Antimicrobial-resistant pathogens in intensive care units in Canada: Results of the Canadian national intensive care unit (CAN-ICU) study, 2005-2006
Antimicrobial-resistant pathogens in intensive care units in Canada: Results of the Canadian national intensive care unit (CAN-ICU) study, 2005-2006
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DOI：
10.1128/aac.01538-07
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发表时间：
2008-04-01
影响因子：
4.9
通讯作者：
Hoban, Daryl J.
中科院分区：
文献类型：
--
作者：
Zhanel, George G.;DeCorby, Mel;Hoban, Daryl J.
2005年9月1日至2006年6月30日期间，19个医学中心从加拿大重症监护室（ICU）患者的临床标本中收集了4，180株分离株。4，180株分离株来自2，292份呼吸道标本（54.8%）、738份血液标本（17.7%）、581份伤口/组织标本（13.9%）和569份尿液标本（13.6%）。从79.5%的临床标本中分离出的10种最常见的微生物是甲氧西林敏感的金黄色葡萄球菌（MSSA）（16.4%）、大肠埃希菌（12.8%）、铜绿假单胞菌（10.0%）、流感嗜血杆菌（7.9%）、凝固酶阴性葡萄球菌/表皮葡萄球菌（6.5%）、肠球菌属（6.5%）。(6.1肺炎链球菌（5.8%）、肺炎克雷伯菌（5.8%）、耐甲氧西林金黄色葡萄球菌（MRSA）（4.7%）和阴沟肠杆菌（3.9%）。MRSA占22.3%（197/884）。金黄色葡萄球菌分离株（90.9%的MRSA为医疗保健相关MRSA，9.1%为社区相关MRSA），而万古霉素耐药肠球菌（VRE）占所有肠球菌分离株的6.7%（111255）（88.2%的VRE具有vanA基因型）。产超广谱β-内酰胺酶（ESBL）的E.埃希菌和肺炎链球菌感染率分别为3.5%（19/536）和1.8%（4/224）。所有19株产ESBL E. PCR检测结果显示，CTX-M阳性率为74%（14/19），bla（CTX-M-15）阳性。MRSA对达托霉素、利奈唑胺、替加环素和万古霉素无耐药，对其他药物的耐药率如下：克拉霉素89.9%;克林霉素76.1%;氟喹诺酮类90.1 - 91.8%;甲氧苄啶-磺胺甲恶唑11.7%。大肠耐药率依次为：头孢唑啉20.1%，头孢吡肟0.7%，头孢曲松3.7%，庆大霉素3.0%，氟喹诺酮类21.1%，哌拉西林-他唑巴坦1.9%，甲氧苄啶-磺胺甲恶唑24.8%。铜绿假单胞菌的耐药率如下：阿米卡星，2.6%;头孢吡肟，10.2%;庆大霉素，15.2%;氟喹诺酮类，23.8%至25.5%;美罗培南，13.6%;哌拉西林-他唑巴坦，9.3%。多药耐药（MDR）表型（对以下三种或三种以上药物耐药：头孢吡肟、哌拉西林-他唑巴坦、美罗培南、阿米卡星或庆大霉素和环丙沙星）在铜绿假单胞菌中常见（12.6%），而在大肠埃希菌中不常见。大肠杆菌（0.2%）、大肠杆菌（0.2%）; Clopidine（0.6%），K.肺炎（0%）。结果表明，S.金黄色葡萄球菌（MSSA和MRSA）、E. coli、铜绿假单胞菌、H.流感，肠球菌属，S.肺炎克雷伯菌和肺炎克雷伯菌。肺炎克雷伯氏菌是从加拿大ICU临床标本中回收的最常见分离株。MDR表型常见于加拿大ICU中的铜绿假单胞菌分离株。
Between 1 September 2005 and 30 June 2006, 19 medical centers collected 4,180 isolates recovered from clinical specimens from patients in intensive care units (ICUs) in Canada. The 4,180 isolates were collected from 2,292 respiratory specimens (54.8%), 738 blood specimens (17.7%), 581 wound/tissue specimens (13.9%), and 569 urinary specimens (13.6%). The 10 most common organisms isolated from 79.5% of all clinical specimens were methicillin-susceptible Staphylococcus aureus (MSSA) (16.4%), Escherichia coli (12.8%), Pseudomonas aeruginosa (10.0%), Haemophilus influenzae (7.9%), coagulase-negative staphylococci/Staphylococcus epidermidis (6.5%), Enterococcus spp. (6.1%), Streptococcus pneumoniae (5.8%), Klebsiella pneumoniae (5.8%), methicillin-resistant Staphylococcus aureus (MRSA) (4.7%), and Enterobacter cloacae (3.9%). MRSA made up 22.3% (197/884) of all S. aureus isolates (90.9% of MRSA were health care-associated MRSA, and 9.1% were community-associated MRSA), while vancomycin-resistant enterococci (VRE) made up 6.7% (111255) of all enterococcal isolates (88.2% of VRE had the vanA genotype). Extended-spectrum P-lactamase (ESBL)-producing E. coli and K. pneumoniae occurred in 3.5% (19/536) and 1.8% (4/224) of isolates, respectively. All 19 ESBL-producing E. coli isolates were PCR positive for CTX-M, with bla(CTX-M-15) occurring in 74% (14/19) of isolates. For MRSA, no resistance against daptomycin, linezolid, tigecycline, and vancomycin was observed, while the resistance rates to other agents were as follows: clarithromycin, 89.9%; clindamycin, 76.1%; fluoroquinolones, 90.1 to 91.8%; and trimethoprim-sulfamethoxazole, 11.7%. For E. coli, no resistance to amikacin, meropenem, and tigecycline was observed, while resistance rates to other agents were as follows: cefazolin, 20.1%; cefepime, 0.7%; ceftriaxone, 3.7%; gentamicin, 3.0%; fluoroquinolones, 21.1%; piperacillin-tazobactam, 1.9%; and trimethoprim-sulfamethoxazole, 24.8%. Resistance rates for P. aeruginosa were as follows: amikacin, 2.6%; cefepime, 10.2%; gentamicin, 15.2%; fluoroquinolones, 23.8 to 25.5%; meropenem, 13.6%; and piperacillin-tazobactam, 9.3%. A multidrug-resistant (MDR) phenotype (resistance to three or more of the following drugs: cefepime, piperacillin-tazobactam, meropenem, amikacin or gentamicin, and ciprofloxacin) occurred frequently in P. aeruginosa (12.6%) but uncommonly in E. coli (0.2%), E. cloacae (0.6%), or K. pneumoniae (0%). In conclusion, S. aureus (MSSA and MRSA), E. coli, P. aeruginosa, H. influenzae, Enterococcus spp., S. pneumoniae, and K. pneumoniae are the most common isolates recovered from clinical specimens in Canadian ICUs. A MDR phenotype is common for P. aeruginosa isolates in Canadian ICUs.