Abstract：
BACKGROUND: Institutions must have access to antibiograms to monitor changes in antimicrobial resistance and direct empirical antibiotic therapy. The first facility-specific cumulative antibiogram was launched in the ICU in 2019. Consequently, many antibiogram-operation-related actions have been adopted in the institution based on reported data. This study aimed to analyze the cumulative antibiogram reports for multiple intensive care units (ICUs) for 2020, and compare the antimicrobial susceptibility testing (AST) patterns between the 2019 and 2020 years in an academic medical center.
METHODS: This cross-sectional study was performed of routine bacterial culture and AST data extracted from a laboratory information system in a 2252-bed capacity hospital. Only the first diagnostic isolate of a given species per patient per year was included in the study. Interpretation and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines.
RESULTS: Of the 46,791 clinical isolates, the Gram-negative bacilli isolation rate witnessed a significant increase: 35,670 isolates in 2020 versus. 33,652 isolates in 2019. Klebsiella pneumoniae showed a statistically significant increase, mainly in pediatric, emergency, and cardiothoracic ICUs (p < 0.001). Neonatal and pediatric ICUs showed statistically significant increases in Pseudomonas aeruginosa and Proteus mirabilis isolates (p < 0.001). A statistically significant decrease was noted in the prevalence of Acinetobacter, Escherichia coli, Burkholderia cepacia, and Enterobacter cloacae. The sensitivities of K. pneumoniae and E. coli to imipenem and tigecycline significantly improved (p < 0.001). The sensitivity to colistin was significantly decreased (p < 0.001). The sensitivity of P. aeruginosa isolates to colistin and carbapenems was improved (p < 0.001). We reported a statistically significant decrease in all Gram-positive cocci (11,121 in 2020 versus. 11,528 in 2019). Staphylococcus aureus showed a statistically significant increase (p < 0.001), particularly in the medical ICU.
CONCLUSIONS: The high susceptibility rates of Enterobacteriaceae toward colistin and tigecycline, should be cautiously considered in empiric therapy while looking for alternatives. The majority of isolates of Gram-positive cocci were coagulase negative staphylococci (CONS), we still need to confirm whether they are true pathogens or commensals before considering anti-staphylococcal agents in the empirical therapy. We underscored some corrective actions that might have improved the susceptibility rates, such as antibiotic cycling.
METHODS: This cross-sectional study was performed of routine bacterial culture and AST data extracted from a laboratory information system in a 2252-bed capacity hospital. Only the first diagnostic isolate of a given species per patient per year was included in the study. Interpretation and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines.
RESULTS: Of the 46,791 clinical isolates, the Gram-negative bacilli isolation rate witnessed a significant increase: 35,670 isolates in 2020 versus. 33,652 isolates in 2019. Klebsiella pneumoniae showed a statistically significant increase, mainly in pediatric, emergency, and cardiothoracic ICUs (p < 0.001). Neonatal and pediatric ICUs showed statistically significant increases in Pseudomonas aeruginosa and Proteus mirabilis isolates (p < 0.001). A statistically significant decrease was noted in the prevalence of Acinetobacter, Escherichia coli, Burkholderia cepacia, and Enterobacter cloacae. The sensitivities of K. pneumoniae and E. coli to imipenem and tigecycline significantly improved (p < 0.001). The sensitivity to colistin was significantly decreased (p < 0.001). The sensitivity of P. aeruginosa isolates to colistin and carbapenems was improved (p < 0.001). We reported a statistically significant decrease in all Gram-positive cocci (11,121 in 2020 versus. 11,528 in 2019). Staphylococcus aureus showed a statistically significant increase (p < 0.001), particularly in the medical ICU.
CONCLUSIONS: The high susceptibility rates of Enterobacteriaceae toward colistin and tigecycline, should be cautiously considered in empiric therapy while looking for alternatives. The majority of isolates of Gram-positive cocci were coagulase negative staphylococci (CONS), we still need to confirm whether they are true pathogens or commensals before considering anti-staphylococcal agents in the empirical therapy. We underscored some corrective actions that might have improved the susceptibility rates, such as antibiotic cycling.
