Randrianirina Frédérique, Vaillant Laetitia, Ramarokoto Charles Emile, Rakotoarijaona Armand, Andriamanarivo Mamy Lalatiana, Razafimahandry Henri Claude, Randrianomenjanahary Jules, Raveloson Jean Roger, Hariniana Elisoa Ratsima, Carod Jean-François, Talarmin Antoine, Richard Vincent
Institut Pasteur de Madagascar.
J Infect Dev Ctries. 2010 Mar 8;4(2):74-82. doi: 10.3855/jidc.454.
In developing countries, knowledge of antimicrobial resistance patterns is essential to define empirical therapy.
All the surgery and intensive care wards of two hospitals in Antananarivo were included to study the antimicrobial susceptibility of the pathogenic bacteria causing nosocomial infections. A repeated cross-sectional survey was conducted between September 2006 and March 2008, one day per week. Isolates were identified using classical methods, and resistance to antibiotics was assessed according to the recommendations of the Antibiogram Committee of the French Microbiology Society.
Clinical specimens from 706 from 651 patients were collected. Of the 533 bacterial pathogens, 46.7% were Enterobacteriaceae, 19.3% were Staphylococcus aureus, and 19.1% were pathogens from the hospital environment (Pseudomonas aeruginosa and Acinetobacter baumannii).Frequencies of resistance were high, particularly in Enterobacteriaceae; however, the rate of Staphylococcus aureus isolates resistant to oxacillin (13.6 %) was moderate and all these isolates were susceptible to glycopeptids. The percentages of isolates susceptible to ceftazidim were 81.8% for E. coli, 60.9% for Klebsiella, and 52.5% for Enterobacter spp. Resistance to third-generation cephalosporins was due to extended spectrum betalactamases (ESBL). Multivariate analysis showed that diabetes (adjusted OR: 3.9) and use of an invasive procedures (adjusted OR: 3.5) were independent risk factors for resistance to third-generation cephalosporins.
A nationwide surveillance programme is needed to monitor the microbial trends and antimicrobial resistance in Madagascar.
在发展中国家，了解抗菌药物耐药模式对于确定经验性治疗至关重要。
纳入塔那那利佛两家医院的所有外科和重症监护病房，以研究引起医院感染的病原菌的抗菌药敏情况。在2006年9月至2008年3月期间，每周进行一天的重复横断面调查。使用经典方法鉴定分离株，并根据法国微生物学会抗菌谱委员会的建议评估对抗生素的耐药性。
收集了来自651例患者的706份临床标本。在533株细菌病原体中，46.7%为肠杆菌科细菌，19.3%为金黄色葡萄球菌，19.1%为医院环境中的病原体（铜绿假单胞菌和鲍曼不动杆菌）。耐药频率较高，尤其是在肠杆菌科细菌中；然而，对苯唑西林耐药的金黄色葡萄球菌分离株比例（13.6%）适中，所有这些分离株对糖肽类敏感。对头孢他啶敏感的分离株百分比，大肠杆菌为81.8%，克雷伯菌为60.9%，肠杆菌属为52.5%。对第三代头孢菌素的耐药是由于超广谱β-内酰胺酶（ESBL）。多变量分析显示，糖尿病（校正比值比：3.9）和侵入性操作的使用（校正比值比：3.5）是对第三代头孢菌素耐药的独立危险因素。
马达加斯加需要一个全国性的监测计划来监测微生物趋势和抗菌药物耐药情况。
