A retrospective analysis of pathogen profile, antimicrobial resistance and mortality in neonatal hospital-acquired bloodstream infections from 2009-2018 at Tygerberg Hospital, South Africa.
A retrospective analysis of pathogen profile, antimicrobial resistance and mortality in neonatal hospital-acquired bloodstream infections from 2009-2018 at Tygerberg Hospital, South Africa.
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DOI：
10.1371/journal.pone.0245089
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Dramowski A
中科院分区：
文献类型：
--
作者：
Reddy K;Bekker A;Whitelaw AC;Esterhuizen TM;Dramowski A
分析医院获得性血液感染（HA-BSI）趋势对于监测新出现的抗菌素耐药性（AMR）威胁和指导经验性抗生素选择具有重要意义。在南非开普敦的Tygerberg医院新生儿病房对新生儿HA-BSI进行了为期10年的回顾性回顾。将2014年至2018年（第2期）新生儿临床和实验室数据与2009年至2013年（第1期）公布的数据进行比较。新生儿单位的HA-BSI率从第一阶段的3.9/1000住院日下降到第二阶段的3.3/1000住院日（p = 0.002）。病原菌产量和血培养污染率保持不变（11.0% ~ 10.4%,p = 0.233; 5.1% ~ 5.3%, p = 0.636）。革兰氏阴性病原菌占主导地位（1047/1636;64.0%）；克雷伯氏菌、金黄色葡萄球菌、粘质沙雷氏菌、肠球菌和鲍曼不动杆菌是最常见的病原体。2009-2018年，克雷伯菌菌株319/432（73.8%）产生广谱β -内酰胺酶，金黄色葡萄球菌菌株171/246（69.5%）耐甲氧西林，不动杆菌菌株115/137（83.9%）广泛耐药。新生儿HA-BSI发作的粗死亡率从第1期的139/717（19.4%）增加到第179/718 (24.9%)(p = 0.014)，但HA-BSI的归因死亡率保持不变（97/139 [69.8%]vs 118/179 [65.9%], p = 0.542）。哌拉西林-他唑巴坦和阿米卡星的体外活性在第2期下降（74.6% ~ 61.4%,p<0.001）。虽然新生儿HA-BSI率下降，但BSI病原体的抗菌素耐药率仍然很高。连续BSI监测是一种有价值的工具，可以检测病原体和抗菌素耐药性谱的变化，并为资源有限的新生儿单位提供经验性抗生素建议。
Analysis of hospital-acquired bloodstream infection (HA-BSI) trends is important to monitor emerging antimicrobial resistance (AMR) threats and guide empiric antibiotic choices. A retrospective 10-year review of neonatal HA-BSI was performed at Tygerberg Hospital’s neonatal unit in Cape Town, South Africa. Neonatal clinical and laboratory data from 2014 to 2018 (Period 2) was compared with published data from 2009 to 2013 (Period 1). The neonatal unit’s HA-BSI rate declined between periods from 3.9/1000 inpatient-days in Period 1 to 3.3/1000 inpatient-days in Period 2 (p = 0.002). Pathogen yield and blood culture contamination rate were unchanged (11.0% to 10.4%, p = 0.233; 5.1% to 5.3%, p = 0.636 respectively). Gram-negative pathogens predominated (1047/1636; 64.0%); Klebsiella species, Staphylococcus aureus, Serratia marcescens, Enterococcus species and Acinetobacter baumannii were the most frequent pathogens. Extended spectrum beta-lactamase production was observed in 319/432 (73.8%) of Klebsiella species, methicillin resistance in 171/246 (69.5%) of Staphylococcus aureus and extensive drug resistance in 115/137 (83.9%) of Acinetobacter species (2009–2018). The crude mortality rate of neonatal HA-BSI episodes increased from Period 1 to Period 2 from 139/717 (19.4%) to 179/718 (24.9%) (p = 0.014), but HA-BSI attributable mortality remained unchanged (97/139 [69.8%] vs 118/179 [65.9%], p = 0.542). The in-vitro activity of piperacillin-tazobactam and amikacin declined during Period 2 (74.6% to 61.4%; p<0.001). Although HA-BSI rates declined in the neonatal unit, antimicrobial resistance rates in BSI pathogens remained high. Continuous BSI surveillance is a valuable tool to detect changes in pathogen and AMR profiles and inform empiric antibiotic recommendations for neonatal units in resource-limited settings.
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作者：
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