Heather M. Draper, Pharm.D., BCPS, is Associate Professor, Department of Clinical Pharmacy, University of Tennessee, Knoxville. Joseph B. Farland, Pharm.D., BCPS, is Pharmacist, Pharmacy Department, Blount Memorial Hospital, Maryville, TN. R. Eric Heidel, Ph.D., is Statistical and Research Design Consultant, University of Tennessee Graduate School of Medicine, Knoxville. Larissa S. May, M.D., M.S.P.H., is Associate Director of Clinical Research and Assistant Professor, Department of Emergency Medicine, George Washington University, Washington, DC. Katie J. Suda, Pharm.D., M.S., is Associate Professor, College of Pharmacy, University of Tennessee, Memphis.
Am J Health Syst Pharm. 2013 Dec 1;70(23):2124-8. doi: 10.2146/ajhp130079.
The frequencies and corresponding susceptibilities of bacteria isolated from patients in the emergency department (ED) were compared with those from hospitalized patients.
A microbiology laboratory report of all positive bacterial cultures obtained in the ED, regardless of the source (e.g., blood, urine, sputum), was obtained. In the case of duplicate cultures, only the first isolate cultured from a single patient was included. Colonization-site cultures (e.g., nasal swabs) and culture reports identified by the laboratory as contaminant organisms were excluded from the evaluation. Antimicrobial susceptibility results were then compiled into a standardized ED-specific antibiogram. Antimicrobial susceptibilities for each pathogen in the ED antibiogram were compared with those in the hospitalwide antibiogram. If there was a difference of ≥5% between the susceptibility of a single antimicrobial agent, chi-square tests were conducted, and unadjusted odds ratios were calculated. Pathogens with fewer than 30 isolates were excluded from the susceptibility comparison.
A total of 3140 cultures were evaluated (1417 from the ED, 1723 from the hospital). The frequencies of pathogens isolated in the ED and hospitalwide were similar, with the exception of Escherichia coli, which were more commonly isolated in ED patients, and Enterococcus species and Pseudomonas aeruginosa, which were more common in hospitalized patients. Significant differences in susceptibility profiles were identified for Staphylococcus aureus, coagulase-negative Staphylococcus, Enterococcus faecalis, E. coli, Klebsiella pneumoniae, and P. aeruginosa.
Significant differences in the frequencies of bacteria isolated and corresponding susceptibilities were found in cultures obtained in ED patients compared with those obtained in hospitalized patients.
比较急诊科（ED）患者和住院患者分离的细菌的频率及其相应的药敏性。
获取 ED 所有阳性细菌培养物（无论来源如何，如血液、尿液、痰液）的微生物学实验室报告。对于重复培养物，仅包括从单个患者培养的第一个分离物。排除定植部位培养物（如鼻拭子）和实验室鉴定为污染菌的培养物报告。然后将抗生素药敏结果汇编成标准化的 ED 特定抗生素谱。ED 抗生素谱中每种病原体的抗生素药敏性与全院抗生素谱进行比较。如果单个抗菌药物的药敏性差异≥5%，则进行卡方检验，并计算未调整的优势比。药敏比较中排除了少于 30 株分离物的病原体。
共评估了 3140 株培养物（ED 分离物 1417 株，医院分离物 1723 株）。ED 和全院分离的病原体频率相似，除了大肠埃希菌，ED 患者中更常见，肠球菌属和铜绿假单胞菌在住院患者中更常见。金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌、大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌的药敏谱存在显著差异。
与住院患者相比，ED 患者的细菌分离频率及其相应的药敏性存在显著差异。
