Bloodstream infection due to Acinetobacter spp:: epidemiology, risk factors and impact of multi-drug resistance
Bloodstream infection due to Acinetobacter spp:: epidemiology, risk factors and impact of multi-drug resistance
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DOI：
10.1007/s10096-008-0473-y
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发表时间：
2008-07-01
影响因子：
4.5
通讯作者：
Millar, M.
中科院分区：
文献类型：
--
作者：
Wareham, D. W.;Bean, D. C.;Millar, M.
不动杆菌属越来越多地被报告为人类感染的重要原因。许多分离株表现出多重耐药性，引起了人们对我们治疗这些生物严重感染的能力的担忧。感染对临床结果的影响以及多药耐药的重要性尚不明确。对1998年至2006年在英国三级护理中心发生的所有不动杆菌菌血症事件进行了描述性回顾性观察研究。记录感染患者的人口统计学资料、感染菌株的特征和抗菌药物敏感性，并评估抗菌治疗对所有30天死亡原因的影响。共发现399例不动杆菌菌血症，其中A。鲍曼不动杆菌是最常见的分离种。大多数事件发生在重症监护中，并与多药耐药性相关，碳青霉烯耐药性从1998年的0%上升到2006年的55%。尽管由碳青霉烯类耐药不动杆菌引起的菌血症和重症监护要求与较高的死亡率相关，但给予适当的经验性抗菌治疗并不能降低死亡率。需要进行前瞻性研究，以确定最有效的干预措施和最有可能从治疗中获益的干预措施。
Acinetobacter spp. are increasingly reported as important causes of human infection. Many isolates exhibit multi-drug resistance, raising concerns over our ability to treat serious infections with these organisms. The impact of infection on clinical outcome as well as the importance of multi-drug resistance is poorly defined. A descriptive retrospective observational study was undertaken of all episodes of Acinetobacter bacteremia occurring in a UK tertiary care centre from 1998-2006. Demographics of infected patients, characteristics and antimicrobial susceptibility of infecting strains were recorded and the impact of antimicrobial therapy on all causes of 30-day mortality assessed. Three hundred ninety-nine episodes of Acinetobacter bacteremia were identified, with A. baumannii being the most frequently isolated species. Most episodes occurred in critical care and were associated with multidrug resistance, with carbapenem resistance rising from 0% in 1998 to 55% in 2006. Although bacteremia due to carbapenem-resistant Acinetobacter and a requirement for critical care were associated with a higher mortality, mortality was not reduced by the administration of appropriate empirical antimicrobial therapy. A prospective study is required to identify both the most effective intervention and those most likely to benefit from treatment.