Moleculer surveillance of gram negative bacteria causung seconder and tertiary peritonitis in intraabdominal infections

Hospital acquired intraabdominal infections lead high mortality rates, while antimicrobial resistance is not important problem in Community-acquired infections having no risk factors. Recent studies performed on gram negative bacteria such as Escherichia coli, Klebsiella pneumonia, Acinetobacter baumannii and Pseudomonas aeruginosa, especially frequently isolated as causative agents of tertiary peritonitis reveal novel mechanisms such as New Delhi Metallo-β-lactamase (NDM-1) that may cause a resistance development against almost all antibiotics. Cases with abdominal sepsis occur to be more serious in our hospital than other tertiary hospitals of our region due to application of surgery in patients with more predisposing diseases as well as performing of more complicated operations. In those patients early and efficient treatment together with surveillance of sources is life-saving. Thus, collective evaluation of the phenotypic and genotypic characteristics of causative microorganisms is becoming more important. In our study, we aimed to detect the resistance patterns of the gram negative bacteria isolated from patients with intraabdominal infection in our hospital as causative agents of secondary and tertiary peritonitis and to determine the phylogenetic relationships between these isolates. In the study, consecutive patients hospitalized in the General Surgery Clinic and Surgical Intensive Care Unit due to clinical diagnosis of secondary and tertiary peritonitis were investigated in two different groups. While first group was consisted of patients operated in other hospitals, second group was consisted of patients operated in our hospital. Blood culture samples and/or swab samples from purulent discharge were obtained from patients of both groups. Species-level identification and antibiotic resistance patterns were carried out using VITEK-II automated system. For detection of molecular relationships between the resistant isolates the Pulsed Field Gel Electrophoresis (PFGE) method was used. Among the 32 Gram(-) strains isolated from patients that diagnosed as peritonitis 20 E.coli, 6 K.pneumoniae, 3 P.aeruginosa, 1 Proteus spp, 1 A. Baumannii and 1 Achromobacter xylosoxidans isolates have been identified. PFGE method which we used revealed no significant clonal relationship between our strains.