医疗保健相关实验室确诊血流感染——物种多样性和耐药机制：波兰南部四年回顾性基于实验室的研究。
Healthcare-Associated Laboratory-Confirmed Bloodstream Infections-Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland.
机构信息
Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
Department of Microbiology, Analytical and Microbiological Laboratory of Ruda Slaska, KORLAB NZOZ, 41-700 Ruda Slaska, Poland.
出版信息
Int J Environ Res Public Health. 2021 Mar 9;18(5):2785. doi: 10.3390/ijerph18052785.
INTRODUCTION
Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine.
OBJECTIVES
The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland.
PATIENTS AND METHODS
Data on 4218 LC-BSIs were collected between 2016-2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations.
RESULTS
Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but with resistance to macrolides, lincosamides and streptogramins B (MLS) in surgery was 66.7%. The highest prevalence of with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while -HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more.
CONCLUSIONS
The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis.
简介
无论在哪个国家，医疗保健的进步和血流感染（BSI）的感染预防和控制都是现代医学的巨大负担。
目的
我们的研究旨在描述波兰南部 16 家医院成人患者实验室确诊的血流感染（LC-BSI）的流行病学和耐药情况。
患者和方法
收集了 2016-2019 年间 4218 例 LC-BSI 数据。使用 MALDI-TOF 进行菌株鉴定。根据欧洲抗菌药物敏感性试验委员会（EUCAST）的建议，研究耐药机制。
结果
从 8899 名患者中采集血培养，确认 LC-BSI 为 47.4%。革兰阳性菌的患病率为 70.9%，革兰阴性菌为 27.8%，酵母为 1.4%。最常分离的属为 （所有 LC-BSI 的 50%），以凝固酶阴性葡萄球菌为主，而 （13.7%）是最常见的革兰阴性菌。4 年来，仅分离出 108 株（2.6%）细菌，包括来自人体微生物群以及环境和人畜共患病微生物的细菌。重症监护病房（ICU）中耐甲氧西林金黄色葡萄球菌（MRSA）的患病率最高（55.6%），但外科手术中对大环内酯类、林可酰胺类和链阳性菌素 B（MLS）的耐药率为 66.7%。高水平氨基糖苷类耐药（HLAR）机制的 患病率最高的是 ICU（84.6%），而外科手术中的 -HLAR 为 83.3%。所有球菌均对糖肽类完全敏感。碳青霉烯类耐药革兰氏阴性杆菌仅在非发酵菌群中检出，流行率为 70%以上。
结论
波兰医院的血流感染微生物学与其他研究报告相似，但 MRSA 和肠球菌-HLAR 的流行率高于预期，碳青霉烯类耐药非发酵菌的流行率也高于预期。现代诊断技术，如 MALDI-TOF，可确保可靠的诊断。
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