarzadeh, Dr. KamyarMostafavizadeh,SinaiMobasherizadeh,FariborzKianpour, Mohsen HosseiniBalam, Ms. KobraMaqhsudi, Mr Ali Mehrabi  and all  persons help us in concert to achieve this research.

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