Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
Institute of Public Health (Section of Hygiene), Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
Eur J Clin Microbiol Infect Dis. 2018 Sep;37(9):1627-1636. doi: 10.1007/s10096-018-3292-9. Epub 2018 Jun 9.
The proportion of antimicrobial resistance (AMR) among the ESKAPE and Escherichia coli (ESKAPEEc) pathogens causing bloodstream infection (BSI) increased worldwide. We described longitudinal trends in ESKAPEEc BSI and AMR over 9 years (2007-2015) at a large teaching hospital in Italy. Of 9720 unique BSI episodes, 6002 (61.7%) were caused by ESKAPEEc pathogens. The majority of these episodes (4374; 72.9%) were hospital-onset infections. The most frequent pathogen was E. coli (32.8%), followed by Staphylococcus aureus (20.6%), Klebsiella pneumoniae (16.1%), and Pseudomonas aeruginosa (11.6%). There was a significant increase of hospital-onset K. pneumoniae (from 2.3 to 5.0 per 10,000 patient-days; P = 0.001) and community-onset E. coli (from 3.3 to 9. 1 per 10,000 emergency admissions; P = 0.04) BSIs. Among hospital-onset BSIs, increases of extended-spectrum β-lactamase (ESBL)-producing E. coli (from 25.4 to 35.2%, P = 0.006), carbapenemase-producing K. pneumoniae (from 4.2 to 51.6%, P < 0.001), and methicillin-resistant S. aureus (from 33.9 to 44.4%, P < 0.001) BSIs were observed between the 2007-2009 and 2010-2012 study periods. In contrast, a decrease of BSIs caused by P. aeruginosa resistant to ceftazidime (from 45.5 to 28.2%, P < 0.001), ciprofloxacin (from 46 to 36.3%, P = 0.05), and meropenem (from 55 to 39.9%, P = 0.03) was observed through all 9 years of the study period. Among community-onset BSIs, increases of BSIs caused by ESBL-producing E. coli (from 28.6 to 42.2%, P = 0.002) and carbapenemase-producing K. pneumoniae (from 0 to 17.6%) were observed between the 2007-2009 and 2010-2012 study periods. Our findings show increased rates of BSI and relative AMR for specific pathogen-health care setting combinations, and call for continued active surveillance and infection control policies.
耐抗生素（AMR）的比例在 ESKAPE 和大肠埃希菌（ESKAPEEc）病原体引起的血流感染（BSI）中在全球范围内增加。我们描述了意大利一家大型教学医院 9 年来（2007-2015 年）ESKAPEEc BSI 和 AMR 的纵向趋势。在 9720 个独特的 BSI 发作中，6002 个（61.7%）由 ESKAPEEc 病原体引起。这些发作中的大多数（4374 个；72.9%）是医院获得性感染。最常见的病原体是大肠埃希菌（32.8%），其次是金黄色葡萄球菌（20.6%）、肺炎克雷伯菌（16.1%）和铜绿假单胞菌（11.6%）。医院获得性肺炎克雷伯菌（从每 10000 个患者日的 2.3 增加到 5.0；P = 0.001）和社区获得性大肠埃希菌（从每 10000 个急诊入院的 3.3 增加到 9.1；P = 0.04）BSI 的发生率显著增加。在医院获得性 BSI 中，产超广谱β-内酰胺酶（ESBL）的大肠埃希菌（从 25.4%增加到 35.2%，P = 0.006）、产碳青霉烯酶的肺炎克雷伯菌（从 4.2%增加到 51.6%，P < 0.001）和耐甲氧西林的金黄色葡萄球菌（从 33.9%增加到 44.4%，P < 0.001）BSI 在 2007-2009 年和 2010-2012 年研究期间观察到。相比之下，耐头孢他啶（从 45.5%降至 28.2%，P < 0.001）、环丙沙星（从 46%降至 36.3%，P = 0.05）和美罗培南（从 55%降至 39.9%，P = 0.03）的铜绿假单胞菌BSI 的发生率在整个 9 年研究期间均下降。在社区获得性 BSI 中，产 ESBL 的大肠埃希菌（从 28.6%增加到 42.2%，P = 0.002）和产碳青霉烯酶的肺炎克雷伯菌（从 0%增加到 17.6%）BSI 的发生率在 2007-2009 年和 2010-2012 年研究期间增加。我们的研究结果表明，特定病原体-医疗保健环境组合的 BSI 和相对 AMR 发生率增加，需要持续进行积极的监测和感染控制政策。
