Damji Shazia, Perrott Jerrold, Shajari Salomeh, Grant Jennifer, Wong Titus, Harbin Megan
Department of Pharmacy, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Department of Pharmacy, Royal Inland Hospital, Kamloops, British Columbia, Canada.
J Assoc Med Microbiol Infect Dis Can. 2022 Jun 3;7(2):108-116. doi: 10.3138/jammi-2021-0025. eCollection 2022 Jun.
Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital.
Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant vancomycin-resistant enterococci, extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, and . Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded.
In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8-15.6 days).
Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.
在住院患者中，自住院起48小时的时间段定义了医院感染，并指导经验性抗生素的选择。这个时间框架可能导致广谱抗生素的过度使用。我们的主要目标是确定在一家学术性三级护理医院的重症监护病房（ICU）住院患者中，自入院以来获得耐抗生素病原体的最早时间和中位时间。
对2018年从家中或同一卫生当局内的另一家医院入住该ICU的成年患者进行回顾性病历审查，以确定获得医院相关病原体的时间：耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌、非ESBL头孢曲松耐药肠杆菌科细菌等。从卫生当局以外的医院转来、住院14天后入住ICU、是实体器官或骨髓移植受者或以其他方式免疫功能低下的患者被排除在外。
2018年，1343名患者入住该ICU；820名符合纳入标准。其中，121名（14.76%）在ICU获得了医院相关病原体。入院48小时内分离出医院相关病原体的概率为3%。分离出这些病原体中任何一种的最早时间为29小时，中位时间为9天（四分位间距[IQR]3.8 - 15.6天）。
该ICU中的大多数患者（85.3%）从未获得医院相关病原体。其余患者获得医院相关病原体的中位时间表明，基于48小时阈值开始使用经验性广谱抗生素可能为时过早。
