Microbiology Laboratory, University Hospital Wroclaw, Borowska Street 213, Wroclaw, Poland.
Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367, Wroclaw, Poland.
BMC Infect Dis. 2021 Feb 16;21(1):180. doi: 10.1186/s12879-021-05883-5.
Pseudomonas aeruginosa has recently shown to be one of the most important strains of bacteria and alert pathogens in Europe among Intensive Care Unit patients that provide serious therapeutic problems because of its multidrug resistance.
The purpose of this microbiological study was data analysis of device associated- healthcare associated infections (DA-HAIs) in an ICU in terms of the incidents of P.aeruginosa strain infections and its susceptibility within an 8.5-year observation.
Among 919 isolated strains responsible for 799 DA-HAIs (17,62 ± 1,98/1000 patient-days) in 4010 ICU patients P.aeruginosa was the pathogen in 108/799 (13.52%) cases. Incidence rate (density) of: VAP/1000 MV- days, UTI /1000 UC- days and CLA-BSI/1000 CL- days were 11,15 ± 2.5, 6.82 ± 0.81, 2.35 ± 1.54.respectivelly. P.aeruginosa was the pathogen most frequently responsible for VAP 69/108 (63.88%). Mean frequency of VAP, UTI and CLA-BSI with P.aeruginosa etiology was 69/493 (14.28%), 32/299 (11.1%) and 7/127 (5.77%) respectively. The mean density of P.aeruginosa infection amounted to 2.43/1000 patient-days. The decrease was observed in the total number of DA-HAIs caused by the P.aeruginosa from 15.75% and 3.23/1000 patient-days in 2011 to 5.0% and 1.17/1000 in 2016 (p = 0.0104, p = 0.0348). Starting from 2016 to 2019 incidence and density of P.aeruginosa DA-HAIs increased to 12.33% and 2.63/1000 (p = 0.1388, p = 0.0818). P.aeruginosa was susceptible to ceftazidime, cefepime, amikacin, meropenem, ciprofloxacin, colistin, in 55.55, 58.33, 70.37, 53.73, 50, and 100% respectively. MDR characterised it in 40% in 2011 and 66.7% in 2019, (p = 0.177).
The study revealed a changeable prevalence of P. aeruginosa strain infections; however their frequency was never highest in our ICU patients as it presented in the last years in Europe. The study showed a significant decrease in 2016 and increase in 2019, a nearly 3-fold increase of P.aeruginosa infections among Gram-negative strain infections, and a 2-fold increase of the P.aeruginosa DA-HAIs frequency between 2016 and 2019 as well as an increased resistance. Microbiological analysis of DA-HAIs in each hospital should be a standard method used in hospital infection control and antibiotic policy. In the case of P.aeruginosa, in order to minimize transmission, preventive infection methods should be assessed mainly in case of VAP.
铜绿假单胞菌最近被证明是欧洲重症监护病房患者中最重要的细菌菌株和警报病原体之一，由于其对多种药物的耐药性，给治疗带来了严重的问题。
本微生物学研究的目的是分析一家重症监护病房中与设备相关的医疗保健相关感染（DA-HAIs）的数据，分析在 8.5 年的观察期内，铜绿假单胞菌菌株感染及其敏感性的情况。
在 4010 名重症监护病房患者中，919 株分离株导致 799 例 DA-HAIs（17.62±1.98/1000 患者-天），其中 108/799（13.52%）为铜绿假单胞菌感染。呼吸机相关性肺炎（VAP）/1000 有创机械通气（MV）-天、尿路感染（UTI）/1000 导尿（UC）-天和血流感染（BSI）/1000 中心静脉置管（CL）-天的发病率（密度）分别为 11.15±2.5、6.82±0.81 和 2.35±1.54。铜绿假单胞菌是引起 VAP 的最常见病原体，占 69/108（63.88%）。铜绿假单胞菌引起的 VAP、UTI 和 BSI 的平均频率分别为 69/493（14.28%）、32/299（11.1%）和 7/127（5.77%）。铜绿假单胞菌感染的平均密度为 2.43/1000 患者-天。从 2011 年的 15.75%和 3.23/1000 患者-天到 2016 年的 5.0%和 1.17/1000 患者-天，铜绿假单胞菌引起的 DA-HAIs 总数减少（p=0.0104，p=0.0348）。从 2016 年到 2019 年，铜绿假单胞菌 DA-HAIs 的发病率和密度分别增加到 12.33%和 2.63/1000（p=0.1388，p=0.0818）。铜绿假单胞菌对头孢他啶、头孢吡肟、阿米卡星、美罗培南、环丙沙星、黏菌素的敏感性分别为 55.55%、58.33%、70.37%、53.73%、50%和 100%。2011 年和 2019 年，多药耐药性分别为 40%和 66.7%（p=0.177）。
研究表明铜绿假单胞菌菌株感染的流行率发生了变化；然而，在过去几年里，它在欧洲重症监护病房患者中的频率从未最高。研究表明，2016 年显著下降，2019 年显著增加，革兰氏阴性菌感染中铜绿假单胞菌感染增加近 3 倍，2016 年至 2019 年铜绿假单胞菌 DA-HAIs 频率增加 2 倍，耐药性增加。每家医院都应将 DA-HAIs 的微生物学分析作为医院感染控制和抗生素政策的标准方法。在铜绿假单胞菌的情况下，为了最大限度地减少传播，应主要评估预防感染的方法，特别是在 VAP 的情况下。
