Clinical Microbiology, Royal University Hospital and the Saskatchewan Health Authority, and the Departments of Pathology and Laboratory Medicine, Microbiology, Immunology and Biochemistry, and Ophthalmology, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada.
Sci Rep. 2023 Aug 29;13(1):14142. doi: 10.1038/s41598-023-40012-z.
We analyzed 5 years (2016-2020) of nested Canadian data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) to identify pathogen predominance and antimicrobial resistance (AMR) patterns of adult Gram-negative infections in Canadian health care and to complement other public surveillance programs and studies in Canada. A total of 6853 isolates were analyzed from medical (44%), surgical (18%), intensive care (22%) and emergency units (15%) and from respiratory tract (36%), intra-abdominal (25%), urinary tract (24%) and bloodstream (15%) infections. Overall, E. coli (36%), P. aeruginosa (18%) and K. pneumoniae (12%) were the most frequent isolates and P. aeruginosa was the most common respiratory pathogen. 18% of Enterobacterales species were ESBL positive. Collective susceptibility profiles showed that P. aeruginosa isolates were highly susceptible (> 95%) to ceftolozane/tazobactam and colistin, though markedly less susceptible (58-74%) to other antimicrobials tested. Multi-drug resistance (MDR) was present in 10% of P. aeruginosa isolates and was more frequent in those from respiratory infections and from ICU than non-ICU locations. Of P. aeruginosa isolates that were resistant to combinations of ceftazidime, piperacillin/tazobactam and meropenem, 73-96% were susceptible to ceftolozane/tazobactam over the period of the study. These national data can now be combined with clinical prediction rules and genomic data to enable expert antimicrobial stewardship applications and guide treatment policies to optimize adult patient care.
我们分析了加拿大监测抗菌药物耐药趋势研究（SMART）的 5 年（2016-2020 年）嵌套式加拿大数据，以确定加拿大卫生保健机构成人革兰氏阴性感染的病原体优势和抗菌药物耐药（AMR）模式，并补充加拿大其他公共监测计划和研究。共分析了来自医疗（44%）、外科（18%）、重症监护（22%）和急诊（15%）的 6853 株分离株，以及来自呼吸道（36%）、腹腔内（25%）、泌尿道（24%）和血流（15%）感染的分离株。总的来说，大肠杆菌（36%）、铜绿假单胞菌（18%）和肺炎克雷伯菌（12%）是最常见的分离株，而铜绿假单胞菌是最常见的呼吸道病原体。18%的肠杆菌科细菌为 ESBL 阳性。总体药敏谱显示，尽管对其他测试的抗菌药物的敏感性明显较低（58-74%），但铜绿假单胞菌分离株对头孢洛扎/他唑巴坦和黏菌素高度敏感（>95%）。10%的铜绿假单胞菌分离株存在多药耐药（MDR），且在呼吸道感染和 ICU 分离株中比非 ICU 分离株更为常见。对头孢他啶、哌拉西林/他唑巴坦和美罗培南组合耐药的铜绿假单胞菌分离株，在研究期间对头孢洛扎/他唑巴坦的敏感性为 73-96%。现在，这些国家数据可以与临床预测规则和基因组数据相结合，以实现专家抗菌药物管理应用，并指导治疗政策，优化成人患者的护理。
