Martín Jaramago J, Armero Ibáñez R, Camarena Miñana J J, Morales Suárez-Varela M
Servicio de Anestesiología y Reanimación, Hospital Universitario Dr. Peset, Valencia, España.
Servicio de Anestesiología y Reanimación, Hospital Universitario Dr. Peset, Valencia, España.
Rev Esp Anestesiol Reanim. 2017 Nov;64(9):490-498. doi: 10.1016/j.redar.2017.03.007. Epub 2017 Apr 20.
The presence of resistant microorganisms is a major cause of failure in initial empirical antimicrobial therapy. The objectives of this study are to determine the resistance profile of microorganisms that cause bacteraemia of abdominal origin and to identify whether the previous use of antibiotics and the place of acquisition of bacteraemia are risk factors associated with the presence of resistant organisms.
A clinical, observational, epidemiological, retrospective cohort study was conducted with all the adult patients admitted to a university hospital from 2011-2013. Antimicrobial resistance profiles were described and a 95% confidence interval chi-square test was used to determine whether the variables studied were risk factors in the isolation of resistant microorganisms.
Of the 1245 patients with bacteraemia, 212 (17%) presented bacteraemia of abdominal origin. The resistance profile highlights the incidence of methicillin resistant Staphylococcus aureus (50%), coagulase-negative staphylococci resistant to linezolid (20.58%), enterococci resistant to vancomycin (3.12%), Escherichia coli resistant to third-generation cephalosporins (9.9%) and fluoroquinolones (35.64%), Klebsiella pneumoniae resistant to third-generation cephalosporins (8.33%), Pseudomonas aeruginosa resistant to fluoroquinolones and carbapenem (25% and 25% respectively) and Acinetobacter baumanii resistant to fluoroquinolones and carbapenem (100% and 100% respectively), Candida albicans resistant to fluconazole (11.11%), single Candida krusei isolate resistant to fluconazole and Candida parapsilosis resistant to echinocandins (12.5%). In our study, previous use of antibiotics had a statistically significant association with the isolation of resistant microorganisms (P=.013) but not the place of acquisition of bacteraemia (P=.239).
Establishing the incidence of resistant organisms can improve empirical antimicrobial therapy in patients with bacteraemia of abdominal origin. Previous use of antibiotics was statistically significantly related to the isolation of resistant microorganisms.
耐药微生物的存在是初始经验性抗菌治疗失败的主要原因。本研究的目的是确定引起腹部源性菌血症的微生物的耐药情况，并确定先前使用抗生素以及菌血症的获得地点是否为与耐药菌存在相关的危险因素。
对2011年至2013年入住某大学医院的所有成年患者进行了一项临床、观察性、流行病学回顾性队列研究。描述了抗菌药物耐药情况，并使用95%置信区间卡方检验来确定所研究的变量是否为分离耐药微生物的危险因素。
在1245例菌血症患者中，212例（17%）表现为腹部源性菌血症。耐药情况突出显示了耐甲氧西林金黄色葡萄球菌的发生率（50%）、对利奈唑胺耐药的凝固酶阴性葡萄球菌（20.58%）、对万古霉素耐药的肠球菌（3.12%）、对第三代头孢菌素耐药的大肠埃希菌（9.9%）和氟喹诺酮类（35.64%）、对第三代头孢菌素耐药的肺炎克雷伯菌（8.33%）、对氟喹诺酮类和碳青霉烯类耐药的铜绿假单胞菌（分别为25%和25%）以及对氟喹诺酮类和碳青霉烯类耐药的鲍曼不动杆菌（分别为100%和100%）、对氟康唑耐药的白色念珠菌（11.11%）、对氟康唑耐药的克鲁斯念珠菌单株分离物以及对棘白菌素耐药的近平滑念珠菌（12.5%）。在我们的研究中，先前使用抗生素与耐药微生物的分离存在统计学显著关联（P = 0.013），但与菌血症的获得地点无关（P = 0.239）。
确定耐药菌的发生率可以改善腹部源性菌血症患者的经验性抗菌治疗。先前使用抗生素与耐药微生物的分离在统计学上有显著相关性。
