入院时和住院≥48 小时后脓毒症驹分离细菌的分离率和抗菌药物敏感性的差异。
Differences in isolation rate and antimicrobial susceptibility of bacteria isolated from foals with sepsis at admission and after ≥48 hours of hospitalization.
机构信息
Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
Department of Infectious Diseases and Immunity, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
出版信息
J Vet Intern Med. 2020 Mar;34(2):955-963. doi: 10.1111/jvim.15692. Epub 2020 Feb 5.
BACKGROUND
Antimicrobial treatment protocols for foals with sepsis that do not improve clinically often are adjusted based on bacteriological and antimicrobial susceptibility testing results from samples collected at hospital admission.
OBJECTIVES
To evaluate whether hospitalization for ≥48 hours affects bacteriological and antimicrobial susceptibility testing results.
ANIMALS
Two-hundred sixty-seven foals <30 days of age admitted to a neonatal intensive care unit and diagnosed with sepsis.
METHODS
Medical records were reviewed retrospectively to identify foals with sepsis and positive bacteriological cultures. Results from samples collected at hospital admission were compared to those collected ≥48 hours after admission. Logistic regression for clustered data and exact logistic regression were used for statistical analysis.
RESULTS
Three-hundred fifty-three unique bacterial isolates were obtained from 231 foals at hospital admission and 92 unique bacterial isolates were obtained from 57 foals after ≥48 hours of hospitalization. Relative isolation frequency after ≥48 hours of hospitalization increased for Acinetobacter spp., 0.6% versus 3.3% (odds ratio [OR], 7.63; 95% confidence interval [CI], 1.28-45.45); Enterococcus spp., 4.8% versus 19.6% (OR, 5.37; 95% CI, 2.64-10.90); Klebsiella spp., 5.1% versus 10.9% (OR, 2.27; 95% CI, 1.05-4.89); Pseudomonas spp., 3.0% versus 7.6% (OR, 3.49; 95% CI, 3.49-240.50); and Serratia spp., 3.0% versus 5.4% (OR, 20.23; 95% CI, 2.20-186.14). Bacteria isolated after ≥48 hours of hospitalization were less susceptible to all tested antimicrobial drugs, except for imipenem.
CONCLUSIONS AND CLINICAL IMPORTANCE
Decreased antimicrobial susceptibility of bacteria isolated after ≥48 hours of hospitalization provides a rationale for repeated bacteriological culture and susceptibility testing in hospitalized foals with sepsis.
背景
对于临床治疗无改善的败血症驹，常根据入院时采集样本的细菌学和药敏试验结果调整抗菌治疗方案。
目的
评估住院时间≥48 小时是否会影响细菌学和药敏试验结果。
动物
267 头＜30 日龄、被诊断为败血症的新生驹，入住新生儿重症监护病房。
方法
回顾性查阅病历，以确定患有败血症且有阳性细菌培养结果的驹。比较驹入院时和入院后≥48 小时采集的样本的结果。采用聚类数据的逻辑回归和确切逻辑回归进行统计学分析。
结果
231 头驹在入院时从 353 株独特的细菌分离株，57 头驹在入院后≥48 小时从 92 株独特的细菌分离株中获得。在≥48 小时的住院治疗后，相对分离频率增加的细菌包括不动杆菌属，0.6%对 3.3%（比值比[OR]，7.63；95%置信区间[CI]，1.28-45.45）；肠球菌属，4.8%对 19.6%（OR，5.37；95%CI，2.64-10.90）；克雷伯菌属，5.1%对 10.9%（OR，2.27；95%CI，1.05-4.89）；铜绿假单胞菌属，3.0%对 7.6%（OR，3.49；95%CI，3.49-240.50）；和沙雷菌属，3.0%对 5.4%（OR，20.23；95%CI，2.20-186.14）。≥48 小时住院后分离的细菌对所有测试的抗菌药物的敏感性降低，除了亚胺培南。
结论和临床意义
住院败血症驹在≥48 小时后分离的细菌的抗菌敏感性降低，这为反复进行细菌培养和药敏试验提供了依据。
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