Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland; UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland.
Clin Microbiol Infect. 2021 Dec;27(12):1820-1825. doi: 10.1016/j.cmi.2021.04.025. Epub 2021 Apr 30.
Changing microorganism distributions and decreasing antibiotic susceptibility with increasing length of hospital stay have been demonstrated for the colonization or infection of selected organ systems. We wanted to describe microorganism distribution or antibiotic resistance in bacteraemia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland.
We conducted a nationwide, observational study on bacteraemia using ANRESIS data from 1 January 2008 to 31 December 2017. We analysed data on bacteraemia from those Swiss hospitals that sent information on a regular basis during the entire study period. We described the pathogen distribution and specific trends of resistance during hospitalization for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens and Staphylococcus aureus.
We included 28 318 bacteraemia isolates from 90 Swiss hospitals. The most common aetiology was E. coli (33.4%, 9459), followed by S. aureus (16.7%, 4721), K. pneumoniae (7.1%, 2005), Enterococcus faecalis (5.2%, 1473), P. aeruginosa (4.3%, 1228), Streptococcus pneumoniae (4.3%, 1208) and Enterococcus faecium (3.9%, 1101). We observed 489 (1.73%) S. marcescens isolates. We observed an increasing trend for E. faecium (from 1.5% at day 0 to 13.7% at day 30; p < 0.001), K. pneumoniae (from 6.1% to 7.8%, p < 0.001) and P. aeruginosa (from 2.9% to 13.7%, p < 0.001) with increasing duration of hospitalization; and decreasing trends for E. coli (from 41.6% to 21.6%; p < 0.001) and S. aureus (p < 0.001). Ceftriaxone resistance among E. coli remained stable for the first 15 days of hospitalization and then increased. Ceftriaxone resistance among K. pneumoniae and S. marcescens and oxacillin resistance among S. aureus increased linearly during the hospitalization. Cefepime resistance among P. aeruginosa remained stable during the hospitalization.
We showed that hospitalization duration is associated with a species- and antibiotic class-dependent pattern of antimicrobial resistance.
已有研究表明，随着住院时间的延长，某些选定的器官系统的定植或感染中微生物的分布和抗生素敏感性会发生变化。我们希望使用瑞士的一个大型国家流行病学/微生物学数据库（ANRESIS），根据住院时间描述菌血症中微生物的分布或抗生素耐药情况。
我们使用 ANRESIS 数据进行了一项全国性的菌血症观察性研究，时间为 2008 年 1 月 1 日至 2017 年 12 月 31 日。我们分析了那些在整个研究期间定期提供信息的瑞士医院的菌血症数据。我们描述了大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、粘质沙雷菌和金黄色葡萄球菌的病原体分布以及住院期间的特定耐药趋势。
我们纳入了来自 90 家瑞士医院的 28318 例菌血症分离株。最常见的病原体是大肠埃希菌（33.4%，9459），其次是金黄色葡萄球菌（16.7%，4721）、肺炎克雷伯菌（7.1%，2005）、粪肠球菌（5.2%，1473）、铜绿假单胞菌（4.3%，1228）、肺炎链球菌（4.3%，1208）和屎肠球菌（3.9%，1101）。我们观察到 489 株粘质沙雷菌。我们观察到屎肠球菌（从第 0 天的 1.5%到第 30 天的 13.7%；p<0.001）、肺炎克雷伯菌（从 6.1%到 7.8%；p<0.001）和铜绿假单胞菌（从 2.9%到 13.7%；p<0.001）的耐药率随着住院时间的延长而增加；而大肠埃希菌（从 41.6%到 21.6%；p<0.001）和金黄色葡萄球菌（p<0.001）的耐药率则下降。大肠埃希菌的头孢曲松耐药性在住院前 15 天保持稳定，然后增加。肺炎克雷伯菌和粘质沙雷菌的头孢噻肟耐药率以及金黄色葡萄球菌的耐苯唑西林耐药率在住院期间呈线性增加。铜绿假单胞菌的头孢吡肟耐药率在住院期间保持稳定。
我们表明，住院时间与抗菌药物耐药性的物种和抗生素类别依赖性模式有关。
