Irenge Leonid M, Kabego Landry, Kinunu Faustin B, Itongwa Moise, Mitangala Prudence N, Gala Jean-Luc, Chirimwami Raphael B
Bukavu General Hospital/Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo; Centre for Applied Molecular Technologies, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium; Defence Laboratories Department, Belgian Armed Forces, Peutie, Belgium.
S Afr Med J. 2015 Sep 14;105(9):752-5. doi: 10.7196/SAMJnew.7937.
Bloodstream infection (BSI) is a life-threatening condition that requires rapid antimicrobial treatment.
We determined the prevalence of bacterial isolates associated with BSI at Bukavu General Hospital (BGH), South Kivu Province, Democratic Republic of the Congo, and their patterns of susceptibility to antimicrobial drugs, from February 2013 to January 2014.
We cultured 112 clinically relevant isolates from 320 blood cultures. Of these isolates, 104 (92.9%) were Gram-negative bacteria (GNB), with 103 bacilli (92.0%) and one coccus (0.9%). Among GNB, Escherichia coli (51.9%), Klebsiella spp. (20.2%), Enterobacter spp. (6.7%), Shigella spp. (5.8%) and Salmonella spp. (4.8%) were the most frequent agents causing BSIs. Other GNB isolates included Proteus spp., Citrobacter spp. and Pseudomonas aeruginosa (both 2.9%), and Acinetobacter spp. and Neisseria spp. (both 0.9%). High rates of resistance to co-trimoxazole (100%), erythromycin (100%) and ampicillin (66.7-100%) and moderate to high resistance to ciprofloxacin, ceftazidime, ceftriaxone, cefuroxime and cefepime were observed among GNB. Furthermore, there were high rates of multidrug resistance and of extended-spectrum β-lactamase (ESBL) production phenotype among Enterobacteriaceae. Gram-positive bacteria included three Staphylococcus aureus isolates (2.7%), four oxacillin-resistant coagulase-negative staphylococci (CoNS) isolates (3.6%) and one Streptococcus pneumoniae (0.9%). No oxacillin-resistant S. aureus was isolated. Among clinically relevant staphylococci, susceptibility to co-trimoxazole and ampicillin was low (0-25%). In addition, 58 contaminant CoNS were isolated from blood cultures, and the calculated ratio of contaminants to pathogens in blood cultures was 1:2.
Multidrug-resistant and ESBL-producing GNB are the leading cause of BSI at BGH.
血流感染（BSI）是一种危及生命的疾病，需要迅速进行抗菌治疗。
我们确定了2013年2月至2014年1月期间刚果民主共和国南基伍省布卡武综合医院（BGH）与BSI相关的细菌分离株的流行情况及其对抗菌药物的敏感性模式。
我们从320份血培养物中培养出112株临床相关分离株。在这些分离株中，104株（92.9%）为革兰氏阴性菌（GNB），其中103株为杆菌（92.0%），1株为球菌（0.9%）。在GNB中，大肠埃希菌（51.9%）、克雷伯菌属（20.2%）、肠杆菌属（6.7%）、志贺菌属（5.8%）和沙门菌属（4.8%）是引起BSI最常见的病原体。其他GNB分离株包括变形杆菌属、柠檬酸杆菌属和铜绿假单胞菌（均为2.9%），不动杆菌属和奈瑟菌属（均为0.9%）。观察到GNB对复方新诺明（100%）、红霉素（100%）和氨苄西林（66.7%-100%）的耐药率较高，对环丙沙星、头孢他啶、头孢曲松、头孢呋辛和头孢吡肟的耐药率为中度至高度。此外，肠杆菌科中多重耐药和产超广谱β-内酰胺酶（ESBL）表型的发生率较高。革兰氏阳性菌包括3株金黄色葡萄球菌分离株（2.7%）、4株耐氧西林凝固酶阴性葡萄球菌（CoNS）分离株（3.6%）和1株肺炎链球菌（0.9%）。未分离出耐氧西林金黄色葡萄球菌。在临床相关葡萄球菌中，对复方新诺明和氨苄西林的敏感性较低（0%-25%）。此外，从血培养物中分离出58株污染性CoNS，血培养物中污染物与病原体的计算比例为1:2。
多重耐药和产ESBL的GNB是BGH中BSI的主要原因。
