三级护理医院重症监护病房患者分离株中ESBL的流行率。
Prevalence of ESBL in Isolates Among ICU Patients in a Tertiary Care Hospital.
作者信息
Singh Nipa, Pattnaik Dipti, Neogi Dhruba Kumar, Jena Jagadananda, Mallick Bandana
机构信息
Assistant Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India .
Professor and HOD, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India .
出版信息
J Clin Diagn Res. 2016 Sep;10(9):DC19-DC22. doi: 10.7860/JCDR/2016/21260.8544. Epub 2016 Sep 1.
INTRODUCTION
Resistance to common antibiotics is a matter of grave concern in treating infections in hospital settings especially in Intensive Care Units (ICUs). One of the most commonly used and effective group of antibiotics, cephalosporins, exhibit resistance due to production of Extended Spectrum Beta- Lactamases (ESBLs). The prevalence of ESBL producing () has increased throughout the world and is a major cause of treatment failure in ICUs. As per our knowledge studies were not available on the prevalence of ESBL producing in ICUs of this region.
AIM
To determine the prevalence of ESBLs among isolates in ICUs of a tertiary care hospital.
MATERIALS AND METHODS
A cross sectional study was conducted over a period of 4 years (Sept 2011 to Sept 2015) in the Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar. Consecutive non-duplicate isolates of recovered from 6800 clinical samples of patients admitted to different Intensive Care Units (ICUs) were subjected to ESBL screening test and then to CLSI recommended Phenotypic Confirmatory Disc Diffusion Tests (PCDDT) for ESBL production determination.
RESULTS
Out of 6800 samples, 1038 were isolates and 452(44%) were resistant to third generation cephalosporins. ESBL producing among them were 276 (61.1%). Paediatric ICU showed the highest prevalence of ESBL at 80.9%. The highest prevalence of ESBL was in urine samples (82.6%) followed by pus (9.8%). The most effective antibiotic for ESBL producers was imipenem (96.7% sensitive), followed by amikacin (88.4%) and piperacillin- tazobactum (87%).
CONCLUSION
This study has highlighted the high prevalence of ESBL producing in the ICUs of our hospital. An in depth analysis of their antibiogram will be helpful in formulating the antibiotic policy and prevent spread of ESBL strains. It is recommended that ESBL testing should be done routinely to curtail antibiotic resistance and to effectively implement infection control measures.
引言
在医院环境中，尤其是在重症监护病房（ICU）治疗感染时，对常用抗生素产生耐药性是一个严重令人担忧的问题。头孢菌素是最常用且有效的一类抗生素，但由于超广谱β-内酰胺酶（ESBLs）的产生而出现耐药性。产ESBLs的（此处原文括号内容缺失，无法准确翻译）在全球范围内的患病率都有所上升，并且是ICU治疗失败的主要原因。据我们所知，关于该地区ICU中产ESBLs的（此处原文括号内容缺失，无法准确翻译）患病率的研究尚无报道。
目的
确定一家三级护理医院ICU中分离出的（此处原文括号内容缺失，无法准确翻译）中产ESBLs的患病率。
材料与方法
在布巴内斯瓦尔的卡林加医学科学研究所（KIMS）微生物学系进行了一项为期4年（2011年9月至2015年9月）的横断面研究。从入住不同重症监护病房（ICU）的患者的6800份临床样本中分离出的连续非重复的（此处原文括号内容缺失，无法准确翻译）菌株进行ESBL筛选试验，然后进行CLSI推荐的用于确定ESBL产生情况的表型确证纸片扩散试验（PCDDT）。
结果
在6800份样本中，有1038份是（此处原文括号内容缺失，无法准确翻译）菌株，其中452份（44%）对第三代头孢菌素耐药。其中产ESBLs的（此处原文括号内容缺失，无法准确翻译）有276份（61.1%）。儿科ICU中产ESBL（此处原文括号内容缺失，无法准确翻译）的患病率最高，为80.9%。产ESBL（此处原文括号内容缺失，无法准确翻译）的患病率在尿液样本中最高（82.6%），其次是脓液样本（9.8%）。对产ESBLs菌株最有效的抗生素是亚胺培南（敏感性为96.7%），其次是阿米卡星（88.4%）和哌拉西林 - 他唑巴坦（87%）。
结论
本研究突出了我院ICU中产ESBLs的（此处原文括号内容缺失，无法准确翻译）患病率很高。对其抗菌谱进行深入分析将有助于制定抗生素政策并防止ESBL菌株传播。建议常规进行ESBL检测以减少抗生素耐药性并有效实施感染控制措施。
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