Hasanzade Hasan, Gürün Kaya Aslıhan, Çiledağ Aydın, Erol Serhat, Çiftçi Fatma, Güriz Haluk, Kaya Akın
Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey.
Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Tuberk Toraks. 2021 Mar;69(1):9-20. doi: 10.5578/tt.20219902.
The patients in the intensive care unit have a higher risk of infections because of the poor general condition of these patients and the frequent application of invasive procedures with longer hospitalization length. Also, this group of patients tend to have resistant infections due to empirically widespread and uncontrolled use of broad-spectrum antibiotics. Hence, data are needed to determine appropriate empirical antibiotic therapy in intensive care patients. In this study, it was aimed to assess the distribution of microorganisms and antibiotic resistance profile from the samples taken from the patients in the intensive care unit.
Patients who were hospitalized in Ankara University Faculty of Medicine Chest Diseases Intensive Care Unit for more than 24 hours between December 2016 and December 2017 were included in our study. Demographic characteristics, comorbid diseases, clinical findings, results of sputum, tracheal aspirate, blood, urine, gaita and pus culture samples and antibiotic susceptibility test results were recorded prospectively.
A total of 287 patients, 150 males and 137 females, were included in the study. The mean age of all patients was 69.96 ± 14.4 years. Two hundred twenty-three positive cultures were detected in 1053 samples taken from 287 patients. Gram-negative bacilli constituted 55.1% of the 223 positive cultures. The most common microorganisms were Acinetobacter (16.6%), Staphylococcus (14.8%) and Klebsiella (10.8%). Colistin resistance was found to be 8.3% in the Acinetobacter strains and resistance rates of 97-100% were observed to other antibiotic groups. Thirty-three staphylococcus were isolated, 17 were S. aureus and 16 were coagulase-negative Staphylococcus. While 29.4% of S. aureus were resistant to methicillin (MRSA), vancomycin resistance was not detected. Meanwhile, the MRSA ratio was 62.5%, there was no vancomycin resistance among the coagulase-negative Staphylococcus. Klebsiella was the third most common microorganism and beta-lactamase producing Klebsiella strain was 62.5%. Gentamycin was found to be the most susceptible antibiotic in Klebsiella strains with a resistance rate of 20.8%. Pseudomonas aeruginosa constituted 9.4% of the cultures. While the resistance to colistin was not detected, resistance to piperacillin/tazobactam 42.8%, tobramycin, imipenem and meropenem 50% and ceftazidime 61.9%. The duration of hospitalization in patients with Acinetobacter isolated (23 [10-34] days vs 12.5 [5-24] days, p= 0.011) and the mortality rate (62.5% vs 37.5%, p= 0.008) were significantly higher than those who were not Acinetobacter isolated.
In conclusion, gram-negative bacilli constitute the majority of the patients in intensive care unit. Acinetobacter, the most common microorganism, has a high resistance rate and has been associated with prolonged hospitalization and mortality.
重症监护病房的患者由于总体状况较差、频繁进行侵入性操作以及住院时间较长，感染风险较高。此外，由于经验性广泛且无节制地使用广谱抗生素，这组患者往往会发生耐药感染。因此，需要数据来确定重症监护患者合适的经验性抗生素治疗方案。本研究旨在评估从重症监护病房患者采集的样本中微生物的分布及抗生素耐药情况。
纳入2016年12月至2017年12月在安卡拉大学医学院胸科疾病重症监护病房住院超过24小时的患者。前瞻性记录人口统计学特征、合并疾病、临床表现、痰液、气管吸出物、血液、尿液、伤口渗出液和脓液培养样本的结果以及抗生素敏感性试验结果。
本研究共纳入287例患者，其中男性150例，女性137例。所有患者的平均年龄为69.96±14.4岁。从287例患者采集的1053份样本中检测到223份阳性培养物。革兰氏阴性杆菌占223份阳性培养物的55.1%。最常见的微生物是不动杆菌（16.6%）、葡萄球菌（14.8%）和克雷伯菌（10.8%）。不动杆菌菌株对黏菌素的耐药率为8.3%，对其他抗生素组的耐药率为97 - 100%。分离出33株葡萄球菌，其中17株为金黄色葡萄球菌，16株为凝固酶阴性葡萄球菌。金黄色葡萄球菌对甲氧西林的耐药率为29.4%（耐甲氧西林金黄色葡萄球菌），未检测到对万古霉素的耐药。同时，凝固酶阴性葡萄球菌的耐甲氧西林金黄色葡萄球菌比例为62.5%，未检测到对万古霉素的耐药。克雷伯菌是第三常见的微生物，产β-内酰胺酶的克雷伯菌菌株占62.5%。庆大霉素是克雷伯菌菌株中最敏感的抗生素，耐药率为20.8%。铜绿假单胞菌占培养物的9.4%。未检测到对黏菌素的耐药，但对哌拉西林/他唑巴坦的耐药率为42.8%，对妥布霉素耐药率为50%，对亚胺培南和美罗培南耐药率为50%，对头孢他啶耐药率为61.9%。分离出不动杆菌的患者住院时间（23[10 - 34]天 vs 12.5[ [5 - 24]天，p = 0.011）和死亡率（62.5% vs 37.5%，p = 0.008）显著高于未分离出不动杆菌的患者。
总之，革兰氏阴性杆菌在重症监护病房患者中占大多数。最常见的微生物不动杆菌具有较高的耐药率，且与住院时间延长和死亡率相关。
