Klein Klouwenberg Peter M C, Oliveira Dos Santos Claudy, van de Wetering Diederik, Provacia Lisette
Medical Microbiology, Analytisch Diagnostisch Centrum, Heelsumstraat 55, Willemstad, Curaçao.
Department of Internal Medicine, Curaçao Medical Center, Willemstad, Curaçao.
Antimicrob Resist Infect Control. 2024 Dec 18;13(1):151. doi: 10.1186/s13756-024-01499-x.
The Caribbean lacks recent comprehensive antimicrobial resistance data to inform clinicians and decision-makers. This study aims to provide a snapshot of susceptibility trends for pathogens on Curaçao, an island in the southern Caribbean.
We analyzed susceptibility data of bacterial pathogens isolated from samples submitted from patients attending general practitioners, outpatient clinics and those who were hospitalized between January 2018 and December 2023. Samples originating from blood, urine, genital tract, soft tissue, and lungs were included. Susceptibility testing was performed by VITEK2 according using the European Committee on Antimicrobial Susceptibility Testing criteria.
In total, 13,528 patients contributed to 22,876 first isolates. Of all infections in adults with Staphylococcus aureus, 14% (95% confidence interval 10-18%) were methicillin-resistant S. aureus (MRSA) in blood, and up to 27% (20-35%) in soft-tissue cultures. For Escherichia coli and Klebsiella pneumoniae, resistance levels were up to 27% (95% CI 22-32%) for cefuroxime and up to 18% (95% CI 18-28%) for third-generation cephalosporins. The addition of gentamicin to empirical therapy with cefuroxime increased coverage only moderately, especially in K. pneumoniae (16%, 95% CI 12-20%). Resistance to amoxicillin-clavulanic acid was up to 47% (95% CI 43-50%), to ciprofloxacin 34% (95% CI 31-37%) and to cotrimoxazole 37% (95% CI 34-39) in urine cultures from outpatients. In contrast, low levels of carbapenem resistant Enterobacterales and Pseudomonas aeruginosa were observed.
Antimicrobial resistance is high and widespread across several important antibiotic classes. The widespread occurrence of MRSA and resistance to third-generation cephalosporins highlights the importance of identifying risk factors, enabling more effective guidance for antimicrobial stewardship.
加勒比地区缺乏近期全面的抗菌药物耐药性数据，无法为临床医生和决策者提供参考。本研究旨在提供加勒比海南部库拉索岛病原体药敏趋势的概况。
我们分析了2018年1月至2023年12月期间从全科医生诊所、门诊诊所就诊患者以及住院患者提交的样本中分离出的细菌病原体的药敏数据。纳入了来自血液、尿液、生殖道、软组织和肺部的样本。使用VITEK2按照欧洲抗菌药物敏感性试验委员会的标准进行药敏试验。
共有13528名患者提供了22876株初次分离株。在所有成年金黄色葡萄球菌感染中，血液中耐甲氧西林金黄色葡萄球菌（MRSA）占14%（95%置信区间10 - 18%），软组织培养物中高达27%（20 - 35%）。对于大肠埃希菌和肺炎克雷伯菌，头孢呋辛的耐药率高达27%（95%CI 22 - 32%），第三代头孢菌素的耐药率高达18%（95%CI 18 - 28%）。在头孢呋辛经验性治疗中加用庆大霉素仅适度增加了覆盖范围，尤其是在肺炎克雷伯菌中（16%，95%CI 12 - 20%）。门诊患者尿液培养物中对阿莫西林 - 克拉维酸的耐药率高达47%（95%CI 43 - 50%），对环丙沙星的耐药率为34%（95%CI 31 - 37%），对复方新诺明的耐药率为37%（95%CI 34 - 39）。相比之下，观察到碳青霉烯类耐药肠杆菌科细菌和铜绿假单胞菌的水平较低。
抗菌药物耐药性在几种重要抗生素类别中很高且广泛存在。MRSA的广泛出现和对第三代头孢菌素的耐药性凸显了识别风险因素的重要性，从而能够为抗菌药物管理提供更有效的指导。
