Lesho Emil, Chukwuma Uzo, Sparks Michael, Neumann Charlotte, Richesson Douglas, Clifford Robert, Gierhart Sarah, Waterman Paige, Hinkle Mary
Antibiotic Resistance Monitoring and Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
Antibiotic Resistance Monitoring and Research Program, EpiData Center Department Navy and Marine Corps Public Health Center, Portsmouth, Virginia, USA.
J Clin Microbiol. 2016 Jun;54(6):1546-1551. doi: 10.1128/JCM.00359-16. Epub 2016 Mar 30.
Carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter spp., and Enterobacteriaceae pose urgent public health threats. The differential burden, relative risks, associations with antimicrobial consumption, and temporal trends of those taxa in large, geographically diverse U.S. health systems remain under reported. Electronic records of all patients in a geographically dispersed 280-hospital managed-care system from 2005 to 2014 were reviewed. Carbapenem-resistant strains were identified based on Clinical and Laboratory Standards Institute guidelines and breakpoints. A total of 360,000 potentially carbapenem-resistant strains were identified from 14.7 million cultures (80% infecting and 20% surveillance). Isolation of bacteria overseas or isolation from the bloodstream was associated with a higher relative risks of carbapenem resistance (CR; P < 0.0001). Enterobacteriaceae were isolated 11 times more frequently than P. aeruginosa and Acinetobacter spp. However, compared to Enterobacteriaceae, the CR levels were 73-fold and 210-fold higher in P. aeruginosa and Acinetobacter spp., respectively. Significant differences in the relative risk of CR between taxa, anatomic, and geographic locations persisted after adjustment for other variables, the biggest differences occurring between taxa. Overall, CR rates increased for Enterobacteriaceae (P = 0.03) and decreased for Acinetobacter spp. and P. aeruginosa (P < 0.0001). These data provide a useful baseline for resistance trending and have implications for surveillance. Infections acquired overseas and bloodstream infections are particularly important areas for continued monitoring.
耐碳青霉烯类的铜绿假单胞菌、不动杆菌属和肠杆菌科细菌对公众健康构成了紧迫威胁。在地域广泛的美国大型医疗系统中，这些分类群的差异负担、相对风险、与抗菌药物使用的关联以及时间趋势仍未得到充分报道。我们回顾了2005年至2014年一个地域分散的由280家医院组成的管理式医疗系统中所有患者的电子记录。根据临床和实验室标准协会的指南及断点来鉴定耐碳青霉烯类菌株。从1470万份培养物中总共鉴定出360,000株潜在的耐碳青霉烯类菌株（80%为感染性培养物，20%为监测性培养物）。在海外分离出细菌或从血液中分离出细菌与耐碳青霉烯类耐药（CR）的相对风险较高相关（P < 0.0001）。肠杆菌科的分离频率比铜绿假单胞菌和不动杆菌属高11倍。然而，与肠杆菌科相比，铜绿假单胞菌和不动杆菌属的CR水平分别高73倍和210倍。在对其他变量进行调整后，不同分类群、解剖部位和地理位置之间CR的相对风险仍存在显著差异，最大的差异出现在不同分类群之间。总体而言，肠杆菌科的CR率上升（P = 0.03），而不动杆菌属和铜绿假单胞菌的CR率下降（P < 0.0001）。这些数据为耐药趋势提供了有用的基线，并对监测具有启示意义。在海外获得的感染和血流感染是持续监测的特别重要领域。
