Syed Beenish, Ishaque Sadia, Imran Abira, Muslim Osaid, Khalid Seema, Siddiqui Abdul Basit
Sindh Infectious Diseases Hospital and Research Center, Dow University of Health Sciences, Karachi, Pakistan.
Shaheed Mohtarma Benazir Bhutto Trauma Center, Karachi, Pakistan.
SAGE Open Med. 2022 Oct 18;10:20503121221132358. doi: 10.1177/20503121221132358. eCollection 2022.
To determine the clinical features, outcomes, and factors associated with the emergence of colistin-resistant gram-negative rods isolated from patients admitted to intensive care units.
This cross-sectional study was conducted at the intensive care units of Liaquat National Hospital, from April 2019 to February 2020. Gram-negative rods resistant to colistin with minimum inhibitory concentrations ⩾ 4 mcg/mL according to Clinical and Laboratory Standards Institute criteria as reported in cultures were included. Clinical, demographical data and treatment given were recorded and analyzed using SPSS version 25.
A total of 93 patients were included; 58.1% were males. The mean age of patients was 59.48 ± 18.36 years. The most common organism isolated was (91.4%). The most common specimen was the tracheal (62.4%). Ventilator-acquired pneumonia was seen in 38.7%. The most common co-morbid disease seen in patients was diabetes (41%); 77% had a symptomatic infection and were treated with a combination of 2 or more antibiotics, most commonly meropenem plus fosfomycin. The most common susceptible antibiotics were fosfomycin (72%) and tigecycline (50.5%). Mean intensive care unit stay and total duration of hospital stay were prolonged (16.83 ± 12.93 and 23.34 ± 17.52 days, respectively). Forty-eight (62.3%) patients with symptomatic infection with colistin-resistant isolates were treated and discharged, and mortality was seen in 23 (29.9%). A significant association was found between mortality and symptomatic infection, endotracheal intubation with mechanical ventilation (p = 0.003), and a prolonged hospital stay of >20 days (p = 0.041).
Colistin-resistant gram-negative rods pose a significant problem especially in developing countries because of limited therapeutic options. Stringent infection control and comprehensive antimicrobial stewardship programs are needed to overcome this challenge.
确定从入住重症监护病房的患者中分离出的耐黏菌素革兰氏阴性杆菌的临床特征、结局及相关因素。
本横断面研究于2019年4月至2020年2月在利亚卡特国家医院重症监护病房进行。纳入根据临床和实验室标准协会标准，培养报告中对黏菌素耐药且最低抑菌浓度⩾4 mcg/mL的革兰氏阴性杆菌。记录临床、人口统计学数据及给予的治疗，并使用SPSS 25版进行分析。
共纳入93例患者；58.1%为男性。患者的平均年龄为59.48±18.36岁。分离出的最常见病原体为（91.4%）。最常见的标本是气管标本（62.4%）。呼吸机相关性肺炎的发生率为38.7%。患者中最常见的合并症是糖尿病（41%）；77%有症状性感染，并接受了2种或更多抗生素联合治疗，最常用的是美罗培南加磷霉素。最常见的敏感抗生素是磷霉素（72%）和替加环素（50.5%）。重症监护病房平均住院时间和总住院时间延长（分别为16.83±12.93天和23.34±17.52天）。48例（62.3%）有症状性感染的耐黏菌素分离株患者接受治疗并出院，23例（29.9%）死亡。发现死亡率与症状性感染、气管插管机械通气（p = 0.003）以及住院时间延长>20天（p = 0.041）之间存在显著关联。
耐黏菌素革兰氏阴性杆菌带来了重大问题，尤其是在发展中国家，因为治疗选择有限。需要严格的感染控制和全面的抗菌药物管理计划来应对这一挑战。
