Microbial Infection Among Admitted Patients of Cardiac Surgery in a Tertiary Hospital Dhaka

The hospital- acquired infections are among major causes of death and increased morbidity in developed and developing countries resulting to significant burden both for patients as well as public health. Drug resistance is an emerging issue in modern health care. Through this study it was targeted to evaluate, which of the major agents is responsible for infections in the different areas of the body, and which age group and gender are most affected. In 2019, a cross sectional study was carried out among 121 respondents (patients admitted in Cardiac Surgery Department in United Hospital Dhaka, Bangladesh) to assess microbial infections among the admitted patients. The present study was targeted to evaluate, which of the major agents is responsible for infections in the different areas of the body, and which age group and gender are most affected. The study results shows 33.1% aged 61-70 years. 50.4% of normal body weight. Multidrug resistance was found in 3 out of 4 type of organisms. Namely Candida. Klebsiella, Pseudomonas and E coli. The only significant correlation was found between advancement of age with growth of Klebsiella. Microbial infections and their antimicrobial sensitivity profile were assessed by frequency and significance level of p value <0.05 was used for statistical analysis (considered as significance), unless specifically mentioned. the 2 nd and 3 rd generation Cephalosporin was resistant in 100% of Klebsiella and Pseudomonas positive culture. The only significant correlation was found between advancement of age with growth of Klebsiella. The study found that alarming rate of multidrug resistance present in the organism found in various culture media. This may potentially be useful for future protocol generation and safety measurement applied to patient admitted in cardiac surgery department. All data were analysed using SPSS software versions of 16.0 (SPSS Inc., Chicago, IL, USA.


Introduction
The hospital-acquired infections are among major causes of death and increased morbidity in developed and developing countries resulting to significant burden both for patients as well as public health. Drug resistance is an emerging issue in modern health care. Especially in case of multi drug resistant organisms.
Inherently these bacteria being plasmid and transposon mediated, has facilitated the spread of antibiotic rescinding enzymes to other species of bacteria-. In addition to indiscriminate use of antimicrobials with sub-optimal dose and duration has given rise to more drug resistance [1][2][3]. Within few years of first isolation of the extended spectrum β-lactamase producing bacteria, it has spread worldwide and is now found in many different species like Enterobacteriaceae, Pseudomonas aeruginosa, Haemophilus bacteria are increasing in number and causing more severe infections, owing to their continuous mutation [4].
Infectious disease society of America addressed these categories of gram-negative bacilli, namely ESBLS producing E. coli and Klebsiella, MDR Pseudomonas and Carbapenem resistant Acinobactor sp are priority pathogen causing severity in ICU- [5][6][7]. "Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill" -reported by WHO (2014) on global surveillance of antimicrobial resistance. The hospital-acquired infections are among major causes of death and increased morbidity in developed and developing countries resulting to significant burden both for patients as well as public health -WHO (2002). The risk of healthcare-associated infection has been estimated to be two to twenty times higher in developing countries than that of resource-rich countries with the percentage of infected patients exceeding 25% [8][9][10]. Hospital acquired infection rates in Bangladesh may exceed 30% in some hospitals [11][12][13]. Ultimately these resistance In an effort to reduce the development of antibiotic resistance, the recent guidelines by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) recommended the regular generation of local antibiogram. According to that recommendations, each hospital should develop and disseminate the antibiogram that is specific to the intensive care population of that hospital. Increasing number of HAIs cases can also be related to the indiscriminate consumption of antimicrobials in primary care in most countries [14] reported that, 30% to 60% of antibiotics prescribed in even in ICUs are unnecessary, inappropriate, or suboptimal. Most tertiary care hospital is responsible for treating patients with multiple morbidity and considerably ill individuals.
These individuals seeking treatment often requires hospital stay along with various interventions. The infection control unit of hospital has a heaving task to manage the patient's safety and apply different protocols to achieve such goal. Especially in Intensive Care Unit (ICU), where physicians treat serious diseases and debilitated patients. As medical care becomes more complex and antimicrobial resistance increases, cases of HAIs tend to grow [15]. Therefore, a major concern is the increase of microorganisms resistant to a greater number of antimicrobials. They are also associated with significant morbidity, mortality, and increased hospital costs [16].
The slow rate of the antimicrobials invention and development in recent years, highlights the importance of understanding current levels of resistance and preserving the efficacy of existing antibiotics [17].
A cross-sectional study in 1991 on the nosocomial infection rate was 30% at DMCH [18]. However, in the 2011 report from DMCH that reviewed infection rates on the surgical and burn units identified a 46.2% rate of nosocomial infections [19]. Wound

Methods and Materials
It is a cross-sectional and observational study. The study was

Results
The aim of this study was to evaluate, the major agents

Microorganisms in Collected Specimen
Collected specimen revealed mostly (89.3%) absence of pathogenic microorganisms. However, 10.7% specimen revealed positive for pathogenic organisms. Only 0.8% being multiple Organisms in a single case ( Table 2). Overall specimen in admitted patients revealed 9.1% were positive for Candida, 4.1% positive for Klebsiella and 1.7% positive for Pseudomonas (Table 2).
Individually these organisms appear in deferent frequency at various specimens. Growth of Candida and Klebsiella was observed only in samples from respiratory tract secretion (Tables 3 & 4).
Pseudomonas found in respiratory secretions and pleural fluid (Table 5). Only one specimen E coli was found in wound sample
Klebsiella was observed at 40% rate in age group of 41-50 and 61-70 years. Pseudomonas was observed equally distributed between age group 51-60 and 71-80 years (Table 5). E coli was observed in a single count in age group 51-60 years. Age was significantly correlated with only Klebsiella growth.

Growth of Microorganisms in Different Weight Groups
Candida growth was observed to be in 11.8% in obese groups.
Though 45.5% Candida was found in normal body weight group. It may be considered unremarkable as half of respondents belong in this group. 40% of Klebsiella was found in in overweight and obese group ( Figure 10). Pseudomonas was distributed equally in both normal and over-weight group of respondents. The single case of E coli was observed in normal body weight group.

Discussion
The purpose of this study was to evaluate, the major agents responsible for infections among admitted patients of Cardiac to evaluate the drug sensitivity and resistance to organisms found in culture media [25].   A single case of E coli was also found to be multidrug resistant.

Conclusion
The patients were evaluated and suggested that 68. e) Hepatic Insufficiencies along with level of renal impairment and pulmonary function should also be evaluated.
As these were not performed as routine investigation for admitted patients and discarded on financial ground.

f)
Hospital can put these shortcomings in a protocol to lessen the risk by evaluating those who are of greater risk and take preventative steps.