Epidemiology of bacteremia episodes in a single center: increase in Gram-negative isolates, antibiotics resistance, and patient age
Epidemiology of bacteremia episodes in a single center: increase in Gram-negative isolates, antibiotics resistance, and patient age
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DOI：
10.1007/s10096-008-0545-z
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发表时间：
2008-11-01
影响因子：
4.5
通讯作者：
Weinberger, M.
中科院分区：
文献类型：
--
作者：
Marchaim, D.;Zaidenstein, R.;Weinberger, M.
导致菌血症的分离株耐药性增强对医疗从业者和机构构成了重大挑战。研究所之间的差异很大，需要对当地趋势进行个别分析。在以色列中部一家拥有850张床位的大学医院进行了一项为期8年（1997-2004年）的菌血症监测研究。分析了发病率、耐药性、年龄和死亡率的趋势。我们研究了6096例患者特有的菌血症发作，其中2722例（45.3%）发生在医院，523例（9.2%）涉及18岁以下的儿童。在研究期间，菌血症发作的总发生率增加了39%，患者平均年龄增加了7.5岁。革兰氏阴性菌占医院获得性病例的72%和社区获得性病例的69%。医院事件的发生率大幅增加，主要是由于革兰氏阴性分离株，主要是鲍曼不动杆菌、肺炎克雷伯菌和大肠杆菌。革兰氏阴性菌对广谱抗生素的耐药性增加，包括喹诺酮类药物（肺炎克雷伯菌）、亚胺培南（鲍曼克雷伯菌和铜绿假单胞菌）、哌西林-他唑巴坦（肺炎克雷伯菌）和阿米卡星（鲍曼克雷伯菌和铜绿假单胞菌）。还注意到凝固酶阴性葡萄球菌对oxacillin的耐药性增加。全因死亡率明显上升。患者年龄、重症监护病房（ICU）住院时间和住院时间与死亡率独立相关。我们描述了革兰氏阴性菌引起菌血症和伴随菌血症患者衰老的发病率和耐药性的增加。其他地方也报告了类似的情况，令人真正关切。
Increased resistance among isolates causing bacteremia constitutes a major challenge to medical practitioners and institutions. Variability between institutes is substantial, and requires the individual analysis of local trends. An eight-year (1997-2004) surveillance study of episodes of bacteremia was conducted in an 850-bed university hospital in central Israel. Trends of incidence, resistance, age, and mortality were analyzed. We studied 6,096 patient-unique episodes of bacteremia, of which, 2,722 (45.3%) were nosocomial and 523 (9.2%) involved children less than 18 years of age. The overall incidence of bacteremia episodes has increased over the study years by 39% and the patient mean age by 7.5 years. Gram-negative organisms accounted for 72% of hospital-acquired cases and 69% of community-acquired cases. There was a substantial increase in the incidence of nosocomial episodes, predominantly due to Gram-negative isolates, mainly Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Increased resistance to broad-spectrum antibiotics was noted among Gram-negative organisms, including quinolones (in K. pneumoniae), imipenem (A. baumannii and P. aeruginosa), piperacillin-tazobactam (K. pneumoniae), and amikacin (A. baumannii and P. aeruginosa). Increased resistance to oxacillin among coagulase-negative staphylococci was also noted. The all-cause mortality rates showed a significant rise. The patient age, intensive care unit (ICU) stay, and hospital acquisition were independently associated with mortality. We describe an increase in the incidence and resistance of Gram-negative organisms causing bacteremia and concomitant ageing of the patients with bacteremia. Similar patterns have been reported from other localities, and are of real concern.