意大利一家教学医院12年间重症监护病房获得性血流感染的流行病学变化

Changed epidemiology of ICU acquired bloodstream infections over 12 years in an Italian teaching hospital.

作者信息

Orsi G B, Giuliano S, Franchi C, Ciorba V, Protano C, Giordano A, Rocco M, Venditti M

机构信息

Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy -

出版信息

Minerva Anestesiol. 2015 Sep;81(9):980-8. Epub 2014 Nov 20.

PMID:25411769

Abstract

BACKGROUND

We compared the etiology of 203 ICU-acquired laboratory confirmed bloodstream infections (LC-BSI) prospectively collected between January 2000-December 2007 (first period) with 83 LC-BSI recorded between January 2010-December 2012 (second period), after the diffusion in 2008 of K. pneumoniae expressing carbapenem-resistance due to K. pneumoniae carbapenemases production (KPC-CR-Kp).

METHODS

In the general ICU of teaching hospital "Umberto I" in Rome, all ICU-acquired LC-BSI episodes occurring in patients admitted to ICU≥48h were included. Baseline characteristics, clinical features, antimicrobial resistance and outcome were recorded. All isolated strains multidrug resistance (MDR) were evaluated according to the European Centre for Disease Control (ECDC) guidelines.

RESULTS

Overall the study included 329 isolates, 214 in 2000-2007 and 115 in 2010-2012. In the second period we registered a Gram-positive reduction (55.1% vs. 26.9%; P<0.01) and Gram-negative increase (40.2% vs. 69.6%; P<0.01). In 2000-2007 staphylococci were responsible for 45.8% LC-BSI's, whereas 18.3% during 2010-2012. Enterobacteriaceae increased dramatically (15.4% vs. 39.2%; P<0.01), especially Klebsiella spp. (5.6% vs. 31.3%; P<0.01). LC-BSI associated mortality decreased among Gram-positive (56.8% vs. 51.6%), but increased in Gram-negative (41.9% vs. 60.0%; P<0.03), especially in Enterobacteriaceae (RR 2.13; 95% CI 1.21 - 3.73; P<0.01). MDR increased remarkably among Enterobacetriaceae (51.5% vs. 73.3%). The study highlighted the associated mortality for Enterobacteriaceae when comparing MDR to non-MDR microorganisms.

CONCLUSION

ICU-acquired LC-BSI etiology shifted from Gram-positive to Gram-negative during the study period in our ICU. Also associated mortality decreased among the former, whereas it increased in the latter. Last MDR increased enormously among Enterobacteriaceae with the diffusion of KPC (75% of strains), adding significantly to associated mortality (RR 2.17; 1.16-4.05; P<0.01).

摘要

背景

我们对2000年1月至2007年12月前瞻性收集的203例重症监护病房获得性实验室确诊血流感染（LC-BSI）的病因与2010年1月至2012年12月记录的83例LC-BSI进行了比较，这是在2008年因肺炎克雷伯菌产生肺炎克雷伯菌碳青霉烯酶（KPC）而导致表达碳青霉烯耐药性的肺炎克雷伯菌传播之后。

方法

在罗马“翁贝托一世”教学医院的综合重症监护病房，纳入了入住重症监护病房≥48小时的患者中发生的所有重症监护病房获得性LC-BSI发作。记录基线特征、临床特征、抗菌药物耐药性和结局。根据欧洲疾病控制中心（ECDC）指南对所有分离的多重耐药（MDR）菌株进行评估。

结果

总体而言，该研究包括329株分离株，2000 - 2007年有214株，2010 - 2012年有115株。在第二个时期，我们记录到革兰氏阳性菌减少（55.1%对26.9%；P<0.01），革兰氏阴性菌增加（40.2%对69.6%；P<0.01）。在2000 - 2007年，葡萄球菌导致45.8%的LC-BSI，而在2010 - 2012年为18.3%。肠杆菌科显著增加（15.4%对39.2%；P<0.01），尤其是克雷伯菌属（5.6%对31.3%；P<0.01）。革兰氏阳性菌相关的LC-BSI死亡率下降（56.8%对51.6%），但革兰氏阴性菌相关死亡率增加（41.9%对60.0%；P<0.03），尤其是肠杆菌科（相对风险2.13；95%置信区间1.21 - 3.73；P<0.01）。肠杆菌科中的MDR显著增加（51.5%对73.3%）。该研究强调了在比较MDR与非MDR微生物时肠杆菌科的相关死亡率。