Center for Sepsis Control and Care (CSCC), Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
Research Group Clinical Epidemiology, CSCC, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
Antimicrob Resist Infect Control. 2021 Sep 8;10(1):132. doi: 10.1186/s13756-021-00997-6.
Monitoring pathogens of bloodstream infections (BSI) and their antibiotic susceptibility is important to guide empiric antibiotic treatment strategies and prevention programs. This study assessed the epidemiology of BSI and antibiotic resistance patterns at the German Federal State of Thuringia longitudinally.
A surveillance network consisting of 26 hospitals was established to monitor BSIs from 01/2015 to 12/2019. All blood culture results, without restriction of age of patients, of the participating hospitals were reported by the respective microbiological laboratory. A single detection of obligate pathogens and a repeated detection of coagulase-negative staphylococci, Bacillus spp., Corynebacterium spp., Micrococcus spp. and Propionibacterium spp., within 96 h were regarded as a relevant positive blood culture. If one of the aforementioned non-obligate pathogens has been detected only once within 96 h, contamination has been assumed. Logistic regression models were applied to analyse the relationship between resistance, year of BSI and hospital size. Generalized estimating equations were used to address potential clustering.
A total of 343,284 blood cultures (BC) of 82,527 patients were recorded. Overall, 2.8% (n = 9571) of all BCs were classified as contaminated. At least one relevant pathogen was identified in 13.2% (n = 45,346) of BCs. Escherichia coli (25.4%) was the most commonly detected pathogen, followed by Staphylococcus aureus (15.2%), Staphylococcus epidermidis (8.1%) and Klebsiella pneumoniae (4.6%). In S. aureus, we observed a decline of methicillin resistance (MRSA) from 10.4% in 2015 to 2.5% in 2019 (p < 0.001). The rate of vancomycin resistance in Enterococcus faecium (VRE) has increased from 16.7% in 2015 to 26.9% in 2019 (p < 0.001), with a peak in 2018 (42.5%). In addition, we observed an increase of Cefotaxime (3GC) resistance in E. coli from 10.7% in 2015 to 14.5% in 2019 (p = 0.007) whereas 3GC resistance in K. pneumoniae was stable (2015: 9.9%; 2019: 7.4%, p = 0.35). Carbapenem resistance was less than 1% for both pathogens. These patterns were robustly observed across sensitivity analyses.
We observed evidence for a decline in MRSA, an increase in VRE and a very low rate of carbapenem resistance in gram-negative bacteria. 3GC resistance in E. coli increased constantly over time.
监测血流感染（BSI）的病原体及其抗生素敏感性对于指导经验性抗生素治疗策略和预防方案非常重要。本研究纵向评估了图林根州德国联邦州的 BSI 流行病学和抗生素耐药模式。
建立了一个由 26 家医院组成的监测网络，以监测 2015 年 1 月至 2019 年 12 月的 BSI。参与医院的各自微生物学实验室报告了所有血液培养结果，不受患者年龄限制。如果在 96 小时内检测到必需病原体的单次检测和凝固酶阴性葡萄球菌、芽孢杆菌属、棒状杆菌属、微球菌属和丙酸杆菌属的重复检测，则被视为相关阳性血培养。如果在 96 小时内只检测到上述非必需病原体之一，则假定为污染。应用逻辑回归模型分析耐药性、BSI 年份和医院规模之间的关系。应用广义估计方程解决潜在的聚类问题。
共记录了 82527 名患者的 343284 份血培养（BC）。总体而言，2.8%（n=9571）的所有 BC 被归类为污染。至少有一种相关病原体在 13.2%（n=45346）的 BC 中被检测到。大肠埃希菌（25.4%）是最常见的病原体，其次是金黄色葡萄球菌（15.2%）、表皮葡萄球菌（8.1%）和肺炎克雷伯菌（4.6%）。在金黄色葡萄球菌中，我们观察到耐甲氧西林金黄色葡萄球菌（MRSA）的下降，从 2015 年的 10.4%下降到 2019 年的 2.5%（p<0.001）。屎肠球菌（VRE）的万古霉素耐药率从 2015 年的 16.7%上升到 2019 年的 26.9%（p<0.001），2018 年达到峰值（42.5%）。此外，我们观察到大肠埃希菌头孢噻肟（3GC）耐药性从 2015 年的 10.7%增加到 2019 年的 14.5%（p=0.007），而肺炎克雷伯菌的 3GC 耐药性保持稳定（2015 年：9.9%；2019 年：7.4%，p=0.35）。两种病原体的碳青霉烯类耐药性均低于 1%。这些模式在敏感性分析中得到了稳健的观察。
我们观察到耐甲氧西林金黄色葡萄球菌减少、屎肠球菌增加和革兰氏阴性菌碳青霉烯类耐药性非常低的证据。大肠埃希菌的 3GC 耐药性持续增加。
