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Silvano Esposito
Renato Gioia
Giuseppe De Simone
Silvana Noviello
Sebastiano Leone


antibiotic resistance, bacterial infections, surgery wards


Objectives: Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011-2013.

Methods: Data concerning bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek II database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher’s exact test were used to analyze categorical variables.

Results: In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated, Enterococcus faecalis, Staphylococcus epidermidis and Staphylococcus aureus being the most commonly found. No significant variation in the antibiotic susceptibility pattern was observed, either among Gram-negative or among Gram-positive pathogens; carbapenems (especially meropenem) consumption remained stable over time.

Conclusions: Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data.


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1. Ramcharan AA, den Heijer CD, Smeets EE, Rouflart MM, van Tiel FH, Bruggeman CA, Breukink SO, Tordoir JH, Baeten CG, Stobberingh EE. Microbiology of surgical site infections after gastrointestinal surgery in the south region of The Netherlands. Future Microbiol. 2014;9:291-8.

2. Montravers P, Lepape A, Dubreuil L, Gauzit R, Pean Y, Benchimol D, Dupont H. Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: results of the French prospective, observational EBIIA study. J Antimicrob Chemother. 2009;63:785-94.

3. De Werra C, Schiavone D, Di Micco R, Triassi M. Surgical site infections in Italy. Infez Med. 2009;17:205-18.

4. Stefani S. Evolution in the antibiotic susceptibility and resistance. Infez Med. 2009;17(Suppl 3):5-12.

5. Esposito S, Capuano A, Noviello S, Mazzeo F, Ianniello F, Filippelli A, Rossi F, Leone S. Modification of patients' endogenous bacterial flora during hospitalization in a large teaching hospital in Naples. J Chemother. 2003;15:568-73.

6. Manian FA, Meyer PL, Setzer J, Senkel D. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin Infect Dis. 2003;36:863-68.

7. Esposito S, Ianniello F, Leone S, Noviello S, Marvaso A, Iannantuoni N, Esposito E, Imperato L, Aiello D, Aloisio T, Maio P, Acierno D, Romano G, Patrelli G. Multicentre survey of post-surgical infections in Campania (Italy). Infez Med. 2003;11:146-52.

8. Drago L. Epidemiology and mechanisms of resistance: clinical and environmental impact. Infez Med. 2007;15(Suppl 2):6-12.

9. Camporese A, Santini G. Surveillance of antibiotic-resistant microorganisms for the rational use of antimicrobial drugs. Infez Med. 1999;7:172-76.

10. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70(Suppl 2):3-10.

11. Leaper DJ. Risk factors for and epidemiology of surgical site infections. Surg Infect. 2010;11:283-87.

12. Young MH, Washer L, Malani PN. Surgical site infections in older adults: epidemiology and management strategies. Drugs Aging. 2008;25:399-414.

13. Esposito S, Leone S, Noviello S, Lanniello F, Fiore M. Antibiotic resistance in long-term care facilities. New Microbiol. 2007;30:326-31.

14. Shree N, Arora BS, Mohil RS, Kasana D, Biswal I. Bacterial profile and patterns of antimicrobial drug resistance in intra-abdominal infections: current experience in a teaching hospital. Indian J Pathol Microbiol. 2013;56:388-92.

15. Nicoletti G, Nicolosi D, Rossolini GM, Stefani S. Etiology, epidemiology and microbiological diagnosis of intra-abdominal infections. Infez Med. 2008;16(Suppl 1):8-18.

16. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2011. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). 2012.

17. Sheng WH, Badal RE, Hsueh PR. SMART Program. Distribution of extended-spectrum ?-lactamases, AmpC ?-lactamases, and carbapenemases among Enterobacteriaceae isolates causing intra-abdominal infections in the Asia-Pacific region: results of the study for Monitoring Antimicrobial Resistance Trends (SMART). Antimicrob Agents Chemother. 2013;57:2981-88.

18. Esposito S, Leone S, Carosi G. Analysis of current guidelines for intra-abdominal infections. J Chemother. 2009;21(Suppl 1):30-35.

19. Deveci Ö, Dal T, Tekin R, Bozkurt F, Tekin A, Dayan S. Carbapenem resistance in Acinetobacter baumannii: where is it heading? Infez Med. 2013;21:211-15.

20. Bassetti M. Strategies for management of difficult to treat Gram-negative infections: focus on Pseudomonas aeruginosa. Infez Med. 2007;15(Suppl 2):20-26.

21. Ece G, Samlioglu P, Atalay S, Kose S. Evaluation of the in vitro colistin susceptibility of Pseudomonas aeruginosa and Acinetobacter baumannii strains at a tertiary care centre in Western Turkey. Infez Med. 2014;22:36-40.

22. Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2008;197:1079-81.

23. Gales AC, Jones RN, Sader HS. Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006-09). J Antimicrob Chemother. 2011;66:2070-74.

24. Fernández-Cuenca F, Tomás-Carmona M, Caballero-Moyano F, Bou G, Martínez-Martínez L, Vila J, Pachón J, Cisneros JM, Rodríguez-Baño J, Pascual A. In vitro activity of

18 antimicrobial agents against clinical isolates of Acinetobacter spp.: multicenter national study GEIH-REIPI-Ab 2010. Enferm Infecc Microbiol Clin. 2013;31:4-9.

25. Karlowsky JA, Adam HJ, Baxter MR, Lagacé-Wiens PR, Walkty AJ, Hoban DJ, Zhanel GG. Antimicrobial susceptibility of 22746 pathogens from Canadian hospitals: results of the CANWARD 2007-11 study. J Antimicrob Chemother. 2013;68(Suppl 1):17-22.

26. Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A Review of Ten Years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel). 2013;6:1335-46.

27. Castanheira M, Mendes RE, Woosley LN, Jones RN. Trends in carbapenemase-producing Escherichia coli and Klebsiella spp. from Europe and the Americas: report from the SENTRY antimicrobial surveillance programme (2007-09). J Antimicrob Chemother. 2011;66:1409-11.

28. Manfredi R, Nanetti A. An active microbiological surveillance project at an Italian teaching hospital: microbial isolates, recent epidemiological trends, major clinical concerns, and antimicrobial susceptibility rates during a four-year period. Infez Med. 2009;17:219-27.

29. Leone S, Stefani S, Venditti M, Grossi P, Colizza S, De Gasperi A, Scaglione F, Sganga G, Esposito S. Intra-abdominal infections: model of antibiotic stewardship in an era with limited antimicrobial options. Int J Antimicrob Agents. 2011;38:271-2.

30. Esposito S, Leone S, Noviello S, Ianniello F. Management of severe bacterial infections and role of the infectious disease specialist: results of an interview-based survey. Infez Med 2004;12:90-100.

31. Esposito S, Leone S, Noviello S. Management of severe bacterial infections. Expert Rev Anti Infect Ther. 2005;3:593-600.