2012-2017 年津巴布韦哈拉雷地区细菌病原体的抗药性趋势：二次数据集分析。
Trends in antimicrobial resistance of bacterial pathogens in Harare, Zimbabwe, 2012-2017: a secondary dataset analysis.
机构信息
Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
African Society of Laboratory Medicine, Addis Ababa, Ethiopia.
出版信息
BMC Infect Dis. 2019 Aug 27;19(1):746. doi: 10.1186/s12879-019-4295-6.
BACKGROUND
Antimicrobial resistance is one of the most serious public health threats of the twenty-first century. The implementation of AMR surveillance in Zimbabwe is limited. However, data from a private laboratory in Harare revealed increasing resistance rates to common antibiotics like ampicillin (i.e., from 73.9% in 2011 to 74.6% in 2015). The increasing resistance rates indicate that Zimbabwe is affected by AMR. This study was done to determine the magnitude of AMR in Harare and determine the trends of AMR to first-line and to last-resort antibiotics and make recommendations to mitigate the problem.
METHODS
A retrospective record review of data collected from the microbiology department at a private laboratory between January 2012 and December 2017 was done. The outcome of interest was the antibiotic susceptibility of bacterial isolates. Microsoft Excel 2016 was used to plot trends from 2012 to 2017 and Epi Info™7 was used for statistical analysis.
RESULTS
A total of 23,432 isolates, of 12 medically important bacteria were analysed. Forty-three percent of the isolates were from urines, 36.7% were from pus swabs and 7% were from blood. The most common pathogen was Escherichia coli (43.2%), followed by Staphylococcus aureus (15.8%) and the least common was Neisseria gonorrhoea (0.2%). Resistance was highest to ampicillin followed by penicillin, both ranging between 70 and 100% over the six years. Statistically significant increases in resistance to commonly used antibiotics were observed in amoxicillin-resistant E. coli and Streptococcus pneumonia and third generation cephalosporin-resistant E. coli. There was an increase in resistance to last-line antibiotics i.e., fluoroquinolone-resistant Salmonella spp. and carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. However, methicillin-resistant S. aureus showed a decreasing trend.
CONCLUSIONS
There is a high burden of drug resistance to common antibiotics in Harare and an emergence of resistance to last-line antibiotics.
背景
抗生素耐药性是 21 世纪最严重的公共卫生威胁之一。津巴布韦的抗生素耐药性监测实施有限。然而，哈拉雷一家私人实验室的数据显示，常见抗生素如氨苄西林（2011 年耐药率为 73.9%，2015 年为 74.6%）的耐药率不断上升。耐药率的上升表明津巴布韦受到抗生素耐药性的影响。本研究旨在确定哈拉雷地区抗生素耐药性的严重程度，确定抗生素耐药性的趋势，了解一线和最后一线抗生素的耐药性，并提出缓解问题的建议。
方法
对 2012 年 1 月至 2017 年 12 月期间一家私人实验室微生物科收集的数据进行回顾性记录审查。感兴趣的结果是细菌分离物的抗生素敏感性。使用 Microsoft Excel 2016 绘制 2012 年至 2017 年的趋势，使用 Epi Info™7 进行统计分析。
结果
共分析了 12 种重要细菌的 23432 株分离物。43%的分离物来自尿液，36.7%来自脓液拭子，7%来自血液。最常见的病原体是大肠杆菌（43.2%），其次是金黄色葡萄球菌（15.8%），最少见的是淋病奈瑟菌（0.2%）。六种抗生素中，氨苄西林和青霉素的耐药率最高，均在 70%至 100%之间。在阿莫西林耐药大肠杆菌和肺炎链球菌和第三代头孢菌素耐药大肠杆菌中观察到常用抗生素耐药性显著增加。最后一线抗生素的耐药性也有所增加，即耐氟喹诺酮的沙门氏菌和耐碳青霉烯的铜绿假单胞菌和鲍曼不动杆菌。然而，耐甲氧西林金黄色葡萄球菌的耐药率呈下降趋势。
结论
哈拉雷地区常见抗生素耐药性负担沉重，最后一线抗生素耐药性也有所增加。
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