Htoutou Sedláková Miroslava, Pudová Vendula, Kolář Milan
Department of Microbiology, Faculty of Medicine and Dentistry, Palacký University in Olomouc, Czech Republic, e-mail:
Klin Mikrobiol Infekc Lek. 2015 Mar;21(1):10-4.
The objectives were to assess the prevalence of etiologic agents of hospital-acquired pneumonia (HAP) in patients staying in four big hospitals in the Czech Republic and requiring artificial ventilation. The resistance of the isolated pathogens to antibiotics was determined and initial antibiotic therapy was discussed.
Included in the study were 155 patients with HAP staying from May 1, 2013 to January 31, 2014 in the Departments of Anesthesiology and Critical Care in the following four centers: Thomayer Hospital Prague, University Hospital Brno, University Hospital Hradec Králové and University Hospital Olomouc. From these patients, endotracheal secretion samples were processed using standard microbiology methods. In identified bacterial strains, susceptibility to antibiotics was tested with the microdilution method according to the EUCAST recommendations. Production of ESBL and AmpC beta-lactamases was detected by disk diffusion tests specific for the particular enzymes. ESBL- and AmpC-positive isolates were subjected to basic genetic analysis.
Over the study period, a total of 266 isolates were obtained from 140 patients, with 15 patients having negative culture result. Late-onset pneumonia was present in 72 %. Gram-negative bacteria were most prevalent (81 %), namely Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. Phenotypic tests for production of broad spectrum beta-lactamases were positive in 37 % of Enterobacteriaceae. Genes for CTX-M, SHV, TEM beta-lactamases or CIT and DHA types of AmpC enzymes were detected. No carbapenemase-producing bacteria, methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci were detected.
The study showed that HAP in the Czech Republic was mostly of Gram-negative etiology. Variable antibiotic susceptibility in the two most frequent etiological agents (Pseudomonas aeruginosa and Klebsiella pneumoniae) resulted in severe therapeutic difficulties. A total of 49 % of patients received inadequate therapy. This fact suggests the impact of antibiotic resistance on intensive care patients´ survival or death. Our study confirmed that one in three patients dies because of HAP.
目的是评估捷克共和国四家大型医院中接受人工通气的患者医院获得性肺炎（HAP）的病原体流行情况。测定分离出的病原体对抗生素的耐药性，并讨论初始抗生素治疗方案。
纳入研究的155例HAP患者于2013年5月1日至2014年1月31日期间在以下四个中心的麻醉学与重症监护科住院：布拉格托马耶尔医院、布尔诺大学医院、赫拉德茨克拉洛韦大学医院和奥洛穆茨大学医院。从这些患者中，采用标准微生物学方法处理气管内分泌物样本。对于鉴定出的细菌菌株，根据欧洲抗菌药物敏感性试验委员会（EUCAST）的建议，采用微量稀释法检测其对抗生素的敏感性。通过针对特定酶的纸片扩散试验检测超广谱β-内酰胺酶（ESBL）和AmpCβ-内酰胺酶的产生。对ESBL和AmpC阳性分离株进行基本的基因分析。
在研究期间，共从140例患者中分离出266株菌株，15例患者培养结果为阴性。迟发性肺炎占72%。革兰阴性菌最为常见（81%），即铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌。37%的肠杆菌科细菌广谱β-内酰胺酶产生的表型试验呈阳性。检测到CTX-M、SHV、TEMβ-内酰胺酶或CIT和DHA型AmpC酶的基因。未检测到产碳青霉烯酶细菌、耐甲氧西林金黄色葡萄球菌或耐万古霉素肠球菌。
该研究表明，捷克共和国的HAP大多由革兰阴性菌引起。两种最常见病原体（铜绿假单胞菌和肺炎克雷伯菌）对抗生素敏感性各异，导致严重的治疗困难。共有49%的患者接受了不充分的治疗。这一事实表明抗生素耐药性对重症监护患者生存或死亡的影响。我们的研究证实，三分之一的患者死于HAP。
