Abstract
Aim: to study the level of colonization by multidrug-resistant microorganisms of open body biocenoses (mucous membranes of the pharynx and rectum) in children of the first year of life with congenital heart defects (CHD) from the risk group of carriage of multidrug-resistant microflora.
Material and methods. In the period 2016–2020 (5 years), 1613 patients were sequentially included in a retrospective clinical study who were admitted for surgical treatment for CHD. The average age of the patients was 1.46 months (from 0.03 to 12 months). Risk factors included emergency hospitalization, transfer from other hospitals, and antibiotic therapy in the near anamnesis. In each patient, no later than 72 hours after admission to the hospital, smears were taken from the mucous membranes of the pharynx and rectum for microbiological examination (total – 3226 samples). The target parameters analyzed were the isolation of enterobacteria – producers of extended spectrum beta-lactamases (ESBL), enterobacteria – producers of carbapenemases, multidrug-resistant gram-negative bacteria, oxacillin-resistant staphylococci and vancomycin-resistant enterococci.
Results. In total 429 (26.6%) out of 1613 patients included in the study were colonized with multidrug-resistant microflora, and in 14 (3.3%) carriers only the pharynx was colonized, in 289 (67.4%) only the rectum, while 126 (29.3%) have both loci. It should be noted a significant trend towards a decrease in the frequency of carriage of "problem" microflora (from 34.6% in 2016 to 19.4% in 2020 – by 15.2%). Colonization of mucous membranes by Enterobacterales – ESBL producers (mucous membrane of the pharynx – 4.9%, mucous membrane of the rectum – 17.3%) was most often noted. The carriage of Enterobacterales – producers of carbapenemases and other multi-resistant gram-negative bacteria – was less common (in total for the studied loci – 6.6 and 3.8%, respectively). The frequency of colonization by vancomycin-resistant enterococci was 4.5%, and by oxacillin-resistant S. aureus – 0.6%.
Conclusion. The carriage of problematic microflora in children with CHD who are admitted for cardiac surgery indicates a high risk of introducing multidrug-resistant microorganisms into the hospital and requires appropriate infection control measures.
References
- Vijarnsorn C., Winijkul G., Laohaprasitiporn D., Chungsomprasong P., Chanthong P., Durongpisitkul K. et al. Postoperative fever and major infections after pediatric cardiac surgery. J. Med. Assoc. Thai. 2012; 95 (6): 761–70.
- Yu X., Chen M., Liu X., Chen Y., Hao Z., Zhang H. et al. Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease. BMC Infect. Dis. 2020; 20 (1): 64. DOI: 10.1186/s12879-020-4769-6
- WHO publishes list of bacteria for which new antibiotics are urgently needed https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed (15 марта 2021 г.).
- Sukhorukova M.V., Eydel'shteyn M.V., Ivanchik N.V., Skleenova E.Yu., Shaydullina E.R., Azizov I.S. et al. Antimicrobial resistance of nosocomial Enterobacterales isolates in Russia: results of multicenter epidemiological study "MARATHON 2015-2016". Clinical Microbiology and Antimicrobial Chemotherapy. 2019; 2: 147–59 (in Russ.). DOI: 10.36488/cmac.2019.2.147-159
- Shek E.A., Sukhorukova M.V., Eydel'shteyn M.V., Skleenova E.Yu., Ivanchik N.V., Shaydullina E.R. et al. Antimicrobial resistance, carbapenemase production, and genotypes of nosocomial Acinetobacter spp. isolates in Russia: results of multicenter epidemiological study "MARATHON 2015- 2016". Clinical Microbiology and Antimicrobial Chemotherapy. 2019; 2: 171–80 (in Russ.). DOI: 10.36488/cmac.2019.2.171-180
- Eydel'shteyn M.V., Shek E.A., Sukhorukova M.V., Skleenova E.Yu., Ivanchik N.V., Shaydullina E.R. Antimicrobial resistance, carbapenemase production, and genotypes of nosocomial Pseudomonas aeruginosa isolates in Russia: results of multicenter epidemiological study "MARATHON 2015–2016". Clinical Microbiology and Antimicrobial Chemotherapy. 2019; 2: 160–70 (in Russ.). DOI: 10.36488/cmac.2019.2.160-170
- Sulian O., Ageevets V., Lazareva I., Gostev V., Popov D., Vostrikova T. et al. Co-production of MCR-1 and NDM-1 by Escherichia coli sequence type 31 isolated from a newborn in Moscow, Russia. Int. J. Infect. Dis. 2020; 101: 4–5. DOI: 10.1016/j.ijid.2020.09.1422
- Dedeić-Ljubović A., Hukić M. Occurrence of colonization and infection with multidrug-resistant organisms in a neonatal intensive care unit. Med. Glas. (Zenica). 2012; 9 (2): 304–10.
- Engelman R., Shahian D., Shemin R., Guy T.S., Bratzler D., Edwards F., et al. The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. Ann. Thorac. Surg. 2007; 83 (4): 1569–76. DOI: 10.1016/j.athoracsur.2006.09.04
About the authors
Dmitriy A. Popov, Dr. Med. Sc., Head of Laboratory,
ORCID
