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Background : Measuring antimicrobial consumption is necessary to understand the volume and patterns of use, to design appropriate interventions to reduce and rationalize its use. Materials and Methods : The antimicrobial consumption in Neurology ICU and IPD were measured over a 5-year period using WHO Defined Daily Dose (DDD) methodology. Results : There was an increasing trend in Antimicrobial Consumption (AMC) from 125.7 to 155.5 DDDs/100 days over 5 years with highest consumption in 2017-2018 (190.7 DDDs). The consumption of Watch group of antibiotics was higher than access group antibiotics both in ICU and IPD and constituted more than 75% of total antibiotic consumption. Conclusions : The initiation of empiric therapy though may be necessary depending on the patients condition, however, duration of antibiotic therapy and reducing usage of prophylactic antibiotics for aspiration pneumonia and reducing consumption of Watch group of antibiotics were identified as stewardship opportunities. Feedback on AMC data and persuasive educational interventions to rationalize and reduce antimicrobial use are required.
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Introduction: We investigated the feasibility and validity of developing a system to monitor prescriptions prescribed by physicians for the promotion of appropriate antimicrobial use in clinics.Methods: The names of injuries and diseases and prescribed drugs stored in the receipt computers of six clinics were output and anonymized. Antimicrobial prescriptions for acute respiratory tract infections and acute diarrhea were compiled and evaluated.Results: Anonymized data were available for all six clinics. We were able to extract data and aggregate prescriptions by linking the name of the injuries and diseases to the prescribed drug.Conclusions: We consider it possible to establish antimicrobial stewardship in clinics through antimicrobial prescription monitoring and to develop such a system. On the other hand, there are multiple ways of naming injuries and diseases, and further investigation is needed to define the names of injuries and diseases to be extracted.
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Objective To understand the current status of healthcare-associated infections (HAI) among inpatients in medical institutions of Wuhan, and to provide a scientific basis for improving the management of healthcare-associated infections. Methods A combined method of bedside investigation and case review of the patients’ medical records were used to investigate all hospitalized patients in 31 hospitals. Results A total of 42 429 inpatients were investigated, of whom 938 had HAI (2.21%), and 7 561 had community-associated infection (CAI, 17.82%). The top three departments with the highest prevalence rate of HAI were ICU (17.95%), hematology (8.49%), and neurosurgery (6.57%), while the top three departments with the highest prevalence rate of CAI were burns (75.00%), pediatric non-neonatal group (70.26%) and respiratory department (67.53%). Both healthcare-associated infections and community infections were mainly in the lower respiratory tract, which accounted for 47.33% and 53.00%, respectively. The main pathogens of both HAI and CAI were Gram-negative bacteria, which accounted for 65.03% and 57.73%, respectively. The use rate of antimicrobial drugs was 31.74%, and the detection rate of pathogenic bacteria before antimicrobial treatment was 55.77%. The three departments with the highest rates of the use of antibacterial drugs were the pediatric non-neonatal group (78.20%), the department of burns (75.00%) and the department of urology (73.24%). Conclusion ICU, hematology department, and neurosurgery department were high-risk departments for healthcare-associated infections. Pediatrics, burns, and urology departments were the departments with high use of antibacterial drugs. The pathogenic bacterial detection rate has declined, which needs to be strengthened.
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ABSTRACT Introduction: Use of antibiotic and bacterial resistance is the result of a complex interaction not completely understood. Objectives: To evaluate the impact of entire antimicrobial use (community plus hospitals) on the incidence of bloodstream infections in intensive care units adjusted by socioeconomic factors, quality of healthcare, and access to the healthcare system. Design: Ecologic study using a hierarchical spatial model. Setting: Data obtained from 309 hospitals located in the state of São Paulo, Brazil from 2008 to 2011. Participants: Intensive care units located at participant hospitals. Outcome: Hospital acquired bloodstream infection caused by MDRO in ICU patients was our primary outcome and data were retrieved from São Paulo Health State Department. Socioeconomic and healthcare indexes data were obtained from IBGE (Brazilian Foundation in charge of national decennial census) and SEADE (São Paulo Planning and Development Department). Information on antimicrobial sales were obtained from IMS Brazil. We divided antibiotics into four different groups (1-4). Results: We observed a direct association between the use of group 1 of antibiotics and the incidences of bloodstream infections caused by MRSA (1.12; 1.04-1.20), and CR-Acinetobacter sp. (1.19; 1.10-1.29). Groups 2 and 4 were directly associated to VRE (1.72; 1.13-2.39 and 2.22; 1.62-2.98, respectively). Group 2 was inversely associated to MRSA