2009 年至 2019 年军人健康系统肠病原体的抗微生物药物耐药性。

Antimicrobial resistance of enteric pathogens in the Military Health System, 2009 - 2019.

机构信息

Walter Reed Army Institute of Research, U.S. Army Medical Research Directorate-Georgia, 99 Kakheti Highway, 0198, Tbilisi, Georgia.

Oak Ridge Institute for Science and Education, Defense Centers for Public Health - Portsmouth, 620 John Paul Jones Circle, Suite 1100, Portsmouth, VA, 23704, USA.

出版信息

BMC Public Health. 2022 Dec 8;22(1):2300. doi: 10.1186/s12889-022-14466-1.

DOI:10.1186/s12889-022-14466-1

PMID:36482429

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9733093/

Abstract

BACKGROUND

Acute diarrhea (AD) can have significant impacts on military troop readiness. Medical providers must understand current trends of enteropathogen antimicrobial resistance (AMR) in service members (SMs) to inform proper, timely treatment options. However, little is known of enteric pathogen profiles across the Military Health System (MHS). The primary objectives of this study were to identify gaps in enteric pathogen surveillance within the MHS, describe the epidemiology of AMR in enteric pathogens, and identify trends across the MHS both within the Continental United States (CONUS) and outside of the Continental United States (OCONUS).

METHODS

Health Level 7 (HL7)-formatted laboratory data were queried for all specimens where Salmonella, Shigella, and Campylobacter species, as well as Shiga toxin-producing Escherichia coli (E. coli) (STEC) were isolated and certified between 1 January 2009 - 31 December 2019. Antibiotic susceptibility testing (AST) results were queried and summarized where available. Descriptive statistics were calculated for each organism by specimen source, year, and susceptibility testing availability.

RESULTS

Among a total of 13,852 enteric bacterial isolates, 11,877 (86%) were submitted from CONUS locations. Out of 1479 Shigella spp. and 6755 Salmonella spp. isolates, 1221 (83%) and 5019 (74%), respectively, reported any susceptibility results through the MHS. Overall, only 15% of STEC and 4% of Campylobacter spp. specimens had AST results available. Comparing AST reporting at CONUS versus OCONUS locations, AST was reported for 1175 (83%) and 46 (78%) of Shigella isolates at CONUS and OCONUS locations, respectively, and for 4591 (76%) and 428 (63%) of Salmonella isolates at CONUS and OCONUS locations, respectively.

CONCLUSIONS

This study revealed inconsistent enteropathogen AST conducted across the MHS, with differing trends between CONUS and OCONUS locations. Additional work is needed to assess pathogen-specific gaps in testing and reporting to develop optimal surveillance that supports the health of the force.

摘要

背景

急性腹泻（AD）会对军队的战备能力产生重大影响。医疗服务提供者必须了解现役军人（SM）中肠病原体抗生素耐药性（AMR）的当前趋势，以提供适当和及时的治疗选择。然而，对于整个医疗保健系统（MHS）中的肠病原体概况知之甚少。本研究的主要目的是确定 MHS 中肠病原体监测的差距，描述肠病原体 AMR 的流行病学，并确定整个 MHS 中的趋势，包括美国大陆（CONUS）和美国大陆以外地区（OCONUS）。

方法

使用健康水平 7（HL7）格式的实验室数据，对 2009 年 1 月 1 日至 2019 年 12 月 31 日期间分离并鉴定出沙门氏菌、志贺氏菌和弯曲杆菌以及产志贺毒素的大肠杆菌（E. coli）（STEC）的所有标本进行查询。查询并总结了抗生素敏感性测试（AST）结果，只要有结果。根据标本来源、年份和药敏试验可用性，对每种病原体进行描述性统计。

结果

在总共 13852 株肠细菌分离株中，有 11877 株（86%）来自 CONUS 地区。在 1479 株志贺氏菌和 6755 株沙门氏菌分离株中，分别有 1221 株（83%）和 5019 株（74%）报告了任何药敏结果。总体而言，只有 15%的 STEC 和 4%的弯曲杆菌标本具有 AST 结果。比较 CONUS 和 OCONUS 地点的 AST 报告率，CONUS 和 OCONUS 地点的志贺氏菌分离株分别有 1175 株（83%）和 46 株（78%）报告 AST，CONUS 和 OCONUS 地点的沙门氏菌分离株分别有 4591 株（76%）和 428 株（63%）报告 AST。