Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University. Key Laboratory of Hepatosplenic Surgery, Ministry of Education, No. 23 Youzheng Street, Harbin, 150001, China.
Department of Hospital Infection Control, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Rui-Jin 2nd Road, Shanghai, 200025, China.
BMC Infect Dis. 2018 Nov 19;18(1):584. doi: 10.1186/s12879-018-3494-x.
The aim was to evaluate the value of organ-specific weighted incidence antibiogram (OSWIA) percentages for bacterial susceptibilities of Gram-negative bacteria (GNB) collected from intra-abdominal infections (IAIs) during SMART 2010-2014.
We retrospectively calculated the OSWIA percentages that would have been adequately covered by 12 common antimicrobials based on the bacterial compositions found in the appendix, peritoneum, colon, liver, gall bladder and pancreas.
The ESBL positive rates were 65.7% for Escherichia coli, 36.2% for Klebsiella pneumoniae, 42.9% for Proteus mirabilis and 33.1% for Klebsiella oxytoca. Escherichia coli were mainly found in the appendix (76.8%), but less so in the liver (32.4%). Klebsiella pneumoniae constituted 45.2% of the total liver pathogenic bacteria and 15.2-20.8% were found in 4 other organs, except the colon and appendix (< 10%). The percentages of Pseudomonas aeruginosa infections were higher in the gall bladder, intra-abdominal abscesses, pancreas and colon (10.2-13.2%) and least (5.4%) in the appendix. The susceptibilities of hospital acquired (HA) and community acquired (CA) IAI isolates from appendix, gall bladder and liver showed ≥80% susceptibilities to amikacin (AMK), imipenem (IPM), piperacillin-tazobactam (TZP) and ertapenem (ETP), while the susceptibility of isolates in abscesses and peritoneal fluid showed ≥80% susceptibility only to amikacin (AMK) and imipenem (IPM). In colon CA IAI isolates susceptibilities did not reach 80% for AMK and ETP, and in pancreatic IAIs susceptibilities of HA GNBs did not reach 80% to AMK, TZP and ETP, and CA GNBs to IMP and ETP. In addition, besides circa 80% susceptibility of HA and CA IAI isolates from appendix to cefoxitin (FOX), IAI isolates from all other organs had susceptibilities between 7.6 and 67.9% to all cephalosporins tested, 28.3-75.2% to fluoroquinolones and 7.6-51.0% to ampicillin-sulbactam (SAM), whether they were obtained from CA or HA infections.
The calculated OSWIA susceptibilities were specific for different organs in abdominal infections.
本研究旨在评估基于 SMART 2010-2014 年间腹腔内感染（IAI）中分离的革兰氏阴性菌（GNB）的器官特异性加权药敏分析（OSWIA）百分比对于细菌药敏结果的评估价值。
我们回顾性地计算了 12 种常见抗菌药物对基于阑尾、腹膜、结肠、肝脏、胆囊和胰腺中分离的细菌组成的 OSWIA 百分比的覆盖度。
大肠埃希菌中 ESBL 阳性率为 65.7%，肺炎克雷伯菌为 36.2%，奇异变形杆菌为 42.9%，产酸克雷伯菌为 33.1%。大肠埃希菌主要存在于阑尾（76.8%），而在肝脏中的比例较低（32.4%）。肺炎克雷伯菌在肝脏病原体中占 45.2%，在其他 4 个器官（除结肠和阑尾外）中的占比为 15.2-20.8%。铜绿假单胞菌在胆囊、腹腔脓肿、胰腺和结肠中的感染比例较高（10.2-13.2%），而在阑尾中则较低（5.4%）。来自阑尾、胆囊和肝脏的医院获得性（HA）和社区获得性（CA）IAI 分离株对阿米卡星（AMK）、亚胺培南（IPM）、哌拉西林-他唑巴坦（TZP）和厄他培南（ETP）的药敏率均≥80%，而脓肿和腹腔液分离株的药敏率仅对 AMK 和 IPM 达到≥80%。在结肠 CA IAI 分离株中，AMK 和 ETP 的药敏率未达到 80%，在胰腺 IAI 中，HA GNB 对 AMK、TZP 和 ETP 的药敏率未达到 80%，CA GNB 对 IMP 和 ETP 的药敏率未达到 80%。此外，除了 HA 和 CA IAI 分离株对头孢西丁（FOX）的药敏率约为 80%外，所有其他器官的 IAI 分离株对所有测试的头孢菌素的药敏率在 7.6-67.9%之间，对氟喹诺酮类药物的药敏率在 28.3-75.2%之间，对氨苄西林-舒巴坦（SAM）的药敏率在 7.6-51.0%之间，无论这些分离株是来自 CA 还是 HA 感染。
计算得出的 OSWIA 药敏结果对于腹部感染的不同器官具有特异性。
