Weiner Lindsey M, Webb Amy K, Limbago Brandi, Dudeck Margaret A, Patel Jean, Kallen Alexander J, Edwards Jonathan R, Sievert Dawn M
Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
Infect Control Hosp Epidemiol. 2016 Nov;37(11):1288-1301. doi: 10.1017/ice.2016.174. Epub 2016 Aug 30.
OBJECTIVE To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred in 2011-2014 and were reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network. METHODS Data from central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical site infections were analyzed. These HAIs were reported from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities. Pooled mean proportions of pathogens that tested resistant (or nonsusceptible) to selected antimicrobials were calculated by year and HAI type. RESULTS Overall, 4,515 hospitals reported that at least 1 HAI occurred in 2011-2014. There were 408,151 pathogens from 365,490 HAIs reported to the National Healthcare Safety Network, most of which were reported from acute care hospitals with greater than 200 beds. Fifteen pathogen groups accounted for 87% of reported pathogens; the most common included Escherichia coli (15%), Staphylococcus aureus (12%), Klebsiella species (8%), and coagulase-negative staphylococci (8%). In general, the proportion of isolates with common resistance phenotypes was higher among device-associated HAIs compared with surgical site infections. Although the percent resistance for most phenotypes was similar to earlier reports, an increase in the magnitude of the resistance percentages among E. coli pathogens was noted, especially related to fluoroquinolone resistance. CONCLUSION This report represents a national summary of antimicrobial resistance among select HAIs and phenotypes. The distribution of frequent pathogens and some resistance patterns appear to have changed from 2009-2010, highlighting the need for continual, careful monitoring of these data across the spectrum of HAI types. Infect Control Hosp Epidemiol 2016;1-14.
目的 描述2011 - 2014年发生并报告给疾病控制与预防中心国家医疗安全网络的医疗保健相关感染(HAIs)的抗菌药物耐药模式。方法 分析来自中心静脉导管相关血流感染、导尿管相关尿路感染、呼吸机相关性肺炎和手术部位感染的数据。这些HAIs报告自急性护理医院、长期急性护理医院和住院康复机构。按年份和HAI类型计算对选定抗菌药物耐药(或不敏感)的病原体的合并平均比例。结果 总体而言,4515家医院报告在2011 - 2014年至少发生了1例HAI。向国家医疗安全网络报告的365490例HAIs中有408151种病原体,其中大部分报告自床位超过200张的急性护理医院。15个病原体组占报告病原体的87%;最常见的包括大肠杆菌(15%)、金黄色葡萄球菌(12%)、克雷伯菌属(8%)和凝固酶阴性葡萄球菌(8%)。一般来说,与手术部位感染相比,器械相关HAIs中具有常见耐药表型的分离株比例更高。虽然大多数表型的耐药百分比与早期报告相似,但注意到大肠杆菌病原体中耐药百分比的幅度有所增加,尤其是与氟喹诺酮耐药相关。结论 本报告代表了特定HAIs和表型中抗菌药物耐药性的全国性总结。常见病原体的分布和一些耐药模式似乎自2009 - 2010年以来发生了变化,突出了对HAI类型范围内这些数据进行持续、仔细监测的必要性。《感染控制与医院流行病学》2016;1 - 14。