Prevalence of Environmental Gram-negative Bacilli in the Intensive Care Units of Hospitals from the City of Qom

Authors
1 Department of Biology, Faculty of Basic Sciences, Payame Noor University of Tehran, Tehran, IR Iran
2 Department of Microbiology and Immunology, Faculty of Medicine, Qom University of Medical Sciences, Qom, IR Iran
3 Department of Pathobiology, School of Health, Tehran University of Medical Sciences, Tehran, IR Iran
4 Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, IR Iran
Abstract
Background: The role of the hospital environment as a source of dissemination of pathogens is critical. Environmental surfaces in the Intensive Care Units (ICUs) are suitable for the growth of Gram-negative bacteria that normally circulate between the environment and patients and can cause outbreaks of nosocomial infections. In this study, the prevalence of Gram-negative bacilli in the environment of the ICUs and neonatal ICU (NICU) of hospitals in the city of Qom was evaluated. Materials and Methods: During a 6 month period from November 2012 to April 2013, samples were collected from environmental surfaces of ICUs of four hospitals and NICU of one hospital located in the city of Qom. Sampling was done from equipment, fluids, and surfaces and identification was carried out based on culture and biochemical tests for Gram-negative bacilli. Results: A total of 230 swab samples was collected and 50 colonies of Gram-negative bacilli were isolated from environmental surfaces. Overall, 64% of the isolates belonged to non-fermentative bacteria and 36% of the isolates belonged to Enterobacteriaceae family. Strains of Pseudomonas aeruginosa and Acinetobacter baumannii complex accounted for the highest rates of environmental isolates. In addition, Klebsiella pneumoniae was isolated from NICU. Conclusion: The high frequency of genus Acinetobacter among Gram negative bacteria isolated from environmental surfaces has a public health impact and Acinetobacter spp. should be considered in the infection control programs in hospitals. Isolation of K. pneumoniae should be regarded as a risk factor for fatal neonatal infections.

Keywords


  1. Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR. Risk factors for pneumonia and fatality in patient receiving continuous mechanical ventilators. Am Rev RespirDis. 1986; 133(5): 792-6.

  2. Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control. Infect Control. 1985; 7(4): 231-5.

  3. Plott R, Polk BF, Murdock B, Rosner B. Risk factors for nosocomial urinary tract infection. Am J Epidemiol. 1986; 124(6): 977-8.

  4. Tikhomirov E. WHO Program for the Control of Hospital Infections. Chemiotherapia. 1987; 6(3): 148-51.

  5. Mayon-White RT. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect. 1988; 11 (Supplement A): 43-8.

  6. Custovic A, Smajlovic J, Hadzic S, Ahmetagic S, Tihic N, Hadzagic H. Epidemiological surveillance of bacterial nosocomial infections in the surgical intensive care unit. Mater Socio Med.2014; 26(1): 7-11.

  7. EL Tantawy AE, Seliem ZS, Agha HM, EL-Kholy AA, Abdolaziz DM. Epidemiology of nosocomial infections and mortality following congenital cardiac surgery in Cairo university. J Egypt Public Health Assoc.2012; 87(3-4): 79-84.

  8. Dereli N, Ozayar E, Degerli S, Sahin S, Koc F. Three-year evaluation of nosocomial infection rates of the ICU. Rev Bras Anestesiol. 2013; 63(1): 73-8.

  9. Ahoyo TA, Bankole HS, Adeoti FM, Gbohoun AA, Assavedo S, Amoussou-Guenou M, et al. Prevalence of nosocomial infections and anti-infective therapy in Benin: results of the first nationwide survey in 2012. Antimicrob Resist Infect Control. 2014; 3(17).

  10. Giasvandian SH. Nosocomial infections in intensive care units. Hayat. 2002; 8(1): 27-34.

  11. World Health Organization. Health care-associated infections. Available from http:// www.who.int / gpsc / country-work / gpsc-ccisc-fact-sheet-en.pdf

  12. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-chanoin MH, et al. The prevalence of nosocomial infections in intensive care units in Europe results of the European Prevalence of Infection in Intensive Care (EPIC) study, EPICInternational Adviscry Committee. JAMA.1995; 247(8): 639-44.

  13. Marrie TJ, Major H, Gurwith M. Prolonged outbreak of nosocomial UTI with a single strain of P. aeruginosa. Can Med Assoc J. 1978; 119(6): 593-596.

