Trends in resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States: 2013-2017
Trends in resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States: 2013-2017
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DOI：
10.1186/s12879-019-4387-3
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发表时间：
2019-08-23
影响因子：
3.7
通讯作者：
Yu, Kalvin
中科院分区：
文献类型：
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作者：
Gupta, Vikas;Ye, Gang;Yu, Kalvin
背景抗菌素耐药性的趋势有助于为感染控制工作提供信息。我们调查了肠杆菌科和不动杆菌属的耐药性趋势。2013年至2017年，在美国住院的患者中。方法我们分析了美国BD Insights Research数据库中住院患者非重复分离株(不限于医院获得性感染)的药敏情况。耐药谱包括肠杆菌科产超广谱β-内酰胺酶(ESBL)、多药耐药(MDR)和碳青霉烯不敏感(Carb-NS)表型，以及MDR和Carb-NS不动杆菌属。时间序列模型被用来评估每100个医院的住院率和每测试菌株所占比例的耐药性趋势模式。结果411家医院共分离肠杆菌科细菌100余万株，其中超广谱β-内酰胺酶12.05%，碳水化合物1.21%，多药耐药7.08%。尿液是最常见的来源。不动杆菌属。19325例患者中，37.48%为Carb-NS，47.66%为MDR，最常见来源为皮肤/伤口培养。趋势分析显示，2013至2017年间，每100名住院患者中ESBL和Carb-NS肠杆菌科细菌的比例大幅上升。肠杆菌科耐药菌和碳水化合物耐药率及不动杆菌耐药率。在这段时间内有所下降。耐药菌株比例的趋势通常反映了每100家医院入院率的趋势。耐多药肠杆菌科与Carb-NS和耐多药不动杆菌属。冬季比夏季更常见。结论在这项针对美国医院患者的大规模研究中，2013至2017年间，每100名住院患者中ESBL和Carb-NS肠杆菌科细菌的比率有所上升。耐多药肠杆菌科与耐多药和碳不动杆菌属。在这段时间里，分离物减少了。这些数据支持继续进行感染控制和管理工作，以及开发新的治疗方案。
Background Trends in antimicrobial resistance help inform infection control efforts. We examined trends in resistance for Enterobacteriaceae and Acinetobacter spp. from 2013 to 2017 in hospitalized US patients. Methods We analyzed antimicrobial susceptibility of non-duplicate isolates in hospitalized patients (not limited to hospital-acquired infections) in the US BD Insights Research Database. Resistance profiles of interest were extended-spectrum beta-lactamase (ESBL)-producing, multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes of Enterobacteriaceae, and MDR and Carb-NS Acinetobacter spp. Time series models were used to evaluate the patterns of resistance trends in rate per 100 hospital admissions and proportion per isolates tested. Results More than 1 million Enterobacteriaceae isolates were obtained from 411 hospitals; 12.05% were ESBL, 1.21% Carb-NS, and 7.08% MDR. Urine was the most common source. For Acinetobacter spp. (n = 19,325), 37.48% were Carb-NS, 47.66% were MDR, and the most common source was skin/wound cultures. Trend analyses showed that the rates of ESBL and Carb-NS Enterobacteriaceae per 100 hospital admissions increased significantly between 2013 and 2017. Rates of MDR Enterobacteriaceae and Carb-NS and MDR Acinetobacter spp. decreased during this time period. Trends in proportions of resistant isolates generally mirrored trends in rates per 100 hospital admissions. MDR Enterobacteriaceae and Carb-NS and MDR Acinetobacter spp. were more common in winter than summer. Conclusions In this large-scale study of patients in US hospitals, rates of ESBL and Carb-NS Enterobacteriaceae per 100 hospital admissions increased between 2013 and 2017. MDR Enterobacteriaceae and MDR and Carb-NS Acinetobacter spp. isolates decreased over this period. These data support continuing infection control and stewardship efforts and the development of new therapeutic options.