Al Johani Sameera M, Akhter Javed, Balkhy Hanan, El-Saed Ayman, Younan Mousaad, Memish Ziad
King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Ann Saudi Med. 2010 Sep-Oct;30(5):364-9. doi: 10.4103/0256-4947.67073.
Patients in the ICU have encountered an increasing emergence and spread of antibiotic-resistant pathogens. We examined patterns of antimicrobial susceptibility in gram-negative isolates to commonly used drugs in an adult ICU at a tertiary care hospital in Riyadh, Saudi Arabia.
A retrospective study was carried out of gram-negative isolates from the adult ICU of King Fahad National Guard Hospital (KFNGH) between 2004 and 2009. Organisms were identified and tested by an automated identification and susceptibility system, and the antibiotic susceptibility testing was confirmed by the disk diffusion method.
The most frequently isolated organism was Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pnemoniae, Stenotrophomonas maltophilia, and Enterobacter. Antibiotic susceptibility patterns significantly declined in many organisms, especially A baumannii, E coli, S marcescens, and Enterobacter. A baumannii susceptibility was significantly decreased to imipenem (55% to 10%), meropenem (33% to 10%), ciprofloxacin (22% to 10%), and amikacin (12% to 6%). E coli susceptibility was markedly decreased (from 75% to 50% or less) to cefuroxime, ceftazidime, cefotaxime, and cefepime. S marcescens susceptibility was markedly decreased to cefotaxime (100% to 32%), ceftazidime (100% to 35%), and cefepime (100% to 66%). Enterobacter susceptibility was markedly decreased to ceftazidime (34% to 5%), cefotaxime (34% to 6%), and pipracillin-tazobactam (51% to 35%). Respiratory samples were the most frequently indicative of multidrug-resistant pathogens (63%), followed by urinary samples (57%).
Antimicrobial resistance is an emerging problem in the KFNGH ICU, justifying new more stringent antibiotic prescription guidelines. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future.
重症监护病房（ICU）患者面临着抗生素耐药病原体日益增多及传播的问题。我们在沙特阿拉伯利雅得一家三级护理医院的成人ICU中，研究了革兰氏阴性菌分离株对常用药物的药敏模式。
对2004年至2009年期间法赫德国民警卫队医院（KFNGH）成人ICU的革兰氏阴性菌分离株进行回顾性研究。通过自动鉴定和药敏系统对微生物进行鉴定和检测，并用纸片扩散法确认抗生素药敏试验结果。
最常分离出的微生物是鲍曼不动杆菌，其次是铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌和肠杆菌。许多微生物的抗生素药敏模式显著下降，尤其是鲍曼不动杆菌、大肠埃希菌、粘质沙雷氏菌和肠杆菌。鲍曼不动杆菌对亚胺培南（从55%降至10%）、美罗培南（从33%降至10%）、环丙沙星（从22%降至10%）和阿米卡星（从12%降至6%）的敏感性显著降低。大肠埃希菌对头孢呋辛、头孢他啶、头孢噻肟和头孢吡肟的敏感性明显降低（从75%降至50%或更低）。粘质沙雷氏菌对头孢噻肟（从100%降至32%）、头孢他啶（从100%降至35%）和头孢吡肟（从100%降至66%）的敏感性明显降低。肠杆菌对头孢他啶（从34%降至5%）、头孢噻肟（从34%降至6%）和哌拉西林-他唑巴坦（从51%降至35%）的敏感性明显降低。呼吸道样本最常显示多重耐药病原体（63%），其次是尿液样本（57%）。
抗生素耐药性是KFNGH ICU中一个新出现的问题，这证明需要制定更严格的新抗生素处方指南。持续监测抗生素药敏性并严格遵守感染预防指南对于未来消除重大疫情至关重要。
