Yayan Josef, Ghebremedhin Beniam, Rasche Kurt
Witten/Herdecke University, Witten, Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic, Wuppertal, Germany.
Witten/Herdecke University, Witten, Institute of Medical Laboratory Diagnostics, Center for Clinical and Translational Research, HELIOS Clinic, Wuppertal, Germany.
PLoS One. 2015 Oct 2;10(10):e0139836. doi: 10.1371/journal.pone.0139836. eCollection 2015.
Pseudomonas aeruginosa is a common cause of community-acquired and nosocomial-acquired pneumonia. The development of resistance of P. aeruginosa to antibiotics is increasing globally due to the overuse of antibiotics. This article examines, retrospectively, the antibiotic resistance in patients with community-acquired versus nosocomial-acquired pneumonia caused by P. aeruginosa or multidrug-resistant (MDR) P. aeruginosa.
Data from patients with community-acquired and nosocomial-acquired pneumonia caused by P. aeruginosa and MDR P. aeruginosa were collected from the hospital charts at the HELIOS Clinic, Witten/Herdecke University, Wuppertal, Germany, between January 2004 and August 2014. An antibiogram was created from all study patients with community-acquired and nosocomial-acquired pneumonia caused by P. aeruginosa or MDR P. aeruginosa.
A total of 168 patients with mean age 68.1 ± 12.8 (113 [67.3% males and 55 [32.7%] females) were identified; 91 (54.2%) had community-acquired and 77 (45.8%) had nosocomial-acquired pneumonia caused by P. aeruginosa. Patients with community-acquired versus nosocomial-acquired pneumonia had a mean age of 66.4 ± 13.8 vs. 70.1 ± 11.4 years [59 vs. 54 (64.8% vs. 70.1%) males and 32 vs. 23 (35.2% vs. 29.9%) females]. They included 41 (24.4%) patients with pneumonia due to MDR P. aeruginosa: 27 (65.9%) community-acquired and 14 (34.1%) nosocomial-acquired cases. P. aeruginosa and MDR P. aeruginosa showed a very high resistance to fosfomycin (community-acquired vs. nosocomial-acquired) (81.0% vs. 84.2%; 0 vs. 85.7%). A similar resistance pattern was seen with ciprofloxacin (35.2% vs. 24.0%; 70.4% vs. 61.5%), levofloxacin (34.6% vs. 24.5%; 66.7% vs. 64.3%), ceftazidime (15.9% vs. 30.9; 33.3% vs. 61.5%), piperacillin (24.2% vs. 29.9%; 44.4% vs. 57.1%), imipenem (28.6% vs. 27.3%; 55.6% vs. 50.0%), piperacillin and tazobactam (23.1% vs. 28.6%; 44.4% vs. 50.0%), tobramycin (28.0% vs. 17.2%; 52.0% vs. 27.3%), gentamicin (26.4% vs. 18.2%; 44.4% vs. 21.4%), and meropenem (20.2% vs. 20.3%; 42.3% vs. 50.0%). An elevated resistance of P. aeruginosa and MDR P. aeruginosa was found for cefepime (11.1% vs. 23.3%; 25.9% vs. 50.0%), and amikacin (10.2% vs. 9.1%; 27.3% vs. 9.1%). Neither pathogen was resistant to colistin (P = 0.574).
While P. aeruginosa and MDR P. aeruginosa were resistant to a variety of commonly used antibiotics, they were not resistant to colistin in the few isolates recovered from patients with pneumonia.
铜绿假单胞菌是社区获得性肺炎和医院获得性肺炎的常见病因。由于抗生素的过度使用，全球范围内铜绿假单胞菌对抗生素的耐药性正在增加。本文回顾性研究了由铜绿假单胞菌或多重耐药（MDR）铜绿假单胞菌引起的社区获得性肺炎与医院获得性肺炎患者的抗生素耐药性。
2004年1月至2014年8月期间，从德国伍珀塔尔维滕/黑尔德克大学赫利俄斯诊所的医院病历中收集了由铜绿假单胞菌和MDR铜绿假单胞菌引起的社区获得性肺炎和医院获得性肺炎患者的数据。为所有由铜绿假单胞菌或MDR铜绿假单胞菌引起的社区获得性肺炎和医院获得性肺炎的研究患者创建了抗菌谱。
共确定了168例患者，平均年龄68.1±12.8岁（113例[67.3%]男性和55例[32.7%]女性）；91例（54.2%）为社区获得性肺炎，77例（45.8%）为医院获得性肺炎，均由铜绿假单胞菌引起。社区获得性肺炎与医院获得性肺炎患者的平均年龄分别为66.4±13.8岁和70.1±11.4岁[男性分别为59例对54例（64.8%对70.1%），女性分别为32例对23例（35.2%对29.9%）]。其中包括41例（24.4%）由MDR铜绿假单胞菌引起的肺炎患者：27例（65.9%）为社区获得性，14例（34.1%）为医院获得性。铜绿假单胞菌和MDR铜绿假单胞菌对磷霉素表现出很高的耐药性（社区获得性与医院获得性）（81.0%对84.2%；0对85.7%）。环丙沙星（35.2%对24.0%；70.4%对61.5%）、左氧氟沙星（34.6%对24.5%；66.7%对64.3%）、头孢他啶（15.9%对30.9%；33.3%对61.5%）、哌拉西林（24.2%对29.9%；44.4%对57.1%）、亚胺培南（28.6%对27.3%；55.6%对50.0%）、哌拉西林和他唑巴坦（23.1%对28.6%；44.4%对50.0%）、妥布霉素（28.0%对17.2%；52.0%对27.3%）、庆大霉素（26.4%对18.2%；44.4%对21.4%）和美罗培南（20.2%对20.3%；42.3%对50.0%）也呈现出类似的耐药模式。发现铜绿假单胞菌和MDR铜绿假单胞菌对头孢吡肟（11.1%对23.3%；25.9%对50.0%）和阿米卡星（10.2%对9.1%；27.3%对9.1%）的耐药性有所升高。两种病原体对黏菌素均无耐药性（P = 0.574）。
虽然铜绿假单胞菌和MDR铜绿假单胞菌对多种常用抗生素耐药，但从肺炎患者中分离出的少数菌株对黏菌素不耐药。
