背景:眼部微生物抗生素耐药性监测研究是一项正在进行的监测研究,旨在追踪美国眼部感染细菌分离株的抗生素耐药性。我们报告了2009年至2016年的抗生素耐药率和趋势。
方法: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,来自各种眼部感染的流感嗜血杆菌来自参与的美国中心。将分离物送至中心实验室以测定抗生素抗性谱。根据临床和实验室标准研究所的十多种抗生素类药物,通过微量肉汤稀释确定最小抑制浓度。根据系统断点将分离株分为易感或抗性,无论哪里可用。还基于患者的十年寿命和在8年时间段内的纵向评估了耐药率。
结果:总共1,695金黄色葡萄球菌,1,475CoNS,474肺炎链球菌,586流感嗜血杆菌,从87个地点收集了599个铜绿假单胞菌。葡萄球菌和肺炎球菌的耐药性较高,在621株(36.6%)金黄色葡萄球菌和717株(48.6%)CoNS分离株中检测到甲氧西林耐药。在葡萄球菌中观察到多药耐药性(≥3种药物),尤其是耐甲氧西林(MR)分离株(MR金黄色葡萄球菌[MRSA]:76.2%;MRCoNS[MRCoNS]:73.5%).根据患者年龄观察到葡萄球菌之间甲氧西林耐药性的差异,在老年患者中观察到更高的发病率(P<0.0001)。对于某些生物-抗生素组合,随着时间的推移,阻力发生了显著的变化,包括金黄色葡萄球菌(但非CoNS)的甲氧西林耐药性下降;肺炎链球菌未观察到显著趋势.
结论:革兰氏阳性生物体中普遍存在抗生素耐药性,和MR葡萄球菌分离株更可能是多药耐药。尽管随着时间的推移,在金黄色葡萄球菌中观察到甲氧西林耐药性略有下降,在治疗眼部感染患者时,应考虑体外耐甲氧西林的持续高发.
BACKGROUND: The Antibiotic Resistance Monitoring in Ocular micRoorganisms
study is an ongoing surveillance
study that tracks antibiotic resistance among bacterial isolates from ocular infections across the United States. We report antibiotic resistance rates and trends from 2009 through 2016.
METHODS: Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae from various ocular infections were obtained from participating United States centers. Isolates were sent to a central laboratory for determination of antibiotic resistance profiles. Minimum inhibitory concentrations were determined by broth microdilution according to the Clinical and Laboratory Standards Institute for drugs from more than ten antibiotic classes, and isolates were classified as susceptible or resistant based on systemic breakpoints, wherever available. Resistance rates were also evaluated based on decade of patient life and longitudinally over the 8-year time period.
RESULTS: A total of 1,695 S. aureus, 1,475 CoNS, 474 S. pneumoniae, 586 H. influenzae, and 599 P. aeruginosa were collected from 87 sites. Resistance was high among staphylococci and pneumococci, with methicillin resistance detected in 621 (36.6%) S. aureus and 717 (48.6%) CoNS isolates. Multidrug resistance (≥3 drug classes) was observed among staphylococci, particularly in methicillin-resistant (MR) isolates (MR S. aureus [MRSA]: 76.2%; MR CoNS [MRCoNS]: 73.5%). Differences in methicillin resistance among staphylococci were observed based on patient age, with higher rates observed in older patients (P<0.0001). For certain organism-antibiotic combinations, there were significant changes in resistance over time, including a decrease in methicillin resistance among S. aureus (but not CoNS); no notable trends were observed for S. pneumoniae.
CONCLUSIONS: Antibiotic resistance was prevalent among gram-positive organisms, and MR staphylococcal isolates were more likely to be multidrug resistant. Although a small decrease in methicillin resistance was observed among S. aureus over time, the continued high prevalence of in vitro methicillin resistance should be considered when treating patients with ocular infections.