摘要：
背景：机构必须能够使用抗菌药物来监测抗菌素耐药性的变化并直接进行经验性抗生素治疗。第一个特定于设施的累积抗菌谱于2019年在ICU启动。因此,根据报告的数据，该机构已采取了许多与抗菌操作相关的措施。这项研究旨在分析2020年多个重症监护病房（ICU）的累积抗菌谱报告，并比较学术医学中心2019年至2020年之间的抗菌药物敏感性测试（AST）模式。
方法：这项横断面研究是对从2252张病床的医院的实验室信息系统中提取的常规细菌培养和AST数据进行的。该研究仅包括每个患者每年给定物种的第一个诊断分离株。根据适用的临床和实验室标准研究所和欧洲抗菌药物敏感性测试委员会指南进行解释和报告。
结果：在46,791个临床分离株中，革兰氏阴性杆菌分离率显着增加：2020年为35,670株。2019年33,652个分离株。肺炎克雷伯菌呈统计学显著增加，主要是儿科，紧急情况,和心胸ICU（p<0.001）。新生儿和儿科ICU显示铜绿假单胞菌和奇异变形杆菌分离株的统计学显著增加(p<0.001)。不动杆菌的患病率有统计学意义的下降，大肠杆菌,洋葱伯克霍尔德菌,阴沟肠杆菌.肺炎克雷伯菌和大肠杆菌对亚胺培南和替加环素的敏感性显著提高(p<0.001)。对粘菌素的敏感性显著降低(p<0.001)。铜绿假单胞菌对粘菌素和碳青霉烯类抗生素的敏感性提高(p<0.001)。我们报告了所有革兰氏阳性球菌的统计学显着下降（2020年为11,121与。2019年11,528）。金黄色葡萄球菌呈统计学显著上升(p<0.001),特别是在医疗重症监护室。
结论：肠杆菌科细菌对粘菌素和替加环素的敏感性较高，在寻找替代方案时，应谨慎考虑经验性治疗。革兰氏阳性球菌的大多数分离物是凝固酶阴性葡萄球菌(CONS),在经验性治疗中考虑使用抗葡萄球菌药物之前,我们仍需要确认它们是真正的病原体还是共生.我们强调了一些可能提高易感性的纠正措施，比如抗生素循环。
方法：这项横断面研究是对从2252张病床的医院的实验室信息系统中提取的常规细菌培养和AST数据进行的。该研究仅包括每个患者每年给定物种的第一个诊断分离株。根据适用的临床和实验室标准研究所和欧洲抗菌药物敏感性测试委员会指南进行解释和报告。
结果：在46,791个临床分离株中，革兰氏阴性杆菌分离率显着增加：2020年为35,670株。2019年33,652个分离株。肺炎克雷伯菌呈统计学显著增加，主要是儿科，紧急情况,和心胸ICU（p<0.001）。新生儿和儿科ICU显示铜绿假单胞菌和奇异变形杆菌分离株的统计学显著增加(p<0.001)。不动杆菌的患病率有统计学意义的下降，大肠杆菌,洋葱伯克霍尔德菌,阴沟肠杆菌.肺炎克雷伯菌和大肠杆菌对亚胺培南和替加环素的敏感性显著提高(p<0.001)。对粘菌素的敏感性显著降低(p<0.001)。铜绿假单胞菌对粘菌素和碳青霉烯类抗生素的敏感性提高(p<0.001)。我们报告了所有革兰氏阳性球菌的统计学显着下降（2020年为11,121与。2019年11,528）。金黄色葡萄球菌呈统计学显著上升(p<0.001),特别是在医疗重症监护室。
结论：肠杆菌科细菌对粘菌素和替加环素的敏感性较高，在寻找替代方案时，应谨慎考虑经验性治疗。革兰氏阳性球菌的大多数分离物是凝固酶阴性葡萄球菌(CONS),在经验性治疗中考虑使用抗葡萄球菌药物之前,我们仍需要确认它们是真正的病原体还是共生.我们强调了一些可能提高易感性的纠正措施，比如抗生素循环。
