Five-Year Antimicrobial Susceptibility Trends among Bacterial Isolates from a Tertiary Health-Care Facility in Kigali, Rwanda
Five-Year Antimicrobial Susceptibility Trends among Bacterial Isolates from a Tertiary Health-Care Facility in Kigali, Rwanda
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DOI：
10.4269/ajtmh.16-0392
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发表时间：
2016-12-01
影响因子：
3.3
通讯作者：
Ogbuagu, Onyema
中科院分区：
文献类型：
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作者：
Carroll, Makeda;Rangaiahagari, Ashok;Ogbuagu, Onyema
抗生素耐药性（AMR）是一个全球性的公共卫生威胁。卢旺达关于抗生素耐药性趋势的信息有限。这项纵向研究旨在描述常见细菌抗生素敏感性的时间趋势。我们整理了2009年1月1日至2013年12月31日期间从住院患者和门诊患者采集的临床标本中培养的细菌的抗菌药物敏感性结果，并提交给卢旺达基加利费萨尔国王医院的微生物实验室。使用X-2试验评估了研究第1年和第5年之间每种细菌菌种的抗菌药物敏感性差异。在收集的5，296株分离株中，46.7%为大肠埃希菌，18.4%为克雷伯菌属，5.9%为不动杆菌属，7.1%为假单胞菌属，金黄色葡萄球菌占11.7%，肠球菌占10.3%。多粘菌素和亚胺培南对革兰氏阴性菌的活性最强。不动杆菌属相对于其他革兰氏阴性菌，对测试的抗菌剂显示出最大的耐药性。万古霉素对S.金黄色葡萄球菌和肠球菌的平均敏感率分别为100%和99.4%。趋势分析表明，克雷伯菌、大肠埃希菌对亚胺培南的耐药性显著增加。大肠埃希菌、假单胞菌和不动杆菌对黏菌素的耐药性也在上升。大肠杆菌和假单胞菌属。只有E.大肠杆菌对庆大霉素的耐药性增强。对于革兰氏阳性病原体，肠球菌属的万古霉素敏感性随着时间的推移而增加，但S.金黄色。我们的数据表明，在卢旺达革兰氏阴性菌中，对亚胺培南和粘菌素的耐药性正在上升。适当的感染控制实践和抗菌管理对于解决这一新出现的威胁至关重要。
Antimicrobial resistance (AMR) is a global public health threat. There is limited information from Rwanda on AMR trends. This longitudinal study aimed to describe temporal trends of antibiotic susceptibility among common bacteria. We collated the antimicrobial susceptibility results of bacteria cultured from clinical specimens collected from inpatients and outpatients and submitted to the microbiology laboratory at King Faisal Hospital, Kigali, Rwanda, from January 1, 2009, to December 31, 2013. Differences in antimicrobial susceptibility between the first and fifth year of the study for each bacterial species was assessed using X-2 test. Of 5,296 isolates collected, 46.7% were Escherichia coli, 18.4% were Klebsiella spp., 5.9% were Acinetobacter spp., 7.1% were Pseudomonas spp., 11.7% were Staphylococcus aureus, and 10.3% were Enterococcus spp. Colistin and imipenem had greatest activity against gram negative bacteria. Acinetobacter spp. showed the greatest resistance profile to antimicrobials tested, relative to other gram-negative bacteria. Vancomycin retained excellent activity against S. aureus and Enterococcus species (average susceptibility was 100% and 99.4%, respectively). Trend analysis determined that resistance to imipenem increased significantly among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates; there was also rising resistance to colistin among E. coli and Pseudomonas species. Only E. coli demonstrated increased resistance to gentamicin. For gram-positive pathogens, vancomycin susceptibility increased over time for Enterococcus species, but was unchanged for S. aureus. Our data suggest that resistance to imipenem and colistin are rising among gram-negative bacteria in Rwanda. Proper infection control practices and antimicrobial stewardship will be important to address this emerging threat.