Senbayrak Akcay Seniha, Inan Asuman, Cevan Simin, Ozaydın Ayse Nilufer, Cobanoglu Naz, Ozyurek Seyfi Celik, Aksaray Sebahat
Haydarpasa Numune Education and Research Hospital, Uskudar, Istanbul, Turkey.
J Infect Dev Ctries. 2014 May 14;8(5):597-604. doi: 10.3855/jidc.4277.
This study aimed to demonstrate the changing epidemiology of infecting microorganisms and their long-term resistance profiles and to describe the microbiological point of view in anti-infective management of intensive care unit (ICU) patients.
A total of 5,690 isolates of Gram-negative bacilli were included in this study. Antibiotic susceptibility was tested using the disk diffusion method and Vitek 2 system. Chi-square tests were used for hypothesis testing.
The most frequently isolated organisms were A. baumannii (37.3%), P. aeruginosa (30.3%), Enterobacter spp. (10.4%), E. coli (10.4%), and Klebsiella spp. (8.9%). A. baumannii was the most frequently isolated organism from the respiratory tract (43.4%); the susceptibility rates for imipenem and meropenem decreased to 7% and 6% (p < 0.0001), respectively. The percentage of multidrug-resistant (MDR) A. baumannii isolates continuously increased from 18.7% in 2004 to 69% in 2011 (p < 0.0001), whereas MDR P. aeruginosa isolates increased from 1.5% to 22% (p < 0.0001). Carbapenem-resistant Klebsiella isolates emerged in 2010 and increased to 20% in the next year. The rates of ESBL-producing Enterobacteriaceae in the ICU was very high in 2011 - 50% for E. coli and 80% for Klebsiella strains.
The most common isolated Gram-negative bacillus in our study was A. baumannii and that the prevalence of MDR isolates has increased markedly over. Accordingly, the comparison of antibiotic resistance of other pathogens in 2004 and 2011 displayed an increasing trend. These data imply the urgent need for new and effective strategies in our hospital and in the region.
本研究旨在阐明感染微生物流行病学的变化及其长期耐药情况，并从微生物学角度描述重症监护病房（ICU）患者抗感染治疗的情况。
本研究共纳入5690株革兰氏阴性杆菌。采用纸片扩散法和Vitek 2系统检测抗生素敏感性。采用卡方检验进行假设检验。
最常分离出的微生物为鲍曼不动杆菌（37.3%）、铜绿假单胞菌（30.3%）、肠杆菌属（10.4%）、大肠杆菌（10.4%）和克雷伯菌属（8.9%）。鲍曼不动杆菌是呼吸道最常分离出的微生物（43.4%）；亚胺培南和美罗培南的敏感率分别降至7%和6%（p<0.0001）。多重耐药鲍曼不动杆菌分离株的比例从2004年的18.7%持续增至2011年的69%（p<0.0001），而多重耐药铜绿假单胞菌分离株从1.5%增至22%（p<0.0001）。耐碳青霉烯类克雷伯菌分离株于2010年出现，并在次年增至20%。2011年ICU中产超广谱β-内酰胺酶肠杆菌科细菌的比例非常高——大肠杆菌为50%，克雷伯菌属菌株为80%。
在我们的研究中，最常见的革兰氏阴性杆菌分离株是鲍曼不动杆菌，多重耐药分离株的患病率显著增加。因此，2004年和2011年其他病原体的抗生素耐药性比较呈上升趋势。这些数据表明我们医院及该地区迫切需要新的有效策略。
