Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018
Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018
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DOI：
10.1001/jamaophthalmol.2020.0155
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发表时间：
2020-05-01
影响因子：
8.1
通讯作者：
DeCory, Heleen H.
中科院分区：
文献类型：
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作者：
Asbell, Penny A.;Sanfilippo, Christine M.;DeCory, Heleen H.
重要性眼部感染的抗生素耐药性会影响治疗结果。关于不断演变的抗菌药物敏感性模式的监测数据为此类感染的治疗提供信息。目的了解10年来眼部细菌分离株的耐药性及其变化趋势。设计、设置和参与者这项横断面研究的纵向数据来自正在进行的全国性、前瞻性、以实验室为基础的监测研究，眼微生物抗生素耐药性监测（ARMOR）研究，包括临床相关的金黄色葡萄球菌、凝固酶阴性葡萄球菌（CoNS）、肺炎链球菌、铜绿假单胞菌、和从2009年1月1日至2018年12月31日在美国中心的眼部感染患者中培养的流感嗜血杆菌。主要结果和措施最低抑菌浓度确定了各种组合的抗生素和物种。确定并发抗生素耐药的比值比（OR）;方差分析和卡方检验用于评估患者年龄和地理区域的耐药率; Cochran-Armitage检验确定了随时间变化的抗生素敏感性趋势。结果来自6091例患者的6091株分离株（2189株金黄色葡萄球菌、1765株CoNS、590株肺炎链球菌、767株铜绿假单胞菌和780株流感嗜血杆菌）由88个研究中心提交。总体而言，765例金黄色葡萄球菌（34.9%）和871例CoNS（49.3%）的分离株对甲氧西林耐药，更可能同时对大环内酯类耐药（阿奇霉素：金黄色葡萄球菌：OR，18.34 [95% CI，13.64-24.67]; CoNS：OR，4.59 [95% CI，3.72-5.66]），氟喹诺酮类（环丙沙星：金黄色葡萄球菌：OR，22.61 [95% CI，17.96-28.47]; CoNS：OR，9.73 [95% CI，7.63-12.40]），氨基糖苷类（妥布霉素：金黄色葡萄球菌：OR，18.29 [95% CI，13.21-25.32]; CoNS：OR，6.28 [95% CI，4.61-8.56]）与甲氧西林敏感分离株相比（所有菌株P <0.001）。在耐甲氧西林金黄色葡萄球菌（577 [75.4%]）和CoNS（642 [73.7%]）分离株中观察到多重耐药。肺炎链球菌分离株对阿奇霉素的耐药性最高（214 [36.3%]），而铜绿假单胞菌和流感嗜血杆菌分离株总体耐药性较低。不同患者年龄的分离株对抗生素的耐药性存在差异（金黄色葡萄球菌：F = 28.07，P < .001; CoNS：F = 11.46，P < .001）和地理区域（金黄色葡萄球菌：F = 8.03，P < .001; CoNS：F = 4.79，P = .003;肺炎链球菌：F = 8.14，P < .001;铜绿假单胞菌：F = 4.32，P = .005）。随着时间的推移，抗生素耐药性发生了微小的变化（
Importance Antibiotic resistance in ocular infections can affect treatment outcomes. Surveillance data on evolving antibacterial susceptibility patterns inform the treatment of such infections. Objective To assess overall antibiotic resistance profiles and trends among bacterial isolates from ocular sources collected during 10 years. Design, Setting, and Participants This cross-sectional study of longitudinal data from the ongoing, nationwide, prospective, laboratory-based surveillance study, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study, included clinically relevant isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae cultured from patients with ocular infections at US centers from January 1, 2009, to December 31, 2018. Main Outcomes and Measures Minimum inhibitory concentrations were determined for various combinations of antibiotics and species. Odds ratios (ORs) were determined for concurrent antibiotic resistance; analysis of variance and chi(2) tests were used to evaluate resistance rates by patient age and geographic region; Cochran-Armitage tests identified changing antibiotic susceptibility trends over time. Results A total of 6091 isolates (2189 S aureus, 1765 CoNS, 590 S pneumoniae, 767 P aeruginosa, and 780 H influenzae) from 6091 patients were submitted by 88 sites. Overall, 765 S aureus (34.9%) and 871 CoNS (49.3%) isolates were methicillin resistant and more likely to be concurrently resistant to macrolides (azithromycin: S aureus: OR, 18.34 [95% CI, 13.64-24.67]; CoNS: OR, 4.59 [95% CI, 3.72-5.66]), fluoroquinolones (ciprofloxacin: S aureus: OR, 22.61 [95% CI, 17.96-28.47]; CoNS: OR, 9.73 [95% CI, 7.63-12.40]), and aminoglycosides (tobramycin: S aureus: OR, 18.29 [95% CI, 13.21-25.32]; CoNS: OR, 6.28 [95% CI, 4.61-8.56]) compared with methicillin-susceptible isolates (P < .001 for all). Multidrug resistance was observed among methicillin-resistant S aureus (577 [75.4%]) and CoNS (642 [73.7%]) isolates. Antibiotic resistance among S pneumoniae isolates was highest for azithromycin (214 [36.3%]), whereas P aeruginosa and H influenzae isolates showed low resistance overall. Differences in antibiotic resistance were found among isolates by patient age (S aureus: F = 28.07, P < .001; CoNS: F = 11.46, P < .001) and geographic region (S aureus: F = 8.03, P < .001; CoNS: F = 4.79, P = .003; S pneumoniae: F = 8.14, P < .001; P aeruginosa: F = 4.32, P = .005). Small changes in antibiotic resistance were noted over time (