Bacteriology of Surgical Wound Infections in a Tertiary Care Hospital in Turkey

Objective: To determine the spectrum of the pathogens cultured from surgical wound infections and assess their antimicrobial drug resistances.

Design: Laboratory-based retrospective study for the five year period.

Setting: A four hundred bed, tertiary-care university hospital in Turkey.

Results: Overall 621 pathogens were identified from January 1999 to January 2004. Of these isolates, 431 (69%) were gram-positive, 178 (29%) were gram-negative bacteria and also 12 (2%) were identified as Candida albicans. The most common organism was Staphylococcus aureus (50%), followed by Escherichia coli (8%), Streptococcus pyogenes (7%), Pseudomonas aeruginosa (7%), coagulase-negative staphylococci (6%), Enterococcus faecalis (4%), Enterobacter spp. (4%), Klebsiella pneumoniae (3%), Acinetobacter spp. (3%), Proteus spp. (3%), group B. B-haemolytic streptococci (2%), Candida albicans (2%), and Citrobacter spp. (1%). The rate of resistance to methicillin in staphylococci and multidrug resistance in S. aureus were 31% and 12%, respectively. There was no increase in resistance to methicillin by years. Piperacillin/tazobactam, sefoperazone/sulbactam, carbapenems, ofloxacin and amikacin were the most active agents against gram-negative isolates. The rates of extended spectrum beta-lactamase production in K. pneumoniae and E. coli strains were determined as 14%, and 6%, respectively.

Conclusion: Methicillin resistant Staphylococcus aureus (MRSA) is emerging as a major pathogen in surgical wound infections. We concluded that antimicrobial treatment of surgical wound infections should include empiric coverage for MRSA. The surveillance of resistance in pathogens causing surgical wound infections is necessary to promote the appropriate therapeutic choices for these infections.