Kuo Lu-Cheng, Yu Chong-Jen, Kuo Ming-Long, Chen Wei-Nan, Chang Chee-Kong, Lin Hen-I, Chen Chih-Chiang, Lu Min-Chi, Lin Ching-Hsiung, Hsieh Wu-Feng, Chen Liang-Wu, Chou Yih, Huang Ming-Shian, Lee Cheng-Hsiung, Chen Shen-Chun, Thai Sun-Lung, Chen Po-Chung, Chen Ching-Hsiung, Tseng Chung-Chia, Chen Yao-Shen, Hsiue Tzuen-Ren, Hsueh Po-Ren
National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Int J Antimicrob Agents. 2008 May;31(5):420-6. doi: 10.1016/j.ijantimicag.2008.01.010. Epub 2008 Mar 20.
A horizontal surveillance study was conducted to identify common bacteria and mycobacteria from 611 respiratory aspirates and 165 urinary samples from 611 patients hospitalised at 17 respiratory care wards (RCWs) in Taiwan. Some major resistance phenotypes, including methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis, and multidrug-resistant Pseudomonas aeruginosa (MDR-PA) and Acinetobacter baumannii (MDR-AB), were identified. Pulsotypes of ESBL-producing P. mirabilis isolates were determined by pulsed-field gel electrophoresis. The prevalences of MRSA, ESBL-producing E. coli (K. pneumoniae and P. mirabilis), carbapenem-resistant (resistant to imipenem and meropenem) P. aeruginosa, MDR-PA, carbapenem-resistant A. baumannii and MDR-AB were, respectively, 86.7%, 20.0% (50.7% and 24.1%), 18.4%, 1.2%, 32.1% and 8.9% for respiratory aspirates and 100%, 25.4% (27.3% and 25.0%), 48.3%, 10.3%, 50.0% and 21.4% for catheterised urinary samples. Among the 44 respiratory isolates of P. mirabilis with an ESBL phenotype, 22 different pulsotypes (>80% identity) were identified. Among 103 isolates of mycobacteria, 90 (87.4%) belonged to rapidly growing mycobacteria and 4 (4%) were Mycobacterium tuberculosis. Among the 404 patients with available clinical information, true infections were found in 28.0%, the most prevalent of which were urinary tract infection (20.5%) and ventilator-associated pneumonia (10.9%). High prevalences of various multidrug-resistant bacteria among the respiratory and urinary tracts of patients present a clinical difficulty in choosing empirical antibiotic treatment in RCWs.
开展了一项横向监测研究，以从台湾17个呼吸照护病房（RCW）的611名住院患者的611份呼吸道吸出物和165份尿液样本中鉴定常见细菌和分枝杆菌。鉴定出了一些主要的耐药表型，包括耐甲氧西林金黄色葡萄球菌（MRSA）、产超广谱β-内酰胺酶（ESBL）的大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌，以及多重耐药铜绿假单胞菌（MDR-PA）和鲍曼不动杆菌（MDR-AB）。通过脉冲场凝胶电泳确定产ESBL奇异变形杆菌分离株的脉冲型。MRSA、产ESBL大肠埃希菌（肺炎克雷伯菌和奇异变形杆菌）、耐碳青霉烯类（对亚胺培南和美罗培南耐药）铜绿假单胞菌、MDR-PA、耐碳青霉烯类鲍曼不动杆菌和MDR-AB在呼吸道吸出物中的患病率分别为86.7%、20.0%（50.7%和24.1%）、18.4%、1.2%、32.1%和8.9%，在导尿尿液样本中的患病率分别为100%、25.4%（27.3%和25.0%）、48.3%、10.3%、50.0%和21.4%。在44株具有ESBL表型的呼吸道奇异变形杆菌分离株中，鉴定出22种不同的脉冲型（同一性>80%）。在103株分枝杆菌分离株中，90株（87.4%）属于快速生长分枝杆菌，4株（4%）为结核分枝杆菌。在404例有可用临床信息的患者中，发现28.0%存在真正感染，其中最常见的是尿路感染（20.5%）和呼吸机相关性肺炎（10.9%）。患者呼吸道和泌尿道中各种多重耐药菌的高患病率给呼吸照护病房选择经验性抗生素治疗带来了临床困难。
