埃及某大学医院成年患者社区获得性肺炎：细菌病因、药敏谱及初始经验性抗生素治疗反应评估
Community acquired pneumonia among adult patients at an Egyptian university hospital: bacterial etiology, susceptibility profile and evaluation of the response to initial empiric antibiotic therapy.
作者信息
El-Sokkary Rehab H, Ramadan Raghdaa A, El-Shabrawy Mohamed, El-Korashi Lobna A, Elhawary Abeer, Embarak Sameh, Tash Rehab M Elsaid, Elantouny Neveen G
机构信息
Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt,
Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
出版信息
Infect Drug Resist. 2018 Nov 2;11:2141-2150. doi: 10.2147/IDR.S182777. eCollection 2018.
BACKGROUND
Effective empirical antibiotic therapy for community acquired pneumonia (CAP), based on frequently updated data about the pattern of bacterial distribution and their antimicrobial susceptibilities, is mandatory.
AIM
To identify the bacterial etiology of CAP in adults and their antibiotic susceptibility patterns and to evaluate the response to initial empirical antibiotic therapy in an Egyptian university hospital.
SETTINGS AND DESIGN
A cross-sectional hospital-based study.
PATIENTS AND METHODS
CAP cases were selected by systemic random sampling from those admitted to the chest department. All were evaluated at admission and 4 days after starting empiric therapy. Typical bacteria were isolated, identified and tested for their antibiotic susceptibility. An indirect IF assay was used to diagnose atypical bacteria. Clinical response to initial empiric antibiotic therapy was clinically, laboratory and radiologically evaluated.
RESULTS
Two hundred and seventy CAP patients were included. Bacteria represented 50.4% of them. was the most prevalent bacterium (10.37%) followed by and (7.78% each). Overall, 76.2% of isolates showed a multidrug resistant phenotype: 82.61% (19/23) , 89.66 % (26/29) , 65.22% (15/23) , 87.50% (7/8) and 81.25 % (13/16) . Broad spectrum β-lactams, especially carbapenems, and moxifloxacin showed in vitro efficacy on most of the tested isolates. Forty-three cases (15.9%) were nonresponders, 37 (86%) of them showed bacterial etiology. The highest rate of nonresponsiveness (30.43%) was observed in cases receiving antipseudomonal/antipneumococcal β-lactam plus a fluoroquinolone for suspected infection.
CONCLUSION
Multidrug resistance in bacteria causing CAP and high frequency of isolation of hospital pathogens are prominent features of this study. Azithromycin containing regimens were associated with the lowest rates of nonresponsiveness. Development and implementation of an antibiotic stewardship program are highly recommended for CAP management.
背景
基于细菌分布模式及其抗菌药敏性的频繁更新数据，对社区获得性肺炎（CAP）进行有效的经验性抗生素治疗至关重要。
目的
确定埃及某大学医院成人CAP的细菌病因及其抗生素药敏模式，并评估初始经验性抗生素治疗的反应。
设置与设计
一项基于医院的横断面研究。
患者与方法
通过系统随机抽样从胸科收治的患者中选取CAP病例。所有患者在入院时和开始经验性治疗4天后进行评估。分离、鉴定典型细菌并检测其抗生素药敏性。采用间接免疫荧光法检测非典型细菌。对初始经验性抗生素治疗的临床反应进行临床、实验室和影像学评估。
结果
纳入270例CAP患者。细菌占其中的50.4%。 是最常见的细菌（10.37%），其次是 和 （各占7.78%）。总体而言，76.2%的分离株表现出多重耐药表型：82.61%（19/23） ，89.66%（26/29） ，65.22%（15/23） ，87.50%（7/8） 和81.25%（13/16） 。广谱β-内酰胺类药物，尤其是碳青霉烯类药物和莫西沙星对大多数测试分离株显示出体外疗效。43例（15.9%）患者治疗无反应，其中37例（86%）有细菌病因。在疑似 感染接受抗假单胞菌/抗肺炎球菌β-内酰胺类药物加氟喹诺酮治疗的病例中，无反应率最高（30.43%）。
结论
本研究的突出特点是引起CAP的细菌存在多重耐药性以及医院病原体的高分离率。含阿奇霉素的治疗方案无反应率最低。强烈建议制定和实施抗生素管理计划以管理CAP。
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