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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Clinical Blood Isolates from Hemodialysis Patients: Distribution of Organisms and Antimicrobial Resistance, 2007-2014
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Clinical Blood Isolates from Hemodialysis Patients: Distribution of Organisms and Antimicrobial Resistance, 2007-2014

机译：血液透析患者的临床血液分离物：生物分布和抗菌性抗性，2007-2014

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Background: Given the morbidity and mortality associated with bloodstream infections in hemodialysis patients, understanding the microbiology is essential to optimizing treatment in this high-risk population. Objectives: To conduct a retrospective surveillance study of clinical blood isolates from adult hemodialysis patients, and to predict the microbiological coverage of empiric therapies for bloodstream infections in this population. Methods: Clinical blood isolate data were collected from the 4 main outpatient hemodialysis units in Winnipeg, Manitoba, from 2007 to 2014. The distribution of organisms and antimicrobial susceptibilities were characterized. When appropriate, changes over time were tested using time series analysis. Study data were used to predict and compare the microbiological coverage of various empiric therapies for bloodstream infections in hemodialysis patients. Results: The estimated annual number of patients receiving chronic hemodialysis increased steadily over the study period (p < 0.001), whereas the number of blood isolates increased initially, then decreased significantly, from 180 in 2011 to 93 in 2014 (p = 0.04). Gram-positive bacteria represented 72.6% (743/1024) of isolates, including Staphylococcus aureus (36.9%, 378/1024) and coagulase-negative staphylococci (23.1%, 237/1024). Only 26.1% (267/1024) of the isolates were gram-negative bacteria, the majority Enterobacteriaceae. The overall rate of methidllin resistance in S. aureus was 17.5%, and although annual rates were variable, there was a significant increase overtime (p = 0.04). Antibiotic resistance in gram-negative bacteria was relatively low, except in Escherichia coli, where 13.5% and 16.2% of isolates were resistant to ceftriaxone and ciprofloxacin, respectively. Empiric therapy with vancomycin plus an agent for gram-negative coverage was predicted to cover 98.8% to 99.7% of blood isolates from hemodialysis patients, whereas cefazolin plus an agent for gram-negative coverage would cover only 67.5% to 68.4%. Conclusions: In an era of increasing antimicrobial resistance, data such as these and ongoing surveillance are essential components of antimicrobial stewardship in the hemodialysis population.
机译：背景：鉴于血液透析患者血液感染的发病率和死亡率，了解微生物学对于优化高危人群的治疗至关重要。目的：对成人血液透析患者临床分离的血液进行回顾性监测研究，并预测该人群血液感染经验性治疗的微生物覆盖率。方法：收集2007年至2014年马尼托巴省温尼伯市4家主要门诊血液透析单位的临床血液分离数据。对微生物的分布和抗菌敏感性进行了表征。适当时，使用时间序列分析测试随时间的变化。研究数据用于预测和比较血液透析患者血液感染各种经验性治疗的微生物覆盖率。结果：在研究期间，接受慢性血液透析患者的估计年数量稳步增加（p<0.001），而血液分离物的数量最初增加，然后显著减少，从2011年的180例增加到2014年的93例（p=0.04）。革兰阳性菌占72.6%（743/1024），包括金黄色葡萄球菌（36.9%，378/1024）和凝固酶阴性葡萄球菌（23.1%，237/1024）。革兰阴性菌仅占26.1%（267/1024），以肠杆菌科为主。金黄色葡萄球菌对甲氧地林的总耐药率为17.5%，尽管年耐药率各不相同，但随着时间的推移，耐药率显著增加（p=0.04）。革兰氏阴性菌的耐药性相对较低，但大肠杆菌除外，其中13.5%和16.2%的分离株对头孢曲松和环丙沙星耐药。万古霉素加革兰氏阴性覆盖剂的经验性治疗预计可覆盖血液透析患者血液分离物的98.8%至99.7%，而头孢唑林加革兰氏阴性覆盖剂仅覆盖67.5%至68.4%。结论：在抗生素耐药性增加的时代，这些数据和持续监测是血液透析人群抗菌药物管理的重要组成部分。

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