Infection Control Department, Dammam Medical Complex, Dammam, Saudi Arabia.
Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
J Infect Public Health. 2020 May;13(5):759-766. doi: 10.1016/j.jiph.2019.12.001. Epub 2019 Dec 31.
We analyse the distribution of ESBL infections in Dammam Medical Complex, Eastern Province, Saudi Arabia with respect to patient demographics, wards, infection site, bacterial species, and antibiotic resistance. We also gauged hospital staff understanding of ESBLs, the procedures in place to identify, treat and infections containing.
Hospital records from 2016 were analysed and 352 ESBL from several samples types were identified using VITEK® 2 system and by phenotypic confirmation using a disk diffusion test. HCWs attitudes and knowledge were assessed using a paper questionnaire.
The percentage of ESBL isolates were Klebsiella pneumoniae(n=148; 42.1%) or Escherichia coli(n=176; 50%), Proteus mirabilis(n=7; 2%), Morganella morganii(n=13; 3.7%), Enterobacter (n=7; 2%) and Citrobacter freundii (n=1; 0.3%). Overall tigecycline susceptibility was 82.2%, however P. mirabilis and M. morganii isolates were uniformly resistant and K. pneumoniae susceptibility levels were significantly lower than for E. coli in urine samples (72.3% v 100%; Chi square=13.76, p=0.0002); for blood samples there was also apparently higher resistance among K. pneumoniae isolates. Overall susceptibility to the carbapenems imipenem, meropenem and ertapenam was high. There were overall high levels of uncertainty among healthcare workers on hospital policies on reporting or prescribing with respect to ESBL-expressing infections.
ESBL control strategies should consider variations among sample types, wards, and antibiotic resistance variability. There is a need to specifically address staff training and communication procedures for infection prevention and control with respect to ESBLs.
我们分析了沙特阿拉伯东部省达曼医疗综合体中 ESBL 感染的分布情况，包括患者人口统计学特征、病房、感染部位、细菌种类和抗生素耐药性。我们还评估了医院工作人员对 ESBL 的了解程度、识别、治疗和感染控制的程序。
分析了 2016 年的医院记录，使用 VITEK® 2 系统从几种样本类型中鉴定出 352 株 ESBL，并通过纸片扩散试验进行表型确认。使用纸质问卷评估 HCWs 的态度和知识。
ESBL 分离株的百分比为肺炎克雷伯菌（n=148; 42.1%）或大肠杆菌（n=176; 50%）、奇异变形杆菌（n=7; 2%）、摩氏摩根菌（n=13; 3.7%）、肠杆菌属（n=7; 2%）和柠檬酸杆菌（n=1; 0.3%）。总体而言，替加环素的敏感性为 82.2%，然而，奇异变形杆菌和摩根摩根菌的分离株均表现出均匀的耐药性，且尿液样本中肺炎克雷伯菌的敏感性水平明显低于大肠杆菌（72.3%对 100%；卡方=13.76，p=0.0002）；血液样本中，肺炎克雷伯菌的耐药性也明显更高。碳青霉烯类抗生素亚胺培南、美罗培南和厄他培南的总体敏感性较高。医护人员对医院关于 ESBL 表达感染的报告或处方政策存在普遍的高度不确定性。
ESBL 控制策略应考虑样本类型、病房和抗生素耐药性变异的差异。需要专门针对感染预防和控制的员工培训和沟通程序来解决 ESBL 问题。
