津巴布韦癌症患者的败血症：细菌和真菌感染病因谱及其抗菌药物敏感性模式。
Sepsis in cancer patients residing in Zimbabwe: spectrum of bacterial and fungal aetiologies and their antimicrobial susceptibility patterns.
机构信息
Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Premier Services Medical Investments, Department of Microbiology, Harare, Zimbabwe.
出版信息
BMC Infect Dis. 2020 Feb 21;20(1):161. doi: 10.1186/s12879-020-4886-2.
BACKGROUND
Cancer and sepsis comorbidity is a major public health problem in most parts of the world including Zimbabwe. The microbial aetiologies of sepsis and their antibiograms vary with time and locations. Knowledge on local microbial aetiologies of sepsis and their susceptibility patterns is critical in guiding empirical antimicrobial treatment choices.
METHODS
This was a descriptive cross-sectional study which determined the microbial aetiologies of sepsis from blood cultures of paediatric and adult cancer patients obtained between July 2016 and June 2017. The TDR-X120 blood culture system and TDR 300B auto identification machine were used for incubation of blood culture bottles and identification plus antimicrobial susceptibility testing, respectively.
RESULTS
A total of 142 participants were enrolled; 50 (35.2%) had positive blood cultures, with 56.0% Gram positive, 42.0% Gram-negative bacteria and 2.0% yeast isolated. Common species isolated included coagulase negative Staphylococcus spp. (CoNS) (22.0%), E. coli (16.0%), K. pneumoniae (14.0%), E. faecalis (14.0%) and S. aureus (8.0%). Gram-negative isolates exhibited high resistance to gentamicin (61.9%) and ceftriaxone (71.4%) which are the empiric antimicrobial agents used in our setting. Amikacin and meropenem showed 85.7 and 95.2% activity respectively against all Gram-negative isolates, whilst vancomycin and linezolid were effective against 96.2 and 100.0% of all Gram-positive isolates respectively. We isolated 10 (66.7%) extended spectrum β-lactamase (ESBL) amongst the E. coli and K. pneumoniae isolates. Ten (66.7%) of the Staphylococcus spp. were methicillin resistant.
CONCLUSIONS
CoNS, E. coli, K. pneumoniae, E. faecalis and S. aureus were the major microbial drivers of sepsis amongst cancer patients in Zimbabwe. Most isolates were found to be resistant to commonly used empirical antibiotics, with isolates exhibiting high levels of ESBL and methicillin resistance carriage. A nationwide survey on microbial aetiologies of sepsis and their susceptibility patterns would assist in the guidance of effective sepsis empiric antimicrobial treatment among patients with cancer.
背景
癌症和脓毒症合并症是包括津巴布韦在内的世界大部分地区的一个主要公共卫生问题。脓毒症的微生物病因及其药敏谱随时间和地点而变化。了解当地脓毒症的微生物病因及其药敏模式对于指导经验性抗菌治疗选择至关重要。
方法
这是一项描述性的横断面研究，确定了 2016 年 7 月至 2017 年 6 月期间从儿科和成年癌症患者的血液培养物中分离的脓毒症的微生物病因。使用 TDR-X120 血液培养系统和 TDR 300B 自动识别机分别对血液培养瓶进行孵育和鉴定以及药敏试验。
结果
共纳入 142 名参与者；50 名（35.2%）血培养阳性，革兰阳性菌占 56.0%，革兰阴性菌占 42.0%，酵母占 2.0%。分离出的常见菌种包括凝固酶阴性葡萄球菌（CoNS）（22.0%）、大肠杆菌（16.0%）、肺炎克雷伯菌（14.0%）、粪肠球菌（14.0%）和金黄色葡萄球菌（8.0%）。革兰氏阴性菌对庆大霉素（61.9%）和头孢曲松（71.4%）表现出高度耐药，这两种药物是我们治疗环境中经验性使用的抗菌药物。阿米卡星和美罗培南对所有革兰氏阴性菌的活性分别为 85.7%和 95.2%，而万古霉素和利奈唑胺对所有革兰氏阳性菌的有效率分别为 96.2%和 100.0%。我们从大肠杆菌和肺炎克雷伯菌分离株中分离出 10 株（66.7%）产超广谱β-内酰胺酶（ESBL）。10 株（66.7%）凝固酶阴性葡萄球菌耐甲氧西林。
结论
凝固酶阴性葡萄球菌、大肠杆菌、肺炎克雷伯菌、粪肠球菌和金黄色葡萄球菌是津巴布韦癌症患者脓毒症的主要微生物驱动因素。大多数分离株对常用的经验性抗生素耐药，分离株表现出高水平的 ESBL 和耐甲氧西林耐药性。对全国范围内脓毒症的微生物病因及其药敏模式进行调查，有助于指导癌症患者脓毒症的有效经验性抗菌治疗。
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