Implementing an antibiogram profile to aid rational antimicrobial therapy and improving infection prevention in an urban hospital in The Gambia; strategies and lessons for low income and middle-income countries
Implementing an antibiogram profile to aid rational antimicrobial therapy and improving infection prevention in an urban hospital in The Gambia; strategies and lessons for low income and middle-income countries
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在冈比亚的一家城市医院实施抗菌谱分析，以帮助合理的抗菌治疗并改善感染预防；
DOI：
10.1101/2022.04.19.22274009
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Darboe S
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作者：
Darboe S
背景诊断微生物学能力在低收入和中等收入国家仍然是一个挑战，导致重大差距。全球抗生素耐药性负担使我们有必要使用适当的处方来遏制这种威胁。这项研究强调了用于开发一个histogram监测阻力的过程中，在二级卫生设施，以帮助实证临床decisionmaking.MethodsThis回顾性横断面描述性研究使用3年的累积数据在医学研究理事会单位冈比亚从2016年1月至2018年12月。将表型数据手动插补至WHONET，并根据CLSI M39-A4指南使用标准化方法构建累积生物统计图。采用标准微生物方法鉴定病原体，根据CLSI M100指南采用Kirby-Bauer纸片扩散法进行药敏试验。（血培养n=4382，尿液n=4914，其他各种拭子和抽吸物分别n=2821和n=390，粪便n=334，粪便n=1463，CSF 353和其他样本n= 119）进行了处理，其中1163（7.9%）例为临床显著病原体阳性。在1163株病原菌中，E. coli（n= 315）; aureus（n=232）和K.肺炎克雷伯氏菌（n=96）是主要致病菌。coliandK.所有样本的肺炎均为：甲氧苄啶-磺胺甲恶唑（17%和28%）、四环素（26%和33%）、庆大霉素（72%和46%）、氯霉素（76%和60%）、环丙沙星（69%和59%）、阿莫西林/克拉维酸（77%和54%）。对超广谱β-内酰胺酶的耐药率分别为23%（71/315）和35%（34/96）。结论金黄色葡萄球菌对常用抗菌药物的敏感性较高。科利森K. ESBL高耐药肺炎支原体的监测。敏感性更好的替代氨基糖苷类药物（如阿米卡星）可能相关，但未对其进行检测，氯唑西林仍是葡萄球菌的首选药物。
BackgroundDiagnostic microbiological capabilities remain a challenge in low- and middle-income countries resulting in major gaps. The global antimicrobial resistance burden has necessitated use of appropriate prescribing to curb the menace. This study highlights the process used to develop an antibiogram to monitor resistance at a secondary-level health facility to aid empirical clinical decision making.MethodsThis retrospective cross-sectional descriptive study used 3 years of cumulative data at the Medical Research Council Unit The Gambia from January 2016 to December 2018. Phenotypic data was manually imputed into WHONET and the cumulative antibiogram constructed using standardised methodologies according to CLSI M39-A4 guidelines. Pathogens were identified by standard microbiological methods and antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method according to CLSI M100 guidelines.ResultsA total of 14776 non-duplicate samples (blood cultures n=4382, urines n=4914, other miscellaneous swabs and aspirates n=2821 and n=390 respectively, sputa n=334, stools n=1463, CSF 353 and other samples n= 119) were processed of which 1163 (7.9%) were positive for clinically significant pathogens. Among the 1163 pathogens,E. coli(n= 315)S. aureus(n=232), andK. pneumoniae(n=96) were the leading cause of disease Overall, the susceptibility forE. coliandK. pneumoniaefrom all samples were: trimethoprim-sulfamethoxazole (17% and 28%), tetracycline (26% and 33%), gentamicin (72% and 46%), chloramphenicol (76 and 60%), and ciprofloxacin (69% and 59%), amoxicillin/clavulanic (77% and 54%) respectively. Extended spectrum beta-lactamase resistance was present in 23% (71/315) vs 35% (34/96) respectively.S. aureussusceptibility for methicillin was 99%.ConclusionThis antibiogram has confirmed susceptibility to commonly used antimicrobials was higher forE. colithanK. pneumoniaewith high ESBL resistance warranting surveillance. An alternative aminoglycoside with better sensitivity such as amikacin might be relevant although this was not tested and that cloxacillin remains a drug of choice for the Staphylococci.