Pharmacy Department, Sohar Hospital, Oman.
Microbiological Laboratory, Sohar Hospital, Oman.
Int J Infect Dis. 2019 Jun;83:77-82. doi: 10.1016/j.ijid.2019.04.004. Epub 2019 Apr 5.
Increasing rate of resistant infections is a challenge to healthcare negatively impacting therapeutic and financial outcomes. Targeted antimicrobial stewardship interventions are needed to counteract this global crisis. On large scale, we sought to identify the prevalence of resistant pathogens and their susceptibility pattern in Northern Oman.
Retrospective analysis of all isolates processed by Suhar Hospital microbiology laboratory between Jan1st, 2016 and Dec31st, 2017. Organism identification, susceptibility and phenotyping were performed following CLSI standards and duplicate isolates were excluded. Pertinent microbiological data were collected and analyzed.
Of 15,733 samples included, Gram-negative bacteria predominate by 67.76%, Gram-positive (29%) and Candida species (2.63%). Frequently isolated Gram-negative bacteria were Escherichia coli (32.39%), Pseudomonas aeruginosa (22.16%), Klebsiellapneumoniae (19.97%) and Acinetobacter baumannii (5.22%), there was virtually no resistance to colistin and tigecycline, while a growing resistance toward ciprofloxacin and meropenem was observed. Resistant E. coli and K. pneumoniae were isolated from bloodstream infection (12%). While Gram-positives were MSSA (27.23%), Streptococcus agalactiae (25.36%), MRSA (16.10%) and CoNS (12.1 %), they were almost universally susceptible to daptomycin and linezolid with low resistance (8˜20%) to clindamycin. Approximately, 50% of Staphylococci (MRSA and CoNS) required vancomycin treatment.
Study findings should guide targeted stewardship interventions to optimize antibiotic prescriptions. Empirical treatment options should be revised, drug-bug match therapy instituted promptly and newer agents considered. Prescribing restriction of formulary antimicrobials that still retain their activity towards bugs - like colistin, linezolid and tigecycline- is a mandatory action. Review empiric use of ciprofloxacin and meropenem to counteract growing resistance.
耐药感染率的上升对医疗保健产生负面影响，影响治疗和财务结果。需要有针对性的抗菌药物管理干预措施来应对这一全球性危机。在大规模的范围内，我们试图确定北阿曼耐药病原体的流行率及其药敏模式。
对 2016 年 1 月 1 日至 2017 年 12 月 31 日期间苏哈尔医院微生物实验室处理的所有分离物进行回顾性分析。根据 CLSI 标准进行了鉴定、药敏试验和表型试验，排除了重复的分离株。收集了相关的微生物学数据并进行了分析。
在 15733 个样本中，革兰氏阴性菌占 67.76%，革兰氏阳性菌（29%）和念珠菌（2.63%）。经常分离到的革兰氏阴性菌是大肠埃希菌（32.39%）、铜绿假单胞菌（22.16%）、肺炎克雷伯菌（19.97%）和鲍曼不动杆菌（5.22%），对黏菌素和替加环素几乎没有耐药性，而对环丙沙星和美罗培南的耐药性则呈上升趋势。耐药性大肠埃希菌和肺炎克雷伯菌从血流感染中分离出来（12%）。而革兰氏阳性菌是 MSSA（27.23%）、无乳链球菌（25.36%）、MRSA（16.10%）和 CoNS（12.1%），它们几乎对达托霉素和利奈唑胺具有普遍的敏感性，而对克林霉素的耐药率较低（8-20%）。大约 50%的葡萄球菌（MRSA 和 CoNS）需要万古霉素治疗。
研究结果应指导有针对性的药物管理干预措施，以优化抗生素处方。应迅速修订经验性治疗方案，实施药物-细菌匹配治疗，并考虑使用新的药物。限制使用仍然对细菌有效的处方抗菌药物（如黏菌素、利奈唑胺和替加环素）是一项强制性措施。审查环丙沙星和美罗培南的经验性使用，以对抗耐药性的增加。
