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肯尼亚一家私立教学医院的微生物疾病谱及耐药模式:对临床实践的启示

Spectrum of Microbial Diseases and Resistance Patterns at a Private Teaching Hospital in Kenya: Implications for Clinical Practice.

作者信息

Maina Daniel, Omuse Geoffrey, Revathi Gunturu, Adam Rodney D

机构信息

Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya.

Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya.

出版信息

PLoS One. 2016 Jan 25;11(1):e0147659. doi: 10.1371/journal.pone.0147659. eCollection 2016.

Abstract

BACKGROUND

Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data.

METHODS

We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014.

RESULTS

For blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci.

CONCLUSIONS

The current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of resistance in Gram positive organisms, notably S. aureus, are remarkably low. A better understanding of the reasons for these trends may contribute to ongoing efforts to combat antimicrobial resistance globally.

摘要

背景

准确的微生物疾病当地流行率和微生物耐药性数据对于患者的最佳治疗至关重要。然而,来自发展中国家,尤其是撒哈拉以南非洲地区的此类数据报告很少。内罗毕阿迦汗大学医院作为一家获得国际认可的医院以及拥有电子病历系统的实验室,使得分析当地流行率和抗菌药物敏感性数据并将其与其他已发表数据进行比较成为可能。

方法

我们利用2010年至2014年期间在医院和实验室电子记录中获取的微生物鉴定和药敏数据,分析了肯尼亚一家拥有300张床位的三级私立教学医院中所见的微生物谱和耐药模式。

结果

对于血培养分离株,我们将住院头三天内的培养结果作为社区发病的替代指标,在该组中,大肠杆菌最为常见,其次是金黄色葡萄球菌。相比之下,念珠菌属和肺炎克雷伯菌是医院获得性血流感染最常见的病因。最常分离出的革兰氏阴性菌的抗菌药物耐药率高于欧洲和北美的许多近期报告。相比之下,革兰氏阳性菌的耐药率相当低,94%的金黄色葡萄球菌对苯唑西林敏感,仅罕见耐万古霉素肠球菌分离株。

结论

本报告显示革兰氏阴性菌的抗菌药物耐药率很高,即使在尿路感染的门诊患者中也是如此。另一方面,革兰氏阳性菌,尤其是金黄色葡萄球菌的耐药率极低。更好地理解这些趋势的原因可能有助于全球范围内正在进行的抗击抗菌药物耐药性的努力。

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