Hidron Alicia I, Edwards Jonathan R, Patel Jean, Horan Teresa C, Sievert Dawn M, Pollock Daniel A, Fridkin Scott K
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.
Infect Control Hosp Epidemiol. 2008 Nov;29(11):996-1011. doi: 10.1086/591861.
To describe the frequency of selected antimicrobial resistance patterns among pathogens causing device-associated and procedure-associated healthcare-associated infections (HAIs) reported by hospitals in the National Healthcare Safety Network (NHSN).
Data are included on HAIs (ie, central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections) reported to the Patient Safety Component of the NHSN between January 2006 and October 2007. The results of antimicrobial susceptibility testing of up to 3 pathogenic isolates per HAI by a hospital were evaluated to define antimicrobial-resistance in the pathogenic isolates. The pooled mean proportions of pathogenic isolates interpreted as resistant to selected antimicrobial agents were calculated by type of HAI and overall. The incidence rates of specific device-associated infections were calculated for selected antimicrobial-resistant pathogens according to type of patient care area; the variability in the reported rates is described.
Overall, 463 hospitals reported 1 or more HAIs: 412 (89%) were general acute care hospitals, and 309 (67%) had 200-1,000 beds. There were 28,502 HAIs reported among 25,384 patients. The 10 most common pathogens (accounting for 84% of any HAIs) were coagulase-negative staphylococci (15%), Staphylococcus aureus (15%), Enterococcus species (12%), Candida species (11%), Escherichia coli (10%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (6%), Enterobacter species (5%), Acinetobacter baumannii (3%), and Klebsiella oxytoca (2%). The pooled mean proportion of pathogenic isolates resistant to antimicrobial agents varied significantly across types of HAI for some pathogen-antimicrobial combinations. As many as 16% of all HAIs were associated with the following multidrug-resistant pathogens: methicillin-resistant S. aureus (8% of HAIs), vancomycin-resistant Enterococcus faecium (4%), carbapenem-resistant P. aeruginosa (2%), extended-spectrum cephalosporin-resistant K. pneumoniae (1%), extended-spectrum cephalosporin-resistant E. coli (0.5%), and carbapenem-resistant A. baumannii, K. pneumoniae, K. oxytoca, and E. coli (0.5%). Nationwide, the majority of units reported no HAIs due to these antimicrobial-resistant pathogens.
描述美国国家医疗安全网络（NHSN）中各医院报告的与设备和操作相关的医疗保健相关感染（HAIs）病原体中特定抗菌药物耐药模式的出现频率。
纳入2006年1月至2007年10月期间向NHSN患者安全组件报告的HAIs数据（即中心静脉导管相关血流感染、导尿管相关尿路感染、呼吸机相关性肺炎和手术部位感染）。评估每家医院对每例HAIs最多3种致病分离株进行的抗菌药物敏感性试验结果，以确定致病分离株中的抗菌药物耐药情况。按HAIs类型和总体计算被判定对选定抗菌药物耐药的致病分离株的合并平均比例。根据患者护理区域类型，计算选定的抗菌药物耐药病原体的特定设备相关感染的发病率；描述报告发病率的变异性。
总体而言，463家医院报告了1例或更多HAIs：412家（89%）为普通急性护理医院，309家（67%）有200 - 1000张床位。在25384名患者中报告了28502例HAIs。10种最常见的病原体（占所有HAIs的84%）为凝固酶阴性葡萄球菌（15%）、金黄色葡萄球菌（15%）、肠球菌属（12%）、念珠菌属（11%）、大肠埃希菌（10%）、铜绿假单胞菌（8%）、肺炎克雷伯菌（6%）、肠杆菌属（5%）、鲍曼不动杆菌（3%）和产酸克雷伯菌（2%）。对于某些病原体 - 抗菌药物组合，不同类型HAIs中对抗菌药物耐药的致病分离株的合并平均比例差异显著。所有HAIs中多达16%与以下多重耐药病原体相关：耐甲氧西林金黄色葡萄球菌（占HAIs的8%）、耐万古霉素屎肠球菌（4%）、耐碳青霉烯铜绿假单胞菌（2%）、产超广谱头孢菌素酶肺炎克雷伯菌（1%）、产超广谱头孢菌素酶大肠埃希菌（0.5%）以及耐碳青霉烯鲍曼不动杆菌、肺炎克雷伯菌、产酸克雷伯菌和大肠埃希菌（0.5%）。在全国范围内，大多数单位报告没有因这些抗菌药物耐药病原体导致的HAIs。
