Document Type : Original Research


1 Dept. of Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

2 Dept. of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

3 Dept. of Infection Control, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran


Background and Objectives: Bacterial bloodstream infections (BSIs) and surgical site infections (SSIs) are among the most common nosocomial infections with high mortality and morbidity. We aimed to evaluate the frequency of various species among BSIs and SSIs at Tehran Heart Center, Tehran, Iran. Methods: Patients with localized or systemic infections that became evident 48 hours or more after hospitalization were included. Data were prospectively collected in 4 intensive care units (ICUs), 5 cardiac care units (CCUs), 7 post-CCUs, and 5 surgical wards during two consecutive years in 2008 and 2009. Approximately 18414 coronary angiography and 7393 open-heart surgeries were done within this period. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method, in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Among 212 detected patients with SSI and/or BSI in the year 2008, 138 had hospital acquired infection (HAI) and 74 had non–HAI while these figures for 2009 was 165/270 and 105/270, respectively. Staphylococcus aureus (21.5%) and  Entrobacter spp. (16.5%) were two most common pathogens responsible for hospital acquired BSIs while S. aureus (20.6%) and S. epidermidis (20.6%) were corresponding isolates responsible for community acquired BSIs. Staphylococcus aureus (53.3%) and Escherichia coli (11.0%) were the two most common pathogens responsible for hospital acquired SSIs in the year 2008, while S. aureus (49.0%) and S. epidermidis (11.0%) were the most frequently reported hospital acquired SSIs in 2009. Conclusions: Making rational decisions about hospital infection control plans may reduce infection rates for bacteria with antimicrobial resistance.  


  1. Wenzel RP, Edmond MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7(2):174-7.
  2. Diekema DJ, Beekmann SE, Chapin KC, Morel KA, Munson E, Doern GV. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol 2003;41(8):3655-60.
  3. Bratzler DW. The Surgical Infection Prevention and Surgical Care Improvement Projects: promises and pitfalls. Am Surg 2006;72(11):1010-6; discussion 21-30, 133-48.
  4. Poulakou G, Giamarellou H. Investigational treatments for postoperative surgical site infections. Expert Opin Investig Drugs 2007;16(2):137-55.
  5. Mylotte JM, Tayara A. Blood cultures: clinical aspects and controversies. Eur J Clin Microbiol Infect Dis 2000;19(3):157-63.
  6. Lepelletier D, Perron S, Bizouarn P, Caillon J, Drugeon H, Michaud JL, et al. Surgical-site infection after cardiac surgery: incidence, microbiology, and risk factors. Infect Control Hosp Epidemiol 2005;26(5):466-72.
  7. Nosrati M, Boroumand M, Tahmasebi S, Sotoudeh M, Sheikhfathollahi M, Goodarzynejad H. Excess costs associated with common healthcare-associated infections in an Iranian cardiac surgical unit. J Hosp Infect 2010;76(4):304-7.
  8. Martone WJ, Nichols RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis 2001;33 Suppl 2:S67-8.
  9. Bitkover CY, Gardlund B. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 1998;65(1):36-40.
  10. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20(11):725-30.
  11. Woods RK, Dellinger EP. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998;57(11):2731-40.
  12. Pittet D, Harbarth S, Ruef C, Francioli P, Sudre P, Petignat C, et al. Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 1999;20(1):37-42.
  13. Olmsted RN. APIC infection Control and Applied Epidemiology: Principles and Practice. St. Louis:Mosby;1996.
  14. Bayram A, Balci I. Patterns of antimicrobial resistance in a surgical intensive care unit of a university hospital in Turkey. BMC Infect Dis 2006;6:155.
  15. Decousser JW, Pina P, Picot F, Delalande C, Pangon B, Courvalin P, et al. Frequency of isolation and antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections: a French prospective national survey. J Antimicrob Chemother 2003;51(5):1213-22.
  16. Mamishi S, Pourakbari B, Ashtiani MH, Hashemi FB. Frequency of isolation and antimicrobial susceptibility of bacteria isolated from bloodstream infections at Children's Medical Center, Tehran, Iran, 1996-2000. Int J Antimicrob Agents 2005;26(5):373-9.
  17. Diekema DJ, Pfaller MA, Jones RN, Doern GV, Kugler KC, Beach ML, et al. Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections in the USA, Canada and Latin America. SENTRY Participants Group. Int J Antimicrob Agents 2000;13(4):257-71.
  18. Fluit AC, Jones ME, Schmitz FJ, Acar J, Gupta R, Verhoef J. Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the SENTRY antimicrobial surveillance program, 1997 and 1998. Clin Infect Dis 2000;30(3):454-60.
  19. Karlowsky JA, Jones ME, Draghi DC, Thornsberry C, Sahm DF, Volturo GA. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Ann Clin Microbiol Antimicrob 2004;3:7.
  20. Abdollahi A, Tabriz HM, Mahfoozi S. Frequency of pathogens and antimicrobial susceptibility of bacteria isolated from bloodstream infections. Iran J Pathol 2010;5:143-9.
  21. Mehta M, Dutta P, Gupta V. Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in north India. Jpn J Infect Dis 2005;58(3):174-6.
  22. Japoni A, Ziyaeyan M, Jmalidoust M, Farshad S, Alborzi A, Rafaatpour N, et al. Antibacterial susceptibility patterns and cross-resistance of methicillin resistant and sensitive Staphyloccus aureus isolated from the hospitalized patients in Shiraz, Iran. Brazil J Microbiol 2010;41:567-73.
  23. Jonkers D, Elenbaas T, Terporten P, Nieman F, Stobberingh E. Prevalence of 90-days postoperative wound infections after cardiac surgery. Eur J Cardiothorac Surg 2003;23(1):97-102.
  24. Sharma M, Berriel-Cass D, Baran J Jr. Sternal surgical-site infection following coronary artery bypass graft: prevalence, microbiology, and complications during a 42-month period. Infect Control Hosp Epidemiol 2004;25(6):468-71.
  25. Khorvash F, Mostafavizadeh K, Mobasherizadeh S, Behjati M, Naeini AE, Rostami S, et al. Antimicrobial susceptibility pattern of microorganisms involved in the pathogenesis of surgical site infection (SSI); A 1 year of surveillance. Pak J Biol Sci 2008;11(15):1940-4.
  26. 26.  Jarvis WR, Schlosser J, Chinn RY, Tweeten S, Jackson M. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. Am J Infect Control 2007;35(10):631-7.
  27. Ghadiri H, Vaez H, Khosravi S, Soleymani E. The Antibiotic Resistance Profiles of Bacterial Strains Isolated from Patients with Hospital-Acquired Bloodstream and Urinary Tract Infections. Crit Care Res Pract 2012;2012:890797.
  28. Soltani R, Khalili H, Abdollahi A, Rasoolinejad M, Dashti-Khavidaki S. Nosocomial Gram-positive antimicrobial susceptibility pattern at a referral teaching hospital in Tehran, Iran. Future Microbiol 2012;7:903-10.