Department of Internal Medicine, University of Crete, Heraklion, Greece.
Eur J Clin Microbiol Infect Dis. 2014 Sep;33(9):1505-10. doi: 10.1007/s10096-014-2097-8. Epub 2014 Apr 15.
The objective of this investigation was to evaluate the association between colistin consumption and the isolation of intrinsically resistant to colistin Enterobacteriaceae (IRCE) in a university hospital in Crete, Greece. The database of the microbiological laboratory was reviewed retrospectively during 2006-2010. All positive cultures for IRCE were retrieved. We assessed the total consumption of colistin in medical, surgical, and intensive care units (ICUs). A total of 1,304 single-patient IRCE isolates were recorded. Of these, 466 (35.7%) were hospital-acquired, while 838 (64.3%) were community-acquired. Proteus spp. accounted for 72% of them, Serratia spp. for 16.6%, Morganella morganii for 8.4%, and Providencia spp. for 3%. Urine (44.8%), pus (20.4%), and lower respiratory tract specimens (12.8%) accounted for the majority of specimens. IRCE isolated during the first half (2006 to 1st semester of 2008) and second half (2nd semester of 2008 to 2010) of the study period accounted for 5.8% and 7.4% of Gram-negative isolates, respectively (p < 0.001). Colistin consumption was not different in the two periods in the hospital, but in the ICU, it was higher in the second half of the study period (p = 0.013). Colistin consumption was associated with the isolation of hospital-acquired IRCE (p = 0.037); a trend was noted between colistin consumption and the isolation of IRCE in the ICU (p = 0.057). In this study, colistin consumption was associated with the isolation of hospital-acquired IRCE. The use of colistin increased in the ICU during the study period. Prudent use of colistin is essential for the prevention of nosocomial outbreaks due to resistant IRCE.
本研究旨在评估希腊克里特岛一家大学医院中粘菌素使用与固有耐粘菌素肠杆菌科（IRCE）分离之间的关联。对 2006-2010 年微生物实验室的数据库进行了回顾性分析。检索到所有 IRCE 阳性培养物。我们评估了医学、外科和重症监护病房（ICU）中粘菌素的总使用量。共记录到 1304 株单患者 IRCE 分离株。其中，466 株（35.7%）为医院获得性，838 株（64.3%）为社区获得性。肠杆菌属占 72%，沙雷氏菌属占 16.6%，摩氏摩根菌占 8.4%，普罗维登斯菌属占 3%。尿液（44.8%）、脓液（20.4%）和下呼吸道标本（12.8%）占大多数标本。研究期间的前半段（2006 年至 2008 年第一学期）和后半段（2008 年第二学期至 2010 年）分离的 IRCE 分别占革兰氏阴性菌分离株的 5.8%和 7.4%（p<0.001）。在医院，两个时期的粘菌素使用量没有差异，但在 ICU，研究期间的后半段更高（p=0.013）。粘菌素的使用与医院获得性 IRCE 的分离有关（p=0.037）；在 ICU 中，粘菌素的使用与 IRCE 的分离之间存在趋势（p=0.057）。在这项研究中，粘菌素的使用与医院获得性 IRCE 的分离有关。在研究期间，ICU 中粘菌素的使用增加。由于耐粘菌素 IRCE 的医院爆发，谨慎使用粘菌素至关重要。
