Hospital Tuanku Ja'afar, Department of Medicine, Seremban, Malaysia.
Hospital Tuanku Ja'afar, Department of Microbiology, Seremban, Malaysia.
Med J Malaysia. 2024 Sep;79(5):569-574.
Community acquired bloodstream infection (CA-BSI) is positive blood culture obtained within 48 hours of hospital admission. Bloodstream infections need to be treated with antibiotics. Inappropriate choice of antibiotics will lead to antimicrobial resistance. This is an observational retrospective study to look at the antimicrobial resistance of organisms causing bloodstream infections in patients admitted to the medical wards in our centre. The aim of the study is to determine the appropriate choice of empirical antibiotics for suspected CA-BSI in our hospital.
All patients admitted to medical wards with blood stream infection during the period January 2021 to June 2021 were enrolled. Identification of organisms and antimicrobial susceptibility testing were obtained. Information regarding the severity of the bacteremia was collected by assessing if the patient needed inotropes, mechanical ventilation or renal replacement therapy. Data on comorbidities which were the presence of end-stage renal failure, diabetic mellitus and immunosuppression were collected.
Total of 269 cases were screened. Out of these 104 communities acquired cases were included. The pathogens frequently isolated were gram negative organisms most commonly Escherichia coli (43%) and Klebsiella species (30%). Staphylococcus aureus accounts for the majority of gram-positive organisms. Only two out of 20 Staphylococcus aureus were methicillin resistant. Bulkholderia pseudomallei accounts for 7.8% cases. All Burkholderia pseudomallei isolates were sensitive to cotrimoxazole. Escherichia coli (46%) isolates demonstrated a higher resistance pattern to Augmentin compared to klebsiella species (17.4%). The overall mortality rate was 22%, with higher rates for those critically ill (39%). Patients with Enterobacteriaceae infection showed no difference in outcome between the groups of patients according to sensitivity to Augmentin and cefotaxime. These groups of patients who were critically ill did not demonstrate any significant difference in terms of resistance pattern to Augmentin (p = 0.3) and cefotaxime (p = 0.7). Patients who are aged 65 or older have a significantly more resistant pattern to Augmentin and cefotaxime.
Antibiogram serves as a guide for clinicians to choose appropriate choices of antibiotics based on local data. Empirical antibiotics of choice for patients with sepsis should be narrow-spectrum beta lactam/beta lactamase inhibitors. Broad spectrum beta lactam/beta lactamase inhibitors such as piperacillin tazobactam should be reserved for patients who are critically ill and elderly patients over 65 years. The antibiotics should be deescalated once the organisms and sensitivity of the antibiotics are known.
社区获得性血流感染（CA-BSI）是指在入院后 48 小时内获得的阳性血培养。血流感染需要用抗生素治疗。抗生素选择不当会导致抗菌药物耐药性。这是一项观察性回顾性研究，旨在观察我院内科病房住院患者血流感染病原体的抗菌药物耐药性。本研究的目的是确定我院疑似 CA-BSI 患者经验性抗生素的合理选择。
纳入 2021 年 1 月至 2021 年 6 月期间在我院内科病房住院且患有血流感染的所有患者。对病原体进行鉴定和药敏试验。通过评估患者是否需要使用血管活性药物、机械通气或肾脏替代治疗来收集有关菌血症严重程度的信息。收集了与终末期肾病、糖尿病和免疫抑制相关的合并症信息。
共筛选出 269 例患者，其中包括 104 例社区获得性病例。最常分离的病原体是革兰氏阴性菌，最常见的是大肠埃希菌（43%）和克雷伯菌属（30%）。金黄色葡萄球菌是革兰氏阳性菌的主要病原体。20 株金黄色葡萄球菌中只有 2 株对甲氧西林耐药。类鼻疽伯克霍尔德菌占 7.8%。所有类鼻疽伯克霍尔德菌分离株对复方磺胺甲噁唑均敏感。大肠埃希菌（46%）分离株对氨苄西林的耐药模式高于克雷伯菌属（17.4%）。总的死亡率为 22%，危重症患者死亡率更高（39%）。根据对氨苄西林和头孢噻肟的药敏试验结果，肠杆菌科感染患者的预后在两组之间无差异。这些危重症患者对氨苄西林（p=0.3）和头孢噻肟（p=0.7）的耐药模式无显著差异。65 岁或以上的患者对氨苄西林和头孢噻肟的耐药模式明显增加。
抗生素药敏试验结果可作为临床医生根据当地数据选择合适抗生素的指南。脓毒症患者经验性抗生素的选择应为窄谱β-内酰胺/β-内酰胺酶抑制剂。对于重症和 65 岁以上的老年患者，应保留广谱β-内酰胺/β-内酰胺酶抑制剂，如哌拉西林他唑巴坦。一旦明确病原体及其药敏情况，就应降低抗生素级别。
