墨西哥医院实施抗菌药物管理计划后，急诊病房、非重症监护病房区域和重症监护病房的细菌耐药情况
Profile of bacterial resistance in emergency wards, non-intensive care unit areas, and intensive care units in Mexican hospitals with the antimicrobial stewardship program.
作者信息
Garza-González Elvira, Nunez-Martinez Marcela Elizabeth, Zuñiga-Mejia Porfirio, Márquez-Monzón Dolores, Morfín-Otero María Del Rayo, Rodríguez-Noriega Eduardo, Castañeda-Méndez Paulo, Ramírez-Rodríguez Jose Manuel, Juárez-Lomelí Alba Guadalupe, Quintanilla-Cazarez Luis Javier, Saldivar-Cornejo Inés, Martínez-Resendez Michel, Ugalde Carlos Vallejo, Lugo-Tavera Miriam, Aguilar Elida González, Morales-Reyes Juan José, Sánchez Itzel Guadalupe Meza, Morales Guillermo Damian Ortega, Navarro-Vargas Norberta Vianay, Vallejo Jose Luis, Peréz Bolde-Villarreal Carlos
机构信息
Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Centro Médico ABC, Observatorio, Mexico City, Mexico.
出版信息
IJID Reg. 2024 Oct 24;13:100474. doi: 10.1016/j.ijregi.2024.100474. eCollection 2024 Dec.
OBJECTIVES
Bacterial infections are important causes of death. Some reports have shown that the COVID-19 pandemic may have had an impact on drug resistance. The objective of this work was to compare the resistance profiles between 2019 and 2020 in the emergency department, non-intensive care units (ICU), and ICU areas in Mexican hospitals.
METHODS
Databases from 15 hospitals from eight states in Mexico including susceptibility results for and collected from blood, urine, respiratory, and intra-abdominal secretions were analyzed. Different hospital areas were included: emergency department, non-ICU wards, and ICU. The databases were converted using the BacLink2 tool and analyzed using the WHONET 2022 platform. The percentage of antibiotic resistance was compared for each species and clinical specimen between years (2019 vs 2020) by a chi-square test using the criterion of <0.05 for statistical significance.
RESULTS
A statistically significant decrease in resistance to imipenem was observed for recovered from respiratory specimens in the ICU (55.6% vs 39.3%) and from urine samples from non-ICU areas (52.9% vs 37.3%). Also, an increase in resistance was detected in blood isolates from non-ICU areas for carbapenems in imipenem (23.3% vs 54.5%) and meropenem (27.4% vs 49%) and in , ertapenem (2.4% vs 10.1%), imipenem (1.9% vs 13.2%), and meropenem (1.6% vs 6.8%). Furthermore, an increase in resistance forimipenem (20.0% vs 57.5%) and meropenem (17.6% vs 48.7%) was detected in the emergency department for in respiratory isolates.
CONCLUSIONS
A decrease in carbapenem resistance for recovered from respiratory specimens in the ICU and from urine samples from non-ICU areas was detected. In contrast, an increase in carbapenem resistance was detected for in blood isolates from non-ICU areas and respiratory isolates from the emergency department. Regarding respiratory samples, a higher resistance for meropenem was detected in 2020 than in 2019 for (2.6 vs 10.6%, = 0.05). These results underline the analysis of antimicrobial resistance in different hospital wards to focus efforts on antimicrobial resistance reduction.
目的
细菌感染是重要的死亡原因。一些报告表明，新冠疫情可能对耐药性产生了影响。本研究的目的是比较2019年和2020年墨西哥医院急诊科、非重症监护病房（ICU）和ICU区域的耐药谱。
方法
分析了来自墨西哥八个州15家医院的数据库，包括从血液、尿液、呼吸道和腹腔分泌物中收集的[具体细菌名称1]和[具体细菌名称2]的药敏结果。纳入了不同的医院区域：急诊科、非ICU病房和ICU。使用BacLink2工具转换数据库，并使用WHONET 2022平台进行分析。采用卡方检验比较各年份（2019年与2020年）每种细菌和临床标本的抗生素耐药百分比，以P<0.05为统计学显著性标准。
结果
在ICU中，从呼吸道标本分离出的[具体细菌名称1]对亚胺培南的耐药性有统计学显著下降（55.6%对39.3%），在非ICU区域的尿液样本中也有下降（52.9%对37.3%）。此外，在非ICU区域的血液分离株中，[具体细菌名称1]对碳青霉烯类抗生素的耐药性增加，亚胺培南（23.3%对54.5%）和美罗培南（27.4%对49%），以及[具体细菌名称2]对厄他培南（2.4%对10.1%）、亚胺培南（1.9%对13.2%）和美罗培南（1.6%对6.8%）。此外，在急诊科的呼吸道分离株中，[具体细菌名称1]对亚胺培南（20.0%对57.5%）和美罗培南（17.6%对48.7%）的耐药性增加。
结论
在ICU中从呼吸道标本以及非ICU区域尿液样本中分离出的[具体细菌名称1]对碳青霉烯类抗生素的耐药性有所下降。相比之下，在非ICU区域的血液分离株和急诊科的呼吸道分离株中，[具体细菌名称1]对碳青霉烯类抗生素的耐药性有所增加。关于呼吸道样本，2020年[具体细菌名称2]对美罗培南的耐药性高于2019年（2.6%对10.6%，P=0.05）。这些结果强调了对不同医院病房抗菌药物耐药性进行分析，以便集中精力降低抗菌药物耐药性。
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