目标:细菌感染,尤其是菌血症,尿路感染(UTI),和脓液感染,仍然是医院中最令人担忧的医疗问题。本研究旨在探索细菌多样性,感染动力学,和细菌分离株的抗生素抗性概况。
方法:我们分析了1750名门诊患者和920名住院患者的数据,其中1.6%和8.47%分别有各种细菌感染。
结果:分析显示,尿路感染最普遍,为41.01%,尤其影响女性。UTI还显示出不同的招生部门分布,特别是在急诊(23.07%)和儿科(14.10%)单位。最常见的分离微生物是大肠杆菌(E.大肠杆菌),其次是溶血克雷伯菌。UTI后出现皮肤感染,占病例的35.88%,在男性中更普遍,金黄色葡萄球菌(S.金黄色葡萄球菌)是主要病原体(57%)。革兰氏阴性菌(GNB)如大肠杆菌和铜绿假单胞菌对皮肤感染有显著贡献(43%)。菌血症病例占细菌感染的11.52%,主要影响女性(67%),与GNB相关(78%)。对抗生素敏感性的比较研究显示,从住院患者中分离出的GNB菌株具有更明显的耐药性,特别是抗生素,如阿莫西林/克拉维酸,四环素,庆大霉素,氯霉素,还有氨苄青霉素.相比之下,来自非卧床患者的菌株对粘菌素表现出更大的抵抗力。住院患者的革兰阳性菌对喹诺酮类和头孢菌素类具有较高的耐药性,而门诊菌株对氨基糖苷类抗生素表现出很高的耐药性,大环内酯类,氟喹诺酮类药物,还有青霉素.此外,这些分析确定了对社区获得性感染和医院感染的经验治疗最有效的抗生素.环丙沙星,氨曲南,阿米卡星在GNB中表现出较低的耐药率,庆大霉素和氯霉素对社区获得性菌株特别有效。对于金黄色葡萄球菌,环丙沙星,利福平,头孢西丁特别有效,万古霉素对社区获得性分离株显示出高疗效,磷霉素和氯霉素对医院获得性菌株有效。
结论:这些结果对于指导抗生素治疗和改善临床结局至关重要。从而有助于精准医疗和抗菌药物管理工作。
OBJECTIVE: Bacterial infections, particularly bacteremia, urinary tract infections (UTIs), and pus infections, remain among hospitals\' most worrying medical problems. This study aimed to explore bacterial diversity, infection dynamics, and antibiotic resistance profiles of bacterial isolates.
METHODS: We analyzed data from 1750 outpatients and 920 inpatients, of whom 1.6% and 8.47% respectively had various bacterial infections.
RESULTS: The analysis revealed that UTIs were the most prevalent at 41.01%, particularly affecting women. UTIs also showed a distinct distribution across admission departments, notably in emergency (23.07%) and pediatric (14.10%) units. The most frequently isolated microorganisms were Escherichia coli (E. coli), followed by Klebsiella ornithinolytica. Skin infections followed UTIs, accounting for 35.88% of cases, more prevalent in men, with Staphylococcus aureus (S. aureus) being the primary pathogen (57%). Gram-negative bacteria (GNB) like E. coli and Pseudomonas aeruginosa contributed significantly to skin infections (43%). Bacteremia cases constituted 11.52% of bacterial infections, predominantly affecting women (67%) and linked to GNB (78%). A comparative study of antibiotic susceptibility profiles revealed more pronounced resistance in GNB strains isolated from inpatients, particularly to antibiotics such as Amoxicillin/clavulanic acid, Tetracyclin, Gentamicin, Chloramphenicol, and Ampicillin. In contrast, strains from ambulatory patients showed greater resistance to Colistin. Gram-positive bacteria from hospitalized patients showed higher resistance to quinolones and cephalosporins, while ambulatory strains showed high resistance to aminoglycosides, macrolides, fluoroquinolones, and penicillin. Furthermore, these analyses identified the most effective antibiotics for the empirical treatment of both community-acquired and nosocomial infections. Ciprofloxacin, aztreonam, and amikacin exhibited low resistance rates among GNB, with gentamicin and chloramphenicol being particularly effective for community-acquired strains. For S. aureus, ciprofloxacin, rifampicin, and cefoxitin were especially effective, with vancomycin showing high efficacy against community-acquired isolates and fosfomycin and chloramphenicol being effective for hospital-acquired strains.
CONCLUSIONS: These results are essential for guiding antibiotic therapy and improving clinical outcomes, thus contributing to precision medicine and antimicrobial stewardship efforts.