坦桑尼亚姆万扎实施国家抗菌药物耐药性行动计划期间及之后血流感染的流行病学和抗菌药物耐药性趋势：一项比较横断面研究
Epidemiology and Antimicrobial Resistance Trends of Bloodstream Infections During and After the Implementation of the National Action Plan on Antimicrobial Resistance in Mwanza, Tanzania: A Comparative Cross-Sectional Study.
作者信息
Silago Vitus, Matthews Louise, Oravcova Katarina, Mshana Stephen E, Seni Jeremiah, Claus Heike
机构信息
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Department of Molecular Epidemiology of Bacterial Infections, Institute for Hygiene and Microbiology, University of Würzburg, Sanderring 2, Würzburg, 97070, Germany.
出版信息
Infect Drug Resist. 2025 Aug 29;18:4441-4453. doi: 10.2147/IDR.S542495. eCollection 2025.
BACKGROUND AND PURPOSE
Bloodstream infections (BSIs) caused by antimicrobial-resistant pathogens, especially WHO-Bacterial-Priority-Pathogens (WHO-BPPs), contribute to significant mortality. The current study determined the prevalence of BSIs, causative bacterial pathogens and their antimicrobial susceptibility profiles, and factors associated with laboratory-confirmed BSIs by WHO-BPPs during and after National Action Plan on Antimicrobial Resistance (NAP-AMR) implementation in Mwanza, Tanzania.
PATIENTS AND METHODS
A comparative cross-sectional study was conducted among sepsis patients in District, Regional, and Zonal Referral Hospitals from June 2019 to June 2020 (during NAP-AMR) and March to July 2023 (after NAP-AMR). Blood cultures were processed using conventional methods, while bacterial identification and antimicrobial susceptibility testing were performed using Vitek MS (MALDI-TOF-MS) and Vitek 2, respectively. STATA version 15.0 was used for data analysis.
RESULTS
Among 1842 enrolled patients (median age: 5 years, IQR: 0-31), 51.4% were female. The overall prevalence of BSIs was 14.7% (271/1842). A total of 306 bacterial isolates were identified, with Gram-negative bacteria predominating during (92.4%) and after (73.5%) NAP-AMR. was most common during (31.2%), whereas dominated after (43.4%) NAP-AMR. BSIs caused by WHO-BPPs rose significantly after NAP-AMR (43.5% vs 76.1%, p<0.001), particularly extended-spectrum beta-lactamase producing Enterobacterales. resistance to cefotaxime (65.3% vs 93.2%, p=0.001), gentamicin (63.3% vs 94.9%, p=0.001), and ciprofloxacin (28.6% vs 76.3%, p=0.001) increased significantly. Higher-tier hospitals (OR: 7.01; 95% CI: 1.58-31.05; p=0.010) and after NAP-AMR enrollment (OR: 2.87; 95% CI: 1.33-6.19; p=0.007) were linked to increased BSIs caused by WHO-BPPs.
CONCLUSION
We observed a high prevalence of BSIs with a rising proportion of BSIs caused by WHO-BPPs, particularly in higher-tier hospitals and after the implementation of NAP-AMR. Our findings highlight the need of hospital-specific antibiograms and reinforced infection prevention measures.
背景与目的
由抗菌药物耐药病原体引起的血流感染（BSIs），尤其是世界卫生组织细菌重点病原体（WHO - BPPs），会导致显著的死亡率。本研究确定了坦桑尼亚姆万扎在实施抗菌药物耐药国家行动计划（NAP - AMR）期间及之后，血流感染的患病率、致病细菌病原体及其抗菌药物敏感性谱，以及与实验室确诊的由WHO - BPPs引起的血流感染相关的因素。
患者与方法
2019年6月至2020年6月（NAP - AMR实施期间）以及2023年3月至7月（NAP - AMR实施之后），在地区、区域和分区转诊医院对脓毒症患者进行了一项比较性横断面研究。血培养采用常规方法处理，而细菌鉴定和抗菌药物敏感性测试分别使用Vitek MS（基质辅助激光解吸电离飞行时间质谱）和Vitek 2进行。使用STATA 15.0版本进行数据分析。
结果
在1842名登记患者中（中位年龄：5岁，四分位间距：0 - 31岁），51.4%为女性。血流感染的总体患病率为14.7%（271/1842）。共鉴定出306株细菌分离株，革兰氏阴性菌在NAP - AMR实施期间（92.4%）和之后（73.5%）占主导。 在NAP - AMR实施期间最为常见（31.2%），而在NAP - AMR实施之后 占主导（43.4%）。NAP - AMR实施后，由WHO - BPPs引起的血流感染显著增加（43.5%对76.1%，p<0.001），尤其是产超广谱β - 内酰胺酶的肠杆菌科细菌。对头孢噻肟的耐药性（65.3%对93.2%，p = 0.001）、庆大霉素（63.3%对94.9%，p = 0.001）和环丙沙星（28.6%对76.3%，p = 0.001）显著增加。高级别医院（比值比：7.01；95%置信区间：1.58 - 31.05；p = 0.010）以及NAP - AMR实施后登记入组（比值比：2.87；95%置信区间：1.33 - 6.19；p = 0.007）与由WHO - BPPs引起的血流感染增加有关。
结论
我们观察到血流感染的患病率较高，由WHO - BPPs引起的血流感染比例不断上升，尤其是在高级别医院以及NAP - AMR实施之后。我们的研究结果凸显了医院特定抗菌谱和强化感染预防措施的必要性。
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