Multidrug- and Carbapenem-Resistant Pseudomonas aeruginosa in Children, United States, 1999-2012
Multidrug- and Carbapenem-Resistant Pseudomonas aeruginosa in Children, United States, 1999-2012
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DOI：
10.1093/jpids/piw064
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发表时间：
2017-12-01
影响因子：
3.2
通讯作者：
Laxminarayan, Ramanan
中科院分区：
文献类型：
--
作者：
Logan, Latania K.;Gandra, Sumanth;Laxminarayan, Ramanan
背景铜绿假单胞菌是医疗保健相关感染的常见原因。多重耐药（MDR）（>3类）和碳青霉烯类耐药（CR）铜绿假单胞菌是全球性的重大威胁。我们使用了一个大型的参考实验室数据库来研究美国儿童铜绿假单胞菌的流行病学。使用来自监测网络的抗菌药物敏感性数据对1999年1月至2012年7月期间1至17岁儿童的MDR和CR铜绿假单胞菌分离株进行表型鉴定。Logistic回归分析用于计算MDR和CR铜绿假单胞菌患病率的趋势。排除了来自婴儿（< 1岁）和囊性纤维化患者的分离株。在检测的分离株中，MDR铜绿假单胞菌的粗比例从1999年的15.4%增加到2012年的26%，CR铜绿假单胞菌的比例从1999年的9.4%增加到2012年的20%。MDR和CR铜绿假单胞菌的比例每年增加4%（比值比[OR]，分别为1.04 [95%置信区间（CI），1.03-1.04]和1.04 [95% CI，1.04-1.05]）。在多变量分析中，MDR和CR铜绿假单胞菌在重症监护环境中、13至17岁儿童中、呼吸道标本中和西北中部地区更常见。此外，对常用于治疗铜绿假单胞菌的其他抗生素类（氨基糖苷类、氟喹诺酮类、头孢菌素类和哌拉西林-他唑巴坦类）的耐药性增加。在全国范围内，儿童铜绿假单胞菌感染的MDR和CR率正在上升。积极的预防策略，包括在儿科环境中建立抗菌素管理计划，对于对抗抗菌素耐药性至关重要。
Background. Pseudomonas aeruginosa is a common cause of healthcare-associated infection. Multidrug-resistant (MDR) (>3 classes) and carbapenem-resistant (CR) P aeruginosa are significant threats globally. We used a large reference-laboratory database to study the epidemiology of P aeruginosa in children in the United States.Methods. Antimicrobial susceptibility data from the Surveillance Network were used to phenotypically identify MDR and CR P aeruginosa isolates in children aged 1 to 17 years between January 1999 and July 2012. Logistic regression analysis was used to calculate trends in the prevalence of MDR and CR P aeruginosa. Isolates from infants (< 1 year old) and patients with cystic fibrosis were excluded.Results. Among the isolates tested, the crude proportion of MDR P aeruginosa increased from 15.4% in 1999 to 26% in 2012, and the proportion of CR P aeruginosa increased from 9.4% in 1999 to 20% in 2012. The proportion of both MDR and CR P aeruginosa increased each year by 4% (odds ratio [OR], 1.04 [95% confidence interval (CI), 1.03-1.04] and 1.04 [95% CI, 1.04-1.05], respectively). In multivariable analysis, both MDR and CR P aeruginosa were more common in the intensive care setting, among children aged 13 to 17 years, in respiratory specimens, and in the West North Central region. In addition, resistance to other antibiotic classes (aminoglycosides, fluoroquinolones, cephalosporins, and piperacillin-tazobactam) often used to treat P aeruginosa increased.Conclusions. Rates of MDR and CR P aeruginosa infection in children are rising nationally. Aggressive prevention strategies, including instituting antimicrobial stewardship programs in pediatric settings, are essential for combating antimicrobial resistance.