Yamba Kaunda, Lukwesa-Musyani Chileshe, Samutela Mulemba Tillika, Kapesa Christine, Hang'ombe Mudenda Bernard, Mpabalwani Evans, Hachaambwa Lottie, Fwoloshi Sombo, Chanda Raphael, Mpundu Mirfin, Kashweka Glory, Nakazwe Ruth, Mudenda Steward, Muma John Bwalya
Department of Pathology & Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia.
Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.
PLOS Glob Public Health. 2023 Jan 31;3(1):e0001414. doi: 10.1371/journal.pgph.0001414. eCollection 2023.
Bloodstream infections (BSI) caused by antimicrobial-resistant (AMR) Gram-negative bacteria (GNB) are a significant cause of morbidity and mortality. Third-generation cephalosporins (3GCs) have been used as empiric treatment for BSI and other invasive infections for years; however, their overuse could promote the emergence of extended-spectrum beta-lactamases (ESBLs). Thus, this study aimed to determine the epidemiological, clinical and microbiological features and the effects of antimicrobial resistance on the outcomes of BSIs at a referral hospital in Lusaka, Zambia. This was a six-month prospective facility-based study undertaken at a referral hospital in Lusaka, Zambia. As part of the routine diagnosis and patient care, blood samples for bacteriological culture were collected from patients presenting with fever and processed for pathogen identification and antimicrobial susceptibility testing using the VITEK 2 Compact instrument. ESBLs and plasmid-mediated quinolone resistance (PMQR) associated genes were determined using the polymerase chain reaction method. Patient information was collected using a structured data collection sheet and entered in CSpro 7.6. Data were analysed in WHOnet and STATA version 14. A total of 88 GNB were isolated, of which 76% were Enterobacterales, 14% Acinetobacter baumannii and 8% Pseudomonas aeruginosa. Resistance to third and fourth-generation cephalosporins was 75% and 32%, respectively. Noteworthy was the high prevalence (68%) of inappropriate empirical treatment, carbapenem resistance (7%), multi-drug resistance (83%) and ESBL-producers (76%). In comparison to E. coli as a causative agent of BSI, the odds of death were significantly higher among patients infected with Acinetobacter baumannii (OR = 3.8). The odds of death were also higher in patients that received 3GCs as empiric treatment than in those that received 4GCs or other (none cephalosporin) treatment options. Structured surveillance, yearly antibiogram updates, improved infection control and a well functional antimicrobial stewardship (AMS) program, are of utmost importance in improving appropriate antimicrobial treatment selection and favourable patient outcomes.
由耐抗菌药物（AMR）的革兰氏阴性菌（GNB）引起的血流感染（BSI）是发病和死亡的重要原因。第三代头孢菌素（3GCs）多年来一直被用作BSI和其他侵袭性感染的经验性治疗药物；然而，它们的过度使用可能会促使超广谱β-内酰胺酶（ESBLs）的出现。因此，本研究旨在确定赞比亚卢萨卡一家转诊医院中BSI的流行病学、临床和微生物学特征以及抗菌药物耐药性对其结局的影响。这是一项在赞比亚卢萨卡一家转诊医院进行的为期六个月的前瞻性基于机构的研究。作为常规诊断和患者护理的一部分，从发热患者中采集血样进行细菌培养，并使用VITEK 2 Compact仪器进行病原体鉴定和抗菌药物敏感性测试。使用聚合酶链反应方法测定ESBLs和质粒介导的喹诺酮耐药性（PMQR）相关基因。使用结构化数据收集表收集患者信息，并录入CSpro 7.6。数据在WHOnet和STATA 14版本中进行分析。共分离出88株GNB，其中76%为肠杆菌科细菌，14%为鲍曼不动杆菌，8%为铜绿假单胞菌。对第三代和第四代头孢菌素的耐药率分别为75%和32%。值得注意的是，不恰当经验性治疗的高患病率（68%）、碳青霉烯类耐药率（7%）、多重耐药率（83%）和产ESBLs率（76%）。与作为BSI病原体的大肠杆菌相比，感染鲍曼不动杆菌的患者死亡几率显著更高（OR = 3.8）。接受3GCs作为经验性治疗的患者死亡几率也高于接受4GCs或其他（非头孢菌素）治疗方案的患者。结构化监测、每年更新抗菌谱、改善感染控制以及运行良好的抗菌药物管理（AMS）计划，对于改善抗菌药物治疗的合理选择和患者的良好结局至关重要。
