Savage Rachel D, Fowler Robert A, Rishu Asgar H, Bagshaw Sean M, Cook Deborah, Dodek Peter, Hall Richard, Kumar Anand, Lamontagne François, Lauzier François, Marshall John, Martin Claudio M, McIntyre Lauralyn, Muscedere John, Reynolds Steven, Stelfox Henry T, Daneman Nick
Dalla Lana School of Public Health (Savage), University of Toronto; Sunnybrook Health Sciences Centre (Savage, Fowler, Rishu, Daneman), Toronto, Ont.; Division of Critical Care Medicine (Fowler), Department of Medicine; Institute of Health Policy, Management and Evaluation (Fowler, Daneman), University of Toronto, Toronto, Ont.; Division of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Medicine and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek, Reynolds), Department of Medicine, University of British Columbia; Center for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital, Vancouver, BC; Department of Critical Care Medicine (Hall), Faculty of Medicine, Dalhousie University; Nova Scotia Health Authority (Hall), Halifax, NS; Section of Critical Care Medicine (Kumar), Department of Medicine; Departments of Medical Microbiology and of Pharmacology and Therapeutics (Kumar), University of Manitoba, Winnipeg, Man.; Centre de recherche du Centre hospitalier universitaire de Sherbrooke (Lamontagne), Sherbrooke, Que.; Service de médecine interne (Lamontagne), Département de médecine, Université de Sherbrooke, Sherbrooke, Que.; Axe Santé des populations et pratiques optimales en santé (Lauzier), Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec, Que.; Départements de medicine et d'anesthésiologie et de soins intensifs (Lauzier), Université Laval, Québec, Que.; St. Michael's Hospital (Marshall), Toronto, Ont.; Department of Surgery (Marshall), University of Toronto, Toronto, Ont.; Department of Medicine (Martin), Western University; Critical Care Medicine (Martin), Schulich School of Medicine & Dentistry, London Health Sciences Centre, London, Ont.; Division of Critical Care (McIntyre), Department of Medicine, The Ottawa Hospital, Ottawa, Ont.; Department of Medicine (Muscedere), Queen's University, Kingston, Ont.; Department of Critical Care Medicine (Muscedere), Kingston General Hospital, Kingston, Ont.; Department of Critical Care Medicine (Stelfox), University of Calgary, Calgary, Alta.; Division of Infectious Diseases (Daneman), Department of Medicine, University of Toronto; Institute for Clinical Evaluative Sciences (Daneman), Toronto, Ont.
CMAJ Open. 2016 Oct 13;4(4):E569-E577. doi: 10.9778/cmajo.20160074. eCollection 2016 Oct-Dec.
Surveillance of antimicrobial resistance is vital to guiding empirical treatment of infections. Collating and reporting routine data on clinical isolate testing may offer more timely information about resistance patterns than traditional surveillance network methods.
Using routine microbiology testing data collected from the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness retrospective cohort study, we conducted a descriptive secondary analysis among critically ill patients in whom bloodstream infections had been diagnosed in 14 intensive care units (ICUs) in Canada. The participating sites were located within tertiary care teaching hospitals and represented 6 provinces and 10 cities. More than 80% of the study population was accrued from 2011-2013. We assessed the epidemiologic features of the infections and corresponding antimicrobial susceptibility profiles. Susceptibility testing was done according to Clinical Laboratory Standards Institute guidelines at accredited laboratories.
A total of 1416 pathogens were isolated from 1202 patients. The most common organisms were (217 isolates [15.3%]), (175 [12.4%]), coagulase-negative staphylococci (117 [8.3%]), (86 [6.1%]) and (85 [6.0%]). The contribution of individual pathogens varied by site. For 13 ICUs, gram-negative susceptibility rates were high for carbapenems (95.4%), tobramycin (91.2%) and piperacillintazobactam (90.0%); however, the proportion of specimens susceptible to these agents ranged from 75.0%-100%, 66.7%-100% and 75.0%-100%, respectively, across sites. Fewer gram-negative bacteria were susceptible to fluoroquinolones (84.5% [range 64.1%-97.2%]). A total of 145 patients (12.1%) had infections caused by highly resistant microorganisms, with significant intersite variation (range 2.6%-24.0%, χ2 = 57.50, < 0.001).
We assessed the epidemiologic features of bloodstream infections in a geographically diverse cohort of critically ill Canadian patients using routine pathogen and susceptibility data extracted from readily available microbiology testing databases. Expanding data sharing across more ICUs, with serial measurement and prompt reporting, could provide much-needed guidance for empiric treatment for patients as well as system-wide prevention methods to limit antimicrobial resistance.
监测抗菌药物耐药性对于指导感染的经验性治疗至关重要。与传统监测网络方法相比，整理和报告临床分离株检测的常规数据可能会提供有关耐药模式的更及时信息。
利用从临床有效性实际所需菌血症抗生素疗程回顾性队列研究中收集的常规微生物检测数据，我们对加拿大14个重症监护病房（ICU）中诊断为血流感染的重症患者进行了描述性二次分析。参与研究的地点位于三级护理教学医院内，代表6个省份和10个城市。超过80%的研究人群是在2011年至2013年期间招募的。我们评估了感染的流行病学特征以及相应的抗菌药物敏感性谱。药敏试验在经认可的实验室按照临床实验室标准协会的指南进行。
共从1202例患者中分离出1416种病原体。最常见的病原体是[具体病原体1]（217株[15.3%]）、[具体病原体2]（175株[12.4%]）、凝固酶阴性葡萄球菌（117株[8.3%]）、[具体病原体3]（86株[6.1%]）和[具体病原体4]（85株[6.0%]）。个体病原体的贡献因地点而异。对于13个ICU，碳青霉烯类（95.4%）、妥布霉素（91.2%）和哌拉西林 - 他唑巴坦（90.0%）对革兰阴性菌的药敏率较高；然而，这些药物敏感标本的比例在各地点分别为75.0% - 100%、66.7% - 100%和75.0% - 100%。对氟喹诺酮类敏感的革兰阴性菌较少（84.5%[范围64.1% - 97.2%]）。共有145例患者（12.1%）感染了高度耐药微生物，各地点之间存在显著差异（范围2.6% - 24.0%，χ2 = 57.50，P < 0.001）。
我们利用从现成的微生物检测数据库中提取的常规病原体和药敏数据，评估了加拿大不同地区重症患者血流感染的流行病学特征。扩大更多ICU之间的数据共享，进行连续测量并及时报告，可为患者的经验性治疗以及全系统限制抗菌药物耐药性的预防方法提供急需的指导。