  14. Montgomerie TJ. Epidemiology of Klebciella infections. Rev Infect Dis. 1979; 131: 45-9.

  15. Steven RM, Teres D, Skillman JJ, Feingold DS. Pneumonia in an intensive care unit. A 30 month experience. Arch Intern Med.1974; 134(1): 106-11.

  16. Weber DJ, Raasch R, Rutala WA. Nosocomial infection in the ICU, The growing importance of antibiotic-resistant pathogens. Chest. 1999; 115(3): 34-41.

  17. Laripour M, Farsad SH. Investigate the incidence of nosocomial infection in one of the hospitals in Qom Province. Iran J Med Microbiol. 2011; 5(3): 7-17.

  18. Vafaei K, Razaviyan F, Zia Sheikholeslami N. The Epidemiologic study of one year nosocomial infections in Kamkar Hospital. J Rafsanjan Univ Med Sci. 2012; 12(4): 320-4.

  19. Danser SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect. 2009; 73(4): 378-85.

  20. Trautmann M, Bauer C, Schumann CH, Hahn PH, Hoher M, Lepper PH. Common RAPD pattern of Pseudomonas aeruginosa from patients and tap water in a medical intensive care unit. Int J Hyg Environ Health. 2006; 209(4): 325-31.

  21. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E.  Role of hospital surfaces in the transmission of emerging healthcare-associated pathogens: Noroviruse, Clostridium difficile, and Acinetobacter species. Am J Infect Control. 2010; 38(5): 25-33.

  22. Fazeli H, Motallebi-Rad T, Nasr Esfahani B, Solgi H, Nazari F .Prevalence and antibiotic resistance pattern of Acinetobacter spp isolated from environment of Al-Zahra hospital in Isfahan, Iran. J Isfahan Med Sci. 2013; 31(233): 493-501.

  23. Simonetti A, Ottaiano E, Diana MV, Onzac C, Triassi M. Epidemiology of hospital acquired infections in an adult intensive care unit. Results of a prospective cohort study. Ann Ig. 2013; 25(4): 281-9.

  24. Seward Rj. Detection of integrons in worldwide nosocomial isolates of Acinetobacter spp. Clin Microbiol Infect.1999; 5(6): 308-18.

  25. Xu Z, Li L, Shirtliff ME, Alam MJ, Yamasaki S, Shi L. Occurrence and characteristics of class 1 and class 2 integrons in Pseudomonas aeruginosa isolates from patients in southern China. J Clin Microbiol.2009; 47(1): 230-4.

  26. Joseph NM, Sistla S, Dutta TK, Badhe A, Rasitha D, Parija CH. Role of intensive care unit environmental and healthcare workers in transmission of ventilator-associated pneumonia. J Infec Dev Ctries. 2010; 4(5): 282-91.

  27. Jalalpoor SH. Frequency of beta lactamase enzyme in isolated pathogen bacteria from hospital in-vivo and in-vitro condition. J Isfahan Med Sci. 2011; 29(131): 234-42.

  28. Chandrashekar MR, Rathish KC, Nagesha CN. Reservoirs of nosocomial pathogens in neonatal intensive care units. J Indian Med Assoc. 1997; 95(3): 72-4.

  29. Gaillot O, Maruejouls C, Abachin E, Lecuru F, Arlet G, Simonet M, et al. Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended spectrum β lactamase, originating from a contaminated ultrasonography coupling gel. J Clin Microbiol. 1998; 36(5): 1357-60.

  30. Lebessi E, Dellagrammaticas H, Tassios PT, Tzouvelekis LS, Ioannidou S, Foustoukou M, et al. Extended-spectrum 1998 lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit in the high-prevalence area of Athens, Greece. J Clin Microbiol. 2002; 40(3): 799-804.

  31. Gupta A. Hospital-acquired infections in the neonatal intensive care unit Klebsiella pneumoniae. Semin Perinatal. 2002; 26(5): 340-5.

  32. Subha A, Anathan S, alavandi SV. Extended spectrum beta lactamase production and multidrug resistance in Klebsiella species isolated from children under five with intestinal and extra intestinal infections. Indian J Med Res. 2001; 113(5): 181-5.

  33. Jarvis WR, Munn VP, Highsmith AK, Culver DH, Hughes JM .The epidemiology of nosocomial infections caused by Klebsiella pneumoniae. Infect control. 1985; 6(2): 68-74.