加拿大医院的革兰氏阳性病原体：CANWARD研究（2007 - 2023年）17年的研究结果
Gram-positive pathogens from Canadian hospitals: 17 years of results from the CANWARD study (2007-23).
作者信息
Zhanel George G, Baxter Melanie R, Golden Alyssa R, Lagacé-Wiens Philippe, Walkty Andrew, Fuller Jeff, Davidson Ross J, Blondeau Joseph, Poutanen Susan, Lavallée Christian, McCracken Melissa, Golding George, Schweizer Frank, Bay Denice, Karlowsky James A, Adam Heather J
机构信息
Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba R3E 0J9, Canada.
National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba R3E 3M4, Canada.
出版信息
J Antimicrob Chemother. 2025 Aug 28;80(Supplement_2):ii5-ii14. doi: 10.1093/jac/dkaf263.
OBJECTIVES
CANWARD is a Canadian Antimicrobial Resistance Alliance (CARA)/Health Canada partnered national surveillance study established in 2007 to annually assess antimicrobial susceptibilities for bacterial pathogens isolated from patients receiving care in Canadian hospitals. This paper focuses on Gram-positive pathogens.
METHODS
In total, 25 897 Gram-positive pathogens were received and 22 132 underwent CLSI broth microdilution testing providing susceptibility data.
RESULTS
47.9%, 30.2%, 5.7% and 16.2% of isolates tested were from blood, respiratory, urine and wound specimens, respectively; 29.9%, 24.8%, 19.0%, 18.1% and 8.2% of isolates were from patients in medical wards, emergency rooms, intensive care units, hospital clinics and surgical wards. Patient demographics associated with the isolates were: 58.9% male/41.1% female; 13.5% patients aged ≤17 years, 48.5% 18-64 years and 38.0% ≥ 65 years. Of the 25 897 pathogens received, the most common were: Staphylococcus aureus [20.9% (MSSA 16.5%/MRSA 4.4%)], Streptococcus pneumoniae (5.2%) and Enterococcus spp. (Enterococcus faecalis and Enterococcus faecium) (5.0%). MRSA rates (MRSA as a % of all S. aureus tested) decreased significantly during 2007-15 from 26.0% to 19.3% (P < 0.0001); subsequently they increased significantly through study years 2016-23 (16.9%-24.1%; P = 0.002). VRE rates (VRE as a % of all E. faecium tested) ranged from 3.8% to 18.4%, with marked fluctuation year-to-year. Susceptibility rates for MRSA were highest with: 100% ceftobiprole, 99.9% linezolid, vancomycin and daptomycin, 99.8% dalbavancin and 99.4% tedizolid, while susceptibility rates for VRE were 98.4% daptomycin and 86.0% with linezolid.
CONCLUSIONS
The CANWARD surveillance study has provided 17 years of reference antimicrobial susceptibility testing data on Gram-positive pathogens.
目的
CANWARD是一项由加拿大抗微生物药物耐药性联盟（CARA）与加拿大卫生部合作开展的全国性监测研究，于2007年设立，旨在每年评估从加拿大医院接受治疗的患者中分离出的细菌病原体的抗菌药物敏感性。本文重点关注革兰氏阳性病原体。
方法
共收到25897株革兰氏阳性病原体，其中22132株进行了CLSI肉汤微量稀释试验，提供了药敏数据。
结果
分别有47.9%、30.2%、5.7%和16.2%的检测分离株来自血液、呼吸道、尿液和伤口标本；分别有29.9%、24.8%、19.0%、18.1%和8.2%的分离株来自内科病房、急诊室、重症监护病房、医院门诊和外科病房的患者。与分离株相关的患者人口统计学特征为：男性58.9%/女性41.1%；13.5%的患者年龄≤17岁，48.5%的患者年龄在18 - 64岁之间，38.0%的患者年龄≥65岁。在收到的25897株病原体中，最常见的是：金黄色葡萄球菌[20.9%（甲氧西林敏感金黄色葡萄球菌16.5%/耐甲氧西林金黄色葡萄球菌4.4%）]、肺炎链球菌（5.2%）和肠球菌属（粪肠球菌和屎肠球菌）（5.0%）。耐甲氧西林金黄色葡萄球菌的比例（耐甲氧西林金黄色葡萄球菌占所有检测金黄色葡萄球菌的百分比）在2007 - 2015年期间从26.0%显著下降至19.3%（P<0.0001）；随后在2016 - 2023年研究期间显著上升（16.9% - 24.1%；P = 0.002）。耐万古霉素肠球菌的比例（耐万古霉素肠球菌占所有检测屎肠球菌的百分比）在3.8%至18.4%之间，逐年波动明显。耐甲氧西林金黄色葡萄球菌对头孢托罗的敏感性最高，为100%，对利奈唑胺、万古霉素和达托霉素的敏感性为99.9%，对达巴万星的敏感性为99.8%，对替加环素的敏感性为99.4%，而耐万古霉素肠球菌对达托霉素的敏感性为98.4%，对利奈唑胺的敏感性为86.0%。
结论
CANWARD监测研究提供了17年关于革兰氏阳性病原体的参考抗菌药物敏感性测试数据。
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