蒙古乌兰巴托一家三级儿科和妇产医院临床革兰氏阳性分离株的微生物学及药敏情况
Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia.
作者信息
Felsenstein Susanna, Bira Sarantsetseg, Altanmircheg Narangerel, Shonkhuuz Enkhtur, Ochirpurev Ariuntuya, Warburton David
机构信息
Cork University Hospital University College Cork, Wilton, Cork, Republic of Ireland.
Central Laboratory Department, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia.
出版信息
Cent Asian J Glob Health. 2019 Sep 30;8(1):380. doi: 10.5195/cajgh.2019.380. eCollection 2019.
INTRODUCTION
Information on microbiological and susceptibility profiles of Monoglian bacterial isolates is scarce. Resistance profiles, patient demographics and microbiological work-up of gram positive isolates were analyzed in order to develop infection control activities and policies at the National Center for Maternity and Children's Health (NCMCH) in Ulaanbataar, Mongolia.
METHODS
All gram positive isolates of specimens submitted to the microbiology laboratory at NCMCH between January 2014 and August 2017 were included. Data collected included demographic data, specimen type, in-/outpatient status, hospital ward of sample origin, and antimicrobial susceptibility testing profile. Susceptibility testing was performed by trained microbiologists at the NCMCH microbiology laboratory. T-test, Mann-Whitney, Chi-square and Fisher exact tests were used as appropriate.
RESULTS
Of 11,889 isolates, 4012 (33.7%) were gram positive, with most identified as S. aureus (62.6%, n=2512). Rates of methicillin resistance (MRSA) remained stable at a quarter, but was significantly higher among inpatients (inpatients: 630/2002, 31.5%; outpatients 67/290, 23.1%; p≤0.05) and sterile site isolates (sterile: 83/171, 48.5%; non-sterile: 416/1678, 24.8%; p≤0.01). The vast majority of S. pneumoniae isolates (12/14; 85%) was found to be penicillin resistant by oxacillin disk diffusion. While identification of Group B streptococci was rare (n=137) due to of lack of diagnostic measures available, the number of enterococcal isolates identified increased significantly due to implementation of improved microbiological work-up (2015: n=7; 2016: n=26; 2017: n=83).
CONCLUSION
Compared with published studies from neighboring nations, the rates of antimicrobial resistance among gram positive isolates at NCMCH, particularly with respect to S. aureus and S. pneumoniae, were much higher. Further improvement of microbiological diagnostics and collaboration of stakeholders is required to address the pressing infection control and stewardship issues and to ensure reliable identification of relevant pathogens in Mongolia.
引言
关于蒙古细菌分离株的微生物学和药敏谱的信息匮乏。为了在蒙古乌兰巴托的国家妇幼保健中心（NCMCH）制定感染控制活动和政策，对革兰氏阳性分离株的耐药谱、患者人口统计学和微生物学检查进行了分析。
方法
纳入2014年1月至2017年8月期间提交至NCMCH微生物实验室的所有标本的革兰氏阳性分离株。收集的数据包括人口统计学数据、标本类型、门诊/住院状态、样本来源的医院病房以及抗菌药物敏感性测试谱。药敏试验由NCMCH微生物实验室经过培训的微生物学家进行。酌情使用t检验、曼-惠特尼检验、卡方检验和费舍尔精确检验。
结果
在11889株分离株中，4012株（33.7%）为革兰氏阳性，其中大多数鉴定为金黄色葡萄球菌（62.6%，n = 2512）。耐甲氧西林金黄色葡萄球菌（MRSA）的比例保持在四分之一稳定，但在住院患者中显著更高（住院患者：630/2002，31.5%；门诊患者67/290，23.1%；p≤0.05）以及无菌部位分离株中（无菌：83/171，48.5%；非无菌：416/1678，24.8%；p≤0.01）。通过苯唑西林纸片扩散法发现绝大多数肺炎链球菌分离株（12/14；85%）对青霉素耐药。由于缺乏可用的诊断措施，B族链球菌的鉴定很少见（n = 137），但由于改进了微生物学检查，鉴定出的肠球菌分离株数量显著增加（2015年：n = 7；2016年：n = 26；2017年：n = 83）。
结论
与邻国发表的研究相比，NCMCH革兰氏阳性分离株的抗菌药物耐药率，特别是金黄色葡萄球菌和肺炎链球菌的耐药率要高得多。需要进一步改进微生物学诊断并加强利益相关者之间的合作，以解决紧迫的感染控制和管理问题，并确保在蒙古可靠鉴定相关病原体。
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