Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information, Cairo, Egypt.
Surg Infect (Larchmt). 2024 Nov;25(9):682-690. doi: 10.1089/sur.2023.375. Epub 2024 Aug 22.
Management of complicated intraabdominal infections (cIAIs) requires containment of the source and appropriate initial antimicrobial therapy. Identifying the local data is important to guide the empirical selection of antimicrobial therapy. In this study, we aimed to describe the pathogen distribution and antimicrobial resistance of cIAI. In two major tertiary care hospitals in Egypt, we enrolled patients who met the case definition of cIAI from October 2022 to September 2023. Blood cultures were performed using the BACTAlert system (BioMerieux, Marcy l'Etoile, France). A culture of aspirated fluid, resected material, or debridement of the infection site was performed. Identification of pathogens and antimicrobial susceptibility testing were conducted by the VITEK-2 system (BioMerieux, Marcy l'Etoile, France). Gram-negative resistance genes were identified by PCR and confirmed by whole bacterial genome sequencing using the Nextera XT DNA Library Preparation Kit and sequencing with the MiSeq Reagent Kit 600 v3 (Illumina, USA) on the Illumina MiSeq. We enrolled 423 patients, 275 (65.01%) males. The median age was 61.35 (range 25-72 years). We studied 452 recovered bacterial isolates. Gram-negative bacteria were the vast majority, dominated by followed by and (33.6%, 30.5%, 13.7%, 13%, and 5.4%, respectively). High rates of resistance were detected to third- and fourth-generation cephalosporins and fluoroquinolones. No resistance was detected to colistin. Resistance to amikacin and tigecycline was low among all isolates. Resistance to meropenem and ceftazidime/avibactam was moderate. ESBL genes were common in and . CTX-M15 gene was the most frequent. Among and were the most prevalent carbapenemase genes. isolates harbored a wide variety of carbapenemase genes (OXA, NDM, VIM, SIM, GIM, SPM, IMP, AIM), dominated by metallo-beta-lactamases. In 20.6% of isolates, we identified two or more resistance genes. High resistance rates were detected to third- and fourth-generation cephalosporins and fluoroquinolones. Amikacin and tigecyclines were the most active antimicrobials. Our data call for urgent implementation of antimicrobial stewardship programs and reinforcement of infection control.
复杂性腹腔内感染（cIAI）的管理需要控制感染源和适当的初始抗菌治疗。确定当地数据对于指导经验性选择抗菌治疗非常重要。在这项研究中，我们旨在描述 cIAI 的病原体分布和抗菌药物耐药性。在埃及的两家主要三级保健医院，我们招募了 2022 年 10 月至 2023 年 9 月符合 cIAI 病例定义的患者。使用 BACTAlert 系统（法国马西-莱托伊尔的生物梅里埃）进行血培养。采集抽吸液、切除物或感染部位清创的培养物。通过 VITEK-2 系统（法国马西-莱托伊尔的生物梅里埃）进行病原体鉴定和药敏试验。通过 PCR 鉴定革兰氏阴性耐药基因，并通过使用 Nextera XT DNA 文库制备试剂盒对整个细菌基因组进行测序和使用 Illumina MiSeq 试剂试剂盒 600 v3（Illumina，美国）在 Illumina MiSeq 上进行测序进行确认。我们共招募了 423 名患者，其中 275 名（65.01%）为男性。中位年龄为 61.35 岁（范围 25-72 岁）。我们研究了 452 株分离的细菌。革兰氏阴性菌占绝大多数，其中 、 和 （33.6%、30.5%、13.7%、13%和 5.4%）分别占主导地位。第三代和第四代头孢菌素和氟喹诺酮类药物的耐药率很高。未检测到对粘菌素的耐药性。所有分离株对阿米卡星和替加环素的耐药率均较低。美罗培南和头孢他啶/阿维巴坦的耐药率为中度。ESBL 基因在 和 中很常见。CTX-M15 基因是最常见的。在 和 中，碳青霉烯酶基因最常见。 分离株携带多种碳青霉烯酶基因（OXA、NDM、VIM、SIM、GIM、SPM、IMP、AIM），以金属β-内酰胺酶为主。在 20.6%的分离株中，我们鉴定出两种或两种以上的耐药基因。第三代和第四代头孢菌素和氟喹诺酮类药物的耐药率很高。阿米卡星和替加环素是最有效的抗菌药物。我们的数据表明，急需实施抗菌药物管理计划并加强感染控制。
