Nutman Amir, Temkin Elizabeth, Wullfhart Liat, Schechner Vered, Schwaber Mitchell J, Carmeli Yehuda
National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv 6423906, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Microorganisms. 2023 Aug 29;11(9):2178. doi: 10.3390/microorganisms11092178.
(Ab) bloodstream infections (BSIs) are a major public health concern and associated with high mortality. We describe the nationwide incidence, antimicrobial resistance, and mortality of Ab-BSI in Israel using laboratory-based BSI surveillance data from January 2018 to December 2019. During the study period, there were 971 Ab-BSI events (508 in 2018 and 463 in 2019), with an average annual incidence of 8.08/100,000 population. The median age of patients was 72 (IQR 62-83), and 56.4% were males. Two-thirds of Ab-BSI events were hospital-onset (HO), with median day of onset 16 (IQR 9-30). HO-BSI incidence was 0.62/10,000 patient-days (rate per 10,000 patient-days: 2.78, 1.17, and 0.2 for intensive care, medical, and surgical wards, respectively). Carbapenem susceptibility was 23.4%; 41.4% and 14.9% in community and HO events, respectively. The 14-day, 30-day, and 1-year mortality were 51.2%, 59.3%, and 81.4%, respectively. Carbapenem-resistant Ab-BSI were associated with a significantly higher 14-day, 30-day, and 1-year mortality ( < 0.001 for all). In the multivariable model, age (aHR 1.02) and carbapenem resistance (aHR 3.21) were independent predictors of 30-day mortality. In conclusion, Ab-BSIs pose a significant burden with high mortality, especially associated with antimicrobial resistance. Attention should be focused on prevention and improving treatment.
（产酸克雷伯菌）血流感染（BSIs）是一个重大的公共卫生问题，且与高死亡率相关。我们利用2018年1月至2019年12月基于实验室的BSI监测数据，描述了以色列产酸克雷伯菌血流感染（Ab-BSI）的全国发病率、抗菌药物耐药性和死亡率。在研究期间，共发生971例Ab-BSI事件（2018年508例，2019年463例），平均年发病率为8.08/100,000人口。患者的中位年龄为72岁（四分位间距62 - 83岁），男性占56.4%。三分之二的Ab-BSI事件为医院获得性（HO），发病中位天数为16天（四分位间距9 - 30天）。HO-BSI发病率为0.62/10,000患者日（每10,000患者日的发生率：重症监护病房为2.78，内科病房为1.17，外科病房为0.2）。碳青霉烯类药物敏感性为23.4%；社区获得性和医院获得性事件中分别为41.4%和14.9%。14天、30天和1年死亡率分别为51.2%、59.3%和81.4%。耐碳青霉烯类Ab-BSI与显著更高的14天、30天和1年死亡率相关（所有P均<0.001）。在多变量模型中，年龄（调整后风险比1.02）和碳青霉烯类耐药（调整后风险比3.21）是30天死亡率的独立预测因素。总之，Ab-BSIs造成了重大负担，死亡率高，尤其是与抗菌药物耐药性相关。应将注意力集中在预防和改善治疗上。
