某军事烧伤中心分离出的多重耐药菌的流行情况。
Prevalence of multidrug-resistant organisms recovered at a military burn center.
机构信息
San Antonio Military Medical Center, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
出版信息
Burns. 2010 Sep;36(6):819-25. doi: 10.1016/j.burns.2009.10.013. Epub 2010 Jan 18.
Infections caused by multidrug-resistant (MDR) pathogens are associated with significant morbidity and mortality in patients with burn injuries. We performed a 6-year antibiotic susceptibility records review from January 2003 to December 2008 to assess the prevalence of MDR isolates by pathogen at the US Army Institute of Surgical Research Burn Center. During the study period Acinetobacter baumannii (780 isolates [22%]) was the most prevalent organism recovered, followed by Pseudomonas aeruginosa (703 isolates [20%]), Klebsiella pneumoniae (695 isolates [20%]), and Staphylococcus aureus (469 isolates [13%]). MDR prevalence rates among these isolates were A. baumannii 53%, methicillin-resistant S. aureus (MRSA) 34%, K. pneumoniae 17% and P. aeruginosa 15%. Two isolates, 1 A. baumannii and 1 P. aeruginosa, were identified as resistant to all 4 classes of antibiotics tested plus colistin. A. baumannii isolates recovered from patients with burns greater than 30% of total body surface area (TBSA) were more likely to be MDR (61%) with no significant difference for P. aeruginosa and K. pneumoniae. A higher proportion of MDR P. aeruginosa isolates were recovered from respiratory specimens compared to blood specimens (24% vs. 9%) while the opposite was true for MRSA (35% vs. 54%). A comparison of A. baumannii recovered during hospitalization days 1-5 and 15-30 revealed higher MDR levels as length of stay increased (48% vs. 75%) while no significant trends were observed for P. aeruginosa and K. pneumoniae. A similar pattern was observed for MDR A. baumannii levels for the facility between 2003 and 2005 and 2006-2008 (39% vs. 70%), with no significant increase in MDR P. aeruginosa and MDR K. pneumoniae. Increasing antibiotic resistance patterns of the most prevalent isolates recovered during extended hospitalization, impact of % TBSA and other clinical parameters may affect empirical antimicrobial therapy and patient management decisions during treatment.
在烧伤患者中，由多药耐药（MDR）病原体引起的感染与显著的发病率和死亡率相关。我们对 2003 年 1 月至 2008 年 12 月的 6 年抗生素药敏记录进行了回顾，以评估美国陆军外科研究所烧伤中心病原体的 MDR 分离株的流行率。在研究期间，鲍曼不动杆菌（780 株[22%]）是最常见的分离株，其次是铜绿假单胞菌（703 株[20%]）、肺炎克雷伯菌（695 株[20%]）和金黄色葡萄球菌（469 株[13%]）。这些分离株的 MDR 流行率分别为鲍曼不动杆菌 53%、耐甲氧西林金黄色葡萄球菌（MRSA）34%、肺炎克雷伯菌 17%和铜绿假单胞菌 15%。有 2 株分离株，1 株鲍曼不动杆菌和 1 株铜绿假单胞菌，被鉴定为对所有 4 类测试抗生素加粘菌素均耐药。烧伤面积大于 30%总体表面积（TBSA）的患者分离的鲍曼不动杆菌更可能为 MDR（61%），而铜绿假单胞菌和肺炎克雷伯菌则无显著差异。与血液标本相比，从呼吸道标本中分离的耐多药铜绿假单胞菌比例更高（24%比 9%），而耐甲氧西林金黄色葡萄球菌则相反（35%比 54%）。与住院第 1-5 天和第 15-30 天相比，在住院期间第 1-5 天和第 15-30 天期间，分离的鲍曼不动杆菌的 MDR 水平更高（48%比 75%），而铜绿假单胞菌和肺炎克雷伯菌则无明显趋势。在 2003 年至 2005 年和 2006 年至 2008 年期间，该机构分离的耐多药鲍曼不动杆菌的水平也观察到类似的模式（39%比 70%），耐多药铜绿假单胞菌和耐多药肺炎克雷伯菌均无显著增加。在延长住院期间，最常见的分离株的抗生素耐药模式不断增加，%TBSA 和其他临床参数的影响可能会影响经验性抗菌治疗和治疗期间的患者管理决策。
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