Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi-110060, India.
J Antimicrob Chemother. 2011 Jul;66(7):1625-30. doi: 10.1093/jac/dkr167. Epub 2011 May 17.
Multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii are becoming increasingly important nosocomial pathogens worldwide. To study the evolution of non-fermenters in a tertiary care hospital, we undertook a retrospective 10 year (1999-2008) trend analysis of antimicrobial consumption and resistance in non-fermenters causing bacteraemia.
Antibiotic consumption and resistance were analysed by linear regression. The Pearson correlation coefficient was used for assessing correlation between them.
A total of 69,010 blood cultures were performed, which grew 15,465 isolates (22% positivity rate), of which 1525 isolates (771 isolates of P. aeruginosa and 754 isolates of A. baumannii) were non-fermenters. Overall antibiotic consumption showed an increasing trend, from 158 to 319 defined daily doses (DDDs)/100 bed-days (r(2)= 0.62, P = 0.007). The largest relative increase in antibiotic consumption was seen for carbapenems (r(2)= 0.68, P = 0.022), followed by β-lactam/inhibitor combinations (r(2 )= 0.45, P = 0.033), whereas third-generation cephalosporins, fluoroquinolones and aminoglycosides showed no significant changes. A significant increase in resistance in A. baumannii to fluoroquinolones (r(2 )= 0.63, P = 0.006), aminoglycosides (r(2 )= 0.63, P = 0.011) and carbapenems (r(2 )= 0.82, P = 0.013) and in P. aeruginosa to aminoglycosides (r(2 )= 0.59, P = 0.01) was observed. Carbapenem consumption was associated with the development of resistance in A. baumannii (r = 0.756, P = 0.049), whereas no such association was observed for other antimicrobials among non-fermenters.
Our study highlights the growing problem of high antimicrobial consumption. The increasing prevalence of non-fermenters and the emergence of multidrug-resistant A. baumannii are associated with the consumption of carbapenems. The data cannot prove cause and effect.
多重耐药铜绿假单胞菌和鲍曼不动杆菌在全球范围内成为日益重要的医院内病原体。为了研究三级护理医院中非发酵菌的演变，我们对 1999 年至 2008 年期间引起菌血症的非发酵菌的抗生素使用和耐药性进行了回顾性的 10 年趋势分析。
通过线性回归分析抗生素的使用和耐药性。采用皮尔逊相关系数评估它们之间的相关性。
共进行了 69010 次血培养，培养出 15465 株（阳性率为 22%），其中 1525 株（771 株铜绿假单胞菌和 754 株鲍曼不动杆菌）为非发酵菌。总体抗生素使用呈上升趋势，从 158 至 319 限定日剂量/100 床日（r²=0.62，P=0.007）。抗生素使用量的最大相对增加见于碳青霉烯类（r²=0.68，P=0.022），其次是β-内酰胺/抑制剂组合（r²=0.45，P=0.033），而第三代头孢菌素、氟喹诺酮类和氨基糖苷类则无明显变化。鲍曼不动杆菌对氟喹诺酮类（r²=0.63，P=0.006）、氨基糖苷类（r²=0.63，P=0.011）和碳青霉烯类（r²=0.82，P=0.013）以及铜绿假单胞菌对氨基糖苷类（r²=0.59，P=0.01）的耐药性显著增加。碳青霉烯类的使用与鲍曼不动杆菌耐药性的发展相关（r=0.756，P=0.049），而非发酵菌的其他抗生素则没有这种相关性。
本研究强调了高抗生素使用量不断增加的问题。非发酵菌的流行率不断上升和多重耐药鲍曼不动杆菌的出现与碳青霉烯类的使用有关。数据不能证明因果关系。
