Pop-Vicas Aurora E, D'Agata Erika M C
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Clin Infect Dis. 2005 Jun 15;40(12):1792-8. doi: 10.1086/430314. Epub 2005 May 6.
The prevalence of multidrug resistance (MDR) among gram-negative bacilli is rapidly increasing. Quantification of the prevalence and the common antimicrobial coresistance patterns of MDR gram-negative bacilli (MDR-GNB) isolates recovered from patients at hospital admission, as well as identification of patients with a high risk of harboring MDR-GNB, would have important implications for patient care.
Over a 6-year period, patients who harbored MDR-GNB (i.e., patients who had MDR-GNB isolates recovered from clinical cultures within the first 48 h after hospital admission) were identified. "MDR-GNB isolates" were defined as Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, and Klebsiella species isolates with resistance to at least 3 antimicrobial groups. A case-control study was performed to determine the independent risk factors for harboring MDR-GNB at hospital admission.
Between 1998 and 2003, the prevalence of MDR-GNB isolates recovered from patients at hospital admission increased significantly for all isolate species (P < .001), with the exception of P. aeruginosa (P = .09). Of 464 MDR-GNB isolates, 12%, 35%, and 53% of isolates were coresistant to 5, 4, and 3 antimicrobial groups, respectively. Multivariable analysis identified age > or = 65 years (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1-7.4; P < .04), prior exposure to antibiotics for > or = 14 days (OR, 8.7; 95% CI, 2.5 -30; P < .001), and prior residence in a long-term care facility (OR, 3.5; 95% CI, 1.3-9.4; P < .01) as independent risk factors for harboring MDR-GNB at hospital admission.
A substantial number of patients harbor MDR-GNB at hospital admission. Identification of common coresistance patterns among MDR-GNB isolates may assist in the selection of empirical antimicrobial therapy for patients with a high risk of harboring MDR-GNB.
革兰阴性杆菌中的多重耐药（MDR）发生率正在迅速上升。对入院患者中分离出的多重耐药革兰阴性杆菌（MDR - GNB）的发生率及其常见的抗菌药物共耐药模式进行量化，以及识别携带MDR - GNB高风险的患者，对患者护理具有重要意义。
在6年期间，识别出携带MDR - GNB的患者（即入院后48小时内从临床培养物中分离出MDR - GNB菌株的患者）。“MDR - GNB菌株”定义为对至少3类抗菌药物耐药的铜绿假单胞菌、大肠杆菌、阴沟肠杆菌和克雷伯菌属菌株。进行了一项病例对照研究，以确定入院时携带MDR - GNB的独立危险因素。
在1998年至2003年期间，除铜绿假单胞菌外（P = 0.09），从入院患者中分离出的所有菌株种类的MDR - GNB菌株发生率均显著增加（P < 0.001）。在464株MDR - GNB菌株中，分别有12%、35%和53%的菌株对5类、4类和3类抗菌药物共耐药。多变量分析确定年龄≥65岁（比值比[OR]，2.8；95%置信区间[CI]，1.1 - 7.4；P < 0.04）、既往使用抗生素≥14天（OR，8.7；95% CI，2.5 - 30；P < 0.001）以及既往居住在长期护理机构（OR，3.5；95% CI，1.3 - 9.4；P < 0.01）是入院时携带MDR - GNB的独立危险因素。
大量患者在入院时携带MDR - GNB。识别MDR - GNB菌株中的常见共耐药模式可能有助于为携带MDR - GNB高风险的患者选择经验性抗菌治疗。
