亚的斯亚贝巴提库尔·安贝萨专科医院革兰阴性菌血流感染的抗菌药物耐药性及相关危险因素

Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa.

作者信息

Beshah Daniel, Desta Adey, Belay Gurja, Abebe Tamrat, Gebreselasie Solomon, Sisay Tessema Tesfaye

机构信息

Microbial Cellular Molecular Biology Infection Biology Stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia.

Department of Diagnostic Laboratory, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

出版信息

Infect Drug Resist. 2022 Aug 31;15:5043-5059. doi: 10.2147/IDR.S371654. eCollection 2022.

BACKGROUND

Bloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria.

OBJECTIVE

To determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia.

METHODS

A cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software.

RESULTS

The prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were 17.6%, CoNS 15.2%, and 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Pre-school P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI.

CONCLUSION

Pediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.

背景

血流感染（BSIs）是埃塞俄比亚乃至全球发病和死亡的重要原因。令人担忧的是，细菌中的抗菌药物耐药性（AMR）在全球迅速蔓延。

目的

确定埃塞俄比亚亚的斯亚贝巴提库尔·安贝萨专科医院（TASH）血流感染的微生物谱、抗菌药物敏感性模式及相关危险因素。

方法

于2018年9月至2019年3月进行了一项横断面研究。按照标准细菌学程序对每位疑似败血症患者采集的两份血液进行处理。根据CLSI 2017和2018指南，采用纸片扩散法进行药敏试验。在Epidata中捕获的数据经清理后，使用SPSS 21版软件进行分析。

结果

血流感染的患病率为28.06%，检测到的病原菌中革兰氏阴性菌（GNB）比例较高（54.5%），革兰氏阳性菌（GPB）比例为（45.43%）。最常见的细菌种类为[具体细菌种类未给出]17.6%，凝固酶阴性葡萄球菌15.2%，[具体细菌种类未给出]11.0%。培养阳性与6岁以下年龄、新生儿调整后比值比p<0.001、婴儿调整后比值比p<0.001、学龄前儿童P=0.002、入住重症监护病房比值比p<0.001、住院时间>5天比值比P=0.016、体温高于38°C、调整后比值比p=0.013、医疗护理期间使用器械调整后比值比p<0.001、慢性病调整后比值比p=0.027以及新生儿孵育调整后比值比p=0.013相关。革兰氏阴性菌对常用抗生素的平均耐药率为57.9%，最有效的药物和效果最差的药物分别是阿米卡星（10.8%）和氨苄西林（94.6%）。革兰氏阴性菌分离株的多重耐药率为95.3%；分别在55.8%、32.2%和7.3%的分离株中观察到多重耐药、广泛耐药和泛耐药情况。这一发现表明儿童尤其是新生儿受耐药性血流感染的影响很大。