Ponyon Jindanoot, Kerdsin Anusak, Preeprem Thanawadee, Ungcharoen Ratchadaporn
Faculty of Public Health, Chalermphrakiat Sakon Nakhon Campus, Kasetsart University, Sakon Nakhon 47000, Thailand.
Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand.
Trop Med Infect Dis. 2022 Oct 23;7(11):328. doi: 10.3390/tropicalmed7110328.
Antimicrobial resistance is a major public health concern globally. The most serious antimicrobial resistance problem among pathogenic bacteria is multidrug resistance (MDR). The objectives of this study were to investigate the risk factors of MDR infections and to develop a risk assessment tool for MDR Gram-negative bacteria (MDR-GNB) infections at a community hospital in rural Thailand. The study revealed 30.77% MDR-GNB among GNB strains. The most common MDR-GNB strains were 63.02% for and 11.46% for . A case-control study was applied to collect clinical data between January 2016 and December 2020. Univariate logistic regression and multivariate logistic regression were used to analyze the risk factors for MDR-GNB and a risk assessment score for each factor was determined based on its regression coefficient. The risk factors for MDR-GNB infections were as follows: the presence of Enterobacteriaceae that produce extended-spectrum beta-lactamase (ESBL) (OR 23.53, 95% CI 7.00-79.09), infections occurring within the urinary tract (OR 2.25, 95% CI 1.44-3.53), and patients with a history of steroid usage (OR 1.91, 95% CI 1.15-3.19). Based on the assigned risk scores for each associated factor, the newly developed risk assessment tool for MDR-GNB infections achieved 64.54% prediction accuracy (AUC-ROC 0.65, 95% CI 0.61-0.68), demonstrating that the tool could be used to assess bacterial infection cases in community hospitals. Its use should provide practical guidance on MDR evaluation and prevention. This study was part of an antibiotic stewardship program; the study surveyed antibiotic-resistant situations in a hospital and implemented an effective risk assessment tool using key risk factors of MDR-GNB infections.
抗菌药物耐药性是全球主要的公共卫生问题。病原菌中最严重的抗菌药物耐药性问题是多重耐药（MDR）。本研究的目的是调查多重耐药感染的危险因素，并开发一种针对泰国农村社区医院多重耐药革兰氏阴性菌（MDR-GNB）感染的风险评估工具。该研究显示，革兰氏阴性菌菌株中多重耐药革兰氏阴性菌占30.77%。最常见的多重耐药革兰氏阴性菌菌株中， 占63.02%， 占11.46%。采用病例对照研究收集2016年1月至2020年12月期间的临床数据。使用单因素逻辑回归和多因素逻辑回归分析多重耐药革兰氏阴性菌的危险因素，并根据回归系数确定每个因素的风险评估分数。多重耐药革兰氏阴性菌感染的危险因素如下：产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌的存在（比值比23.53，95%置信区间7.00-79.09）、发生在泌尿道的感染（比值比2.25，95%置信区间1.44-3.53）以及有类固醇使用史的患者（比值比1.91，95%置信区间1.15-3.19）。根据每个相关因素的指定风险分数，新开发的多重耐药革兰氏阴性菌感染风险评估工具的预测准确率达到64. .54%（曲线下面积0.65，95%置信区间0.61-0.68），表明该工具可用于评估社区医院的细菌感染病例。其应用应为多重耐药评估和预防提供实用指导。本研究是抗生素管理计划的一部分；该研究调查了一家医院的抗生素耐药情况，并使用多重耐药革兰氏阴性菌感染的关键危险因素实施了一种有效的风险评估工具。
