Microbial Pattern and Antimicrobial Resistance, a Surgeon’s Perspective: Retrospective Study in Surgical Wards and Seven Intensive-Care Units in Two University Hospitals in Cairo, Egypt

Abstract

Significant morbidity and mortality in surgical practice is due to infection with resistant pathogens. Data from Egyptian hospitals may reflect a peculiar pattern. Retrospective study of antimicrobial susceptibility of 1,064 isolates from patients in surgical zones and intensive-care units (ICUs) in the largest 2 hospitals in Cairo in 2003. The infection rate in surgical wards was 0.41%, mostly surgical site infections. Cardiothoracic wards showed higher rates (0.52%). In ICUs, the infection rate was 6.51%, the majority were respiratory. The highest resistance rate was shown by Staphylococcus aureus (23.8%), Pseudomonas (14.9%) and Escherichia coli (10.48%). Enterococci and Citrobacter had rates below 1%. Pseudomonas aeruginosa had the highest resistance rate with third-generation cephalosporins (Cef3) and the lowest with imipenem, while for Enterobacter and Klebsiella it was highest with Cef3 and lowest with imipenem. E. coli showed the highest rate with quinolone 2 and Cef3, but there was no resistance to imipenem. Acinetobacter demonstrated the highest resistance rate with quinolone 2 and the lowest with fourth-generation cephalosporins (Cef4), while for methicillin-resistant S. aureus it was 60%. All enterococci were sensitive to vancomycin. The study provides meaningful data on a high antimicrobial resistance in Egypt. Failure of hospital hygiene and overuse of antibiotics are considered responsible.