Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy.
Anaerobe. 2022 Jun;75:102583. doi: 10.1016/j.anaerobe.2022.102583. Epub 2022 May 11.
A lack of updated data on the burden and profile of anaerobic bloodstream infections (ABIs) exists. We assessed the incidence of ABIs and trends in antimicrobial resistance in anaerobes isolated from blood in Italy.
We conducted a retrospective study on 17 Italian hospitals (2016-2020). Anaerobes isolated from blood culture and their in vitro susceptibility profiles (EUCAST-interpreted) were registered and analyzed.
A total of 1960 ABIs were identified. The mean age of ABIs patients was 68.6 ± 18.5 years, 57.6% were males. The overall incidence rate of ABIs was 1.01 per 10.000 patient-days. Forty-seven% of ABIs occurred in medical wards, 17% in ICUs, 14% in surgical wards, 7% in hemato-oncology, 14% in outpatients. The three most common anti-anaerobic tested drugs were metronidazole (92%), clindamycin (89%) and amoxicillin/clavulanate (83%). The three most common isolated anaerobes were Bacteroides fragilis (n = 529), Cutibacterium acnes (n = 262) and Clostridium perfringens (n = 134). The lowest resistance rate (1.5%) was to carbapenems, whereas the highest rate (51%) was to penicillin. Clindamycin resistance was >20% for Bacteroides spp., Prevotella spp. and Clostridium spp. Metronidazole resistance was 9.2% after excluding C. acnes and Actinomyces spp. Bacteroides spp. showed an increased prevalence of clindamycin resistance through the study period: 19% in 2016, 33% in 2020 (p ≤ 0.001).
Our data provide a comprehensive overview of the epidemiology of ABIs in Italy, filling a gap that has existed since 1995. Caution is needed when clindamycin is used as empirical anti-anaerobic drug.
目前缺乏关于厌氧血流感染（ABIs）负担和特征的最新数据。我们评估了意大利从血液中分离的厌氧菌引起的 ABIs 的发生率和抗生素耐药趋势。
我们对意大利的 17 家医院进行了回顾性研究（2016-2020 年）。登记并分析了从血培养中分离出的厌氧菌及其体外药敏谱（EUCAST 解释）。
共发现 1960 例 ABIs。ABIs 患者的平均年龄为 68.6±18.5 岁，男性占 57.6%。ABIs 的总发生率为 1.01/10000 患者天。47%的 ABIs 发生在普通病房，17%发生在 ICU，14%发生在外科病房，7%发生在血液肿瘤病房，14%发生在门诊。测试的三种最常见的抗厌氧菌药物分别为甲硝唑（92%）、克林霉素（89%）和阿莫西林/克拉维酸（83%）。三种最常见的分离厌氧菌分别为脆弱拟杆菌（n=529）、痤疮丙酸杆菌（n=262）和产气荚膜梭菌（n=134）。最低的耐药率（1.5%）为碳青霉烯类，而最高的耐药率（51%）为青霉素类。克林霉素耐药率>20%的菌属为拟杆菌属、普雷沃菌属和梭菌属。甲硝唑耐药率排除痤疮丙酸杆菌和放线菌属后为 9.2%。拟杆菌属在整个研究期间对克林霉素的耐药率呈上升趋势：2016 年为 19%，2020 年为 33%（p≤0.001）。
我们的数据提供了意大利 ABIs 流行病学的全面概述，填补了自 1995 年以来的空白。当克林霉素被用作经验性抗厌氧菌药物时需要谨慎。
