Antimicrobial-Resistant Pathogens in Intensive Care Units in Canada: Results of the Canadian National Intensive Care Unit (CAN-ICU) Study, 2005-2006

Antimicrobial Agents and Chemotherapy - Tập 52 Số 4 - Trang 1430-1437 - 2008
George G. Zhanel1,2,3, Mel DeCorby1,2, Nancy M. Laing1,2, Barb Weshnoweski1, Ravi Vashisht1,2, Franil Tailor1, Kim Nichol1, Aleksandra Wierzbowski1,2, Patricia J. Baudry1,2, James A. Karlowsky1,2, Philippe Lagacé‐Wiens1,2, Andrew Walkty1,2, Melissa McCracken4, Michael R. Mulvey4, Jack Johnson5, Daryl J. Hoban1,2
1Clinical Microbiology, Health Sciences Centre, Winnipeg, Manitoba, Canada
2Department of Medical Microbiology, Faculty of Medicine, University of Manitoba
3Departments of Medicine
4Nosocomial Infections Branch, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
5International Health Management Associates, Chicago, Illinois

Tóm tắt

ABSTRACT Between 1 September 2005 and 30 June 2006, 19 medical centers collected 4,180 isolates recovered from clinical specimens from patients in intensive care units (ICUs) in Canada. The 4,180 isolates were collected from 2,292 respiratory specimens (54.8%), 738 blood specimens (17.7%), 581 wound/tissue specimens (13.9%), and 569 urinary specimens (13.6%). The 10 most common organisms isolated from 79.5% of all clinical specimens were methicillin-susceptible Staphylococcus aureus (MSSA) (16.4%), Escherichia coli (12.8%), Pseudomonas aeruginosa (10.0%), Haemophilus influenzae (7.9%), coagulase-negative staphylococci/ Staphylococcus epidermidis (6.5%), Enterococcus spp. (6.1%), Streptococcus pneumoniae (5.8%), Klebsiella pneumoniae (5.8%), methicillin-resistant Staphylococcus aureus (MRSA) (4.7%), and Enterobacter cloacae (3.9%). MRSA made up 22.3% (197/884) of all S. aureus isolates (90.9% of MRSA were health care-associated MRSA, and 9.1% were community-associated MRSA), while vancomycin-resistant enterococci (VRE) made up 6.7% (11/255) of all enterococcal isolates (88.2% of VRE had the vanA genotype). Extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae occurred in 3.5% (19/536) and 1.8% (4/224) of isolates, respectively. All 19 ESBL-producing E. coli isolates were PCR positive for CTX-M, with bla CTX-M-15 occurring in 74% (14/19) of isolates. For MRSA, no resistance against daptomycin, linezolid, tigecycline, and vancomycin was observed, while the resistance rates to other agents were as follows: clarithromycin, 89.9%; clindamycin, 76.1%; fluoroquinolones, 90.1 to 91.8%; and trimethoprim-sulfamethoxazole, 11.7%. For E. coli , no resistance to amikacin, meropenem, and tigecycline was observed, while resistance rates to other agents were as follows: cefazolin, 20.1%; cefepime, 0.7%; ceftriaxone, 3.7%; gentamicin, 3.0%; fluoroquinolones, 21.1%; piperacillin-tazobactam, 1.9%; and trimethoprim-sulfamethoxazole, 24.8%. Resistance rates for P. aeruginosa were as follows: amikacin, 2.6%; cefepime, 10.2%; gentamicin, 15.2%; fluoroquinolones, 23.8 to 25.5%; meropenem, 13.6%; and piperacillin-tazobactam, 9.3%. A multidrug-resistant (MDR) phenotype (resistance to three or more of the following drugs: cefepime, piperacillin-tazobactam, meropenem, amikacin or gentamicin, and ciprofloxacin) occurred frequently in P. aeruginosa (12.6%) but uncommonly in E. coli (0.2%), E. cloacae (0.6%), or K. pneumoniae (0%). In conclusion, S. aureus (MSSA and MRSA), E. coli , P. aeruginosa , H. influenzae , Enterococcus spp., S. pneumoniae , and K. pneumoniae are the most common isolates recovered from clinical specimens in Canadian ICUs. A MDR phenotype is common for P. aeruginosa isolates in Canadian ICUs.

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Tài liệu tham khảo

10.1053/ic.1999.v27.a98878

10.1093/jac/dkh391

10.1093/jac/dkm319

10.1056/NEJMe058023

10.1056/NEJM199907223410403

10.1128/JCM.02500-06

Performance standards for antimicrobial susceptibility testing: 16th informational supplement document M100-S16. 2006

Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically 7th ed. 2006

10.1016/j.diagmicrobio.2006.12.022

10.1128/AAC.45.6.1721-1729.2001

Esposito, S., and S. Leone. 2007. Antimicrobial treatment for intensive care unit (ICU) infections including the role of the infectious diseases specialist. Int. J. Antimicrob. Agents29:494-500.

Farr, B. 2006. What to think if the results of the National Institutes of Health randomized trial of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus control measures are negative (and other advice to young epidemiologists): a review and an au revoir. Infect. Control Hosp. Epidemiol.27:1096-1106.

10.1086/321893

10.1503/cmaj.051565

10.1086/507636

10.1177/003335490712200205

Levin, P. D., R. A. Fowler, C. Guest, W. J. Sibbald, A. Kiss, and A. E. Simor. 2007. Risk factors associated with resistance to ciprofloxacin in clinical bacterial isolates from intensive care unit patients. Infect. Control Hosp. Epidemiol.28:331-336.

10.1128/AAC.00576-07

10.1128/JCM.01284-07

10.1128/JCM.00756-06

10.1128/AAC.48.4.1204-1214.2004

10.1128/JCM.39.10.3481-3485.2001

10.3201/eid1106.041146

10.1128/AAC.46.7.2155-2161.2002

10.1093/jac/dki166

10.1128/AAC.01377-06

Rhomberg, P. R., T. R. Fritsche, H. S. Sader, and R. N. Jones. 2006. Antimicrobial susceptibility pattern comparisons among intensive care unit and general ward gram-negative isolates from meropenem yearly susceptibility test information collection program (USA). Diagn. Microbiol. Infect. Dis.56:57-62.

Rubinstein, E., and G. G. Zhanel. 2007. Anti-infectives research and development problems, challenges and solutions: the clinical practitioner perspective. Lancet Infect. Dis.7:69-70.

10.1093/jac/dkm318

10.1086/507960

10.1128/JCM.33.9.2233-2239.1995

10.1056/NEJM200012283432603

Ylipalosaari, P., T. I. Ala-Kokko, J. Laurila, P. Ohtonene, and H. Syrjala. 2006. Epidemiology of intensive care unit (ICU)-acquired infections in a 14 month prospective cohort study in a single mixed Scandinavian university hospital ICU. Acta Anaesthesiol. Scand.50:1192-1197.

10.1093/jac/dkg352

Can. J. Infect. Dis. Med. Microbiol.

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Antimicrobial Agents and Chemotherapy

Tập 52 Số 4

1430-1437

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