Amissah Nana Ama, van Dam Lieke, Ablordey Anthony, Ampomah Opoku-Ware, Prah Isaac, Tetteh Caitlin S, van der Werf Tjip S, Friedrich Alexander W, Rossen John W, van Dijl Jan Maarten, Stienstra Ymkje
Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
PLoS One. 2017 Jul 13;12(7):e0181072. doi: 10.1371/journal.pone.0181072. eCollection 2017.
In developing countries, hospitalized burn victims are at high risk of nosocomial infections caused by Staphylococcus aureus. Risk factors include poor infection control practices, prolonged hospitalisation and limited capacity for laboratory microbiological analyses. These problems are compounded by widespread use of antibiotics that drives the spread of multi-drug resistant bacteria.
During the study period (November 2014-June 2015), nasal and invasive S. aureus isolates were collected consecutively from patients and healthcare workers (HCWs) within the burn unit of the Reconstructive Plastic Surgery and Burn Center of Korle Bu Teaching Hospital in Ghana. Antibiotic prescription, antibiotic susceptibility and bacterial typing were used to assess antibiotic pressure, antibiotic resistance, and possible transmission events among patients and HCWs.
Eighty S. aureus isolates were obtained from 37 of the 62 included burn patients and 13 of the 29 HCWs. At admission, 50% of patients carried or were infected with S. aureus including methicillin resistant S. aureus (MRSA). Antibiotic use per 100 days of hospitalization was high (91.2 days), indicating high selective pressure for resistant pathogens. MRSA isolates obtained from 11 patients and one HCW belonged to the same spa-type t928 and multi-locus sequence type 250, implying possible transmission events. A mortality rate of 24% was recorded over the time of admission in the burn unit.
This study revealed a high potential for MRSA outbreaks and emergence of resistant pathogens amongst burn patients due to lack of patient screening and extended empirical use of antibiotics. Our observations underscore the need to implement a system of antibiotic stewardship and infection prevention where microbiological diagnostics results are made available to physicians for timely and appropriate patient treatment.
在发展中国家，住院烧伤患者极易感染由金黄色葡萄球菌引起的医院感染。危险因素包括感染控制措施不力、住院时间延长以及实验室微生物分析能力有限。广泛使用抗生素导致多重耐药菌传播，使这些问题更加复杂。
在研究期间（2014年11月至2015年6月），连续从加纳科勒布教学医院整形重建与烧伤中心烧伤病房的患者和医护人员中收集鼻腔和侵入性金黄色葡萄球菌分离株。通过抗生素处方、抗生素敏感性和细菌分型来评估抗生素压力、抗生素耐药性以及患者和医护人员之间可能的传播事件。
从62名纳入研究的烧伤患者中的37名以及29名医护人员中的13名获得了80株金黄色葡萄球菌分离株。入院时，50%的患者携带或感染了金黄色葡萄球菌，包括耐甲氧西林金黄色葡萄球菌（MRSA）。每100天住院时间的抗生素使用量很高（91.2天），表明对抗药性病原体的选择压力很大。从11名患者和1名医护人员中获得的MRSA分离株属于相同的spa型t928和多位点序列类型250，这意味着可能存在传播事件。在烧伤病房入院期间记录的死亡率为24%。
本研究表明，由于缺乏患者筛查和抗生素的广泛经验性使用，烧伤患者中MRSA暴发和耐药病原体出现的可能性很高。我们的观察结果强调需要实施抗生素管理和感染预防系统，以便将微生物诊断结果提供给医生，从而及时、适当地治疗患者。
