Secular Trends in Nosocomial Bloodstream Infections: Antibiotic-Resistant Bacteria Increase the Total Burden of Infection
Secular Trends in Nosocomial Bloodstream Infections: Antibiotic-Resistant Bacteria Increase the Total Burden of Infection
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DOI：
10.1093/cid/cis1006
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发表时间：
2013-03-15
影响因子：
11.8
通讯作者：
Bonten, M. J. M.
中科院分区：
文献类型：
--
作者：
Ammerlaan, H. S. M.;Harbarth, S.;Bonten, M. J. M.
背景。目前尚不清楚抗生素耐药菌（ARB）引起的院内血流感染（BSI）发生率上升是否会取代抗生素敏感菌（ASB），从而使总BSI发生率不受影响。我们调查了1998年至2007年间7家ARB流行医院和7家ARB非流行医院由耐甲氧西林金黄色葡萄球菌（MRSA）、MRSA以外的ARB和ASB引起的医院性脑损伤的年发病率密度（每10万患者日发病率）的时间趋势。33130例医院性脑损伤（14%由ARB引起）产生36679个微生物。1998 - 2007年，arb非流行医院的MRSA发病率密度从0.2上升到0.7（年增长22%），arb流行医院的MRSA发病率密度从3.1上升到11.7（年增长10%）（P = 0.2）， arb流行医院与arb非流行医院的发病率密度差从2.9上升到11.0。非mrsa ARB发病率密度在ARB非流行医院从2.8上升到4.1（年上升5%），在ARB流行医院从1.5上升到17.4（年上升22%）（P < 0.001），使发病率密度差从-1.3上升到13.3。两组ASB发病率密度趋势相似（P = 0.7）。arb -非流行医院和arb -流行医院的所有医院性脑梗死分别每年增加3.8%和5.4% (P < 0.001)，总发病率密度差从3.8增加到24.4。除了ASB引起的感染外，ARB引起的院内BSI发生率增加，增加了疾病的总负担。2005年ARB感染率高的医院在10年期间的BSI超额负担为每10万病人日20.6例，主要是由ARB感染引起的。
Background. It is unknown whether rising incidence rates of nosocomial bloodstream infections (BSIs) caused by antibiotic-resistant bacteria (ARB) replace antibiotic-susceptible bacteria (ASB), leaving the total BSI rate unaffected.Methods. We investigated temporal trends in annual incidence densities (events per 100 000 patient-days) of nosocomial BSIs caused by methicillin-resistant Staphylococcus aureus (MRSA), ARB other than MRSA, and ASB in 7 ARB-endemic and 7 ARB-nonendemic hospitals between 1998 and 2007.Results. 33 130 nosocomial BSIs (14% caused by ARB) yielded 36 679 microorganisms. From 1998 to 2007, the MRSA incidence density increased from 0.2 to 0.7 (annual increase, 22%) in ARB-nonendemic hospitals, and from 3.1 to 11.7 (annual increase, 10%) in ARB-endemic hospitals (P = .2), increasing the incidence density difference between ARB-endemic and ARB-nonendemic hospitals from 2.9 to 11.0. The non-MRSA ARB incidence density increased from 2.8 to 4.1 (annual increase, 5%) in ARB-nonendemic hospitals, and from 1.5 to 17.4 (annual increase, 22%) in ARB-endemic hospitals (P < .001), changing the incidence density difference from -1.3 to 13.3. Trends in ASB incidence densities were similar in both groups (P = .7). With annual increases of 3.8% and 5.4% of all nosocomial BSIs in ARB-nonendemic and ARB-endemic hospitals, respectively (P < .001), the overall incidence density difference of 3.8 increased to 24.4.Conclusions. Increased nosocomial BSI rates due to ARB occur in addition to infections caused by ASB, increasing the total burden of disease. Hospitals with high ARB infection rates in 2005 had an excess burden of BSI of 20.6 per 100 000 patient-days in a 10-year period, mainly caused by infections with ARB.