Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Crete, Greece.
Surg Infect (Larchmt). 2012 Oct;13(5):326-31. doi: 10.1089/sur.2011.115. Epub 2012 Sep 26.
In this era of increasing antimicrobial resistance, infections caused by multi-drug-resistant (MDR) gram-negative bacilli (GNB) are becoming more common and pose a challenge to all clinicians, including surgeons.
We evaluated the epidemiology and antimicrobial sensitivities of GNB isolated from patients treated on surgical wards at the University Hospital of Heraklion, Crete, Greece, from 2004 to 2009. The MDR isolates were defined according to an international expert proposal supported by the U.S. Centers for Disease Control and Prevention and the European Centre for Disease Prevention and Control.
A total of 1,153 GNB were isolated; 536 (46.5%) were MDR. The most common isolates were Escherichia coli (312 [27.8%]; MDR rate 50.2%), Pseudomonas aeruginosa (298 [25.8%]; MDR rate 39.6%), Acinetobacter baumannii (137 [11.9%]; MDR rate 83.9%), and Klebsiella pneumoniae (112 [9.7%]; MDR rate 44.6%). Most pathogens were isolated from patients hospitalized in the Departments of Surgical Oncology (32.3%), Orthopedic and Trauma Surgery (31.8%), General Surgery (18.1%), and Pediatric Surgery (15.5%). The clinical specimens comprised pus (45.1%), normally sterile fluids (22.5%), urine (16.8%), blood (6.3%), and other body fluids. Most effective in vitro against all MDR pathogens were colistin (83%), meropenem (57%), and imipenem-cilastatin (56%). The MDR P. aeruginosa was susceptible most often to colistin (94%) and aminoglycosides (tobramycin 56%, amikacin 55%), MDR A. baumannii only to colistin (94%), and MDR K. pneumoniae to meropenem (92%) and aminoglycosides (amikacin 76%, gentamicin 74%).
In a region with a high prevalence of antibiotic resistance, almost one-half of GNB isolated from surgical patients were MDR. Surgeons may consider these developments to guide empiric antibiotic therapy for infections caused by gram-negative pathogens.
在这个抗生素耐药性日益增加的时代，多药耐药（MDR）革兰氏阴性菌（GNB）引起的感染越来越常见，对包括外科医生在内的所有临床医生都构成了挑战。
我们评估了 2004 年至 2009 年期间在希腊伊拉克利翁大学医院外科病房接受治疗的患者分离出的 GNB 的流行病学和抗生素敏感性。MDR 分离株根据美国疾病控制与预防中心和欧洲疾病预防与控制中心支持的国际专家建议定义。
共分离出 1153 株 GNB；536 株（46.5%）为 MDR。最常见的分离株是大肠埃希菌（312 株[27.8%]；MDR 率 50.2%）、铜绿假单胞菌（298 株[25.8%]；MDR 率 39.6%）、鲍曼不动杆菌（137 株[11.9%]；MDR 率 83.9%）和肺炎克雷伯菌（112 株[9.7%]；MDR 率 44.6%）。大多数病原体分离自外科肿瘤学系（32.3%）、矫形和创伤外科系（31.8%）、普通外科系（18.1%）和小儿外科系（15.5%）住院的患者。临床标本包括脓液（45.1%）、正常无菌液（22.5%）、尿液（16.8%）、血液（6.3%）和其他体液。对所有 MDR 病原体最有效的体外药物是粘菌素（83%）、美罗培南（57%）和亚胺培南-西司他丁（56%）。MDR 铜绿假单胞菌最常对粘菌素（94%）和氨基糖苷类（妥布霉素 56%，阿米卡星 55%）敏感，MDR 鲍曼不动杆菌仅对粘菌素（94%）敏感，MDR 肺炎克雷伯菌对美罗培南（92%）和氨基糖苷类（阿米卡星 76%，庆大霉素 74%）敏感。
在一个抗生素耐药性高发的地区，外科患者分离出的革兰氏阴性菌中，近一半为 MDR。外科医生可以考虑这些发展情况，以指导针对革兰氏阴性病原体引起的感染的经验性抗生素治疗。
