Chazan Bibiana, Raz Raul, Teitler Nava, Nitzan Orna, Edelstein Hana, Colodner Raul
Infectious Diseases Unit, HaEmek Medical Center, Afula, Israel.
Isr Med Assoc J. 2009 Oct;11(10):592-7.
Identification of pathogens and their susceptibility to antimicrobials is mandatory for successful empiric antibiotic treatment.
To compare the clinical characteristics of patients with bacteremia, as well as the bacterial distribution and antimicrobial susceptibility in community, hospital and long-term care facilities during two periods (2001-2002 and 2005-2006).
The study was conducted at the HaEmek Medical Center, a community 500-bed teaching hospital in northern Israel serving a population of approximately 500,000 inhabitants. All episodes of bacteremia (n = 1546) during two 2 year periods (2001-2 and 2005-6) were prospectively recorded, evaluated and compared (755 in 2001-2 and 791 in 2005-6).
In both periods the urinary tract was the main port of entry in community and long-term care facility bacteremia, while the urinary tract--primary and catheter-related--were similar in frequency as sources of hospital bacteremia. Escherichia coli was the most frequent pathogen isolate. No significant changes in the frequency of methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing bacteria were seen between the two 2 year periods (2001-2 and 2005-6). The susceptibility of non-ESBL-producing E. coli decreased for some antibiotics while non-ESBL-producing Klebsiella pneumoniae susceptibility profile improved in the same period. A non-statistically significant trend of increased resistance in gram-negative isolates to quinolones, piperacillin and piperacillin-tazobactam was observed, but most isolates still remained highly susceptible to carbapenems. There was a small increase in mortality rate in hospital bacteremia during the second period.
Continuous surveillance is imperative for monitoring the local epidemiology and for developing local treatment guidelines.
对于成功进行经验性抗生素治疗而言，识别病原体及其对抗菌药物的敏感性是必不可少的。
比较两个时期（2001 - 2002年和2005 - 2006年）社区、医院和长期护理机构中菌血症患者的临床特征、细菌分布及抗菌药物敏感性。
该研究在位于以色列北部的哈梅克医疗中心进行，这是一家拥有500张床位的社区教学医院，服务人口约50万居民。前瞻性记录、评估并比较了两个2年期间（2001 - 2年和2005 - 6年）所有的菌血症发作病例（n = 1546）（2001 - 2年为755例，2005 - 6年为791例）。
在两个时期，泌尿道都是社区和长期护理机构菌血症的主要感染途径，而泌尿道（原发性和导管相关）作为医院菌血症的感染源，其发生率相似。大肠埃希菌是最常见的病原体分离株。在两个2年期间（2001 - 2年和2005 - 6年），耐甲氧西林金黄色葡萄球菌和产超广谱β - 内酰胺酶细菌的发生率未见显著变化。非产超广谱β - 内酰胺酶大肠埃希菌对某些抗生素的敏感性下降，而同期非产超广谱β - 内酰胺酶肺炎克雷伯菌的药敏谱有所改善。观察到革兰阴性菌分离株对喹诺酮类、哌拉西林和哌拉西林 - 他唑巴坦的耐药性呈非统计学显著上升趋势，但大多数分离株对碳青霉烯类仍高度敏感。第二个时期医院菌血症的死亡率略有上升。
持续监测对于监测当地流行病学情况和制定当地治疗指南至关重要。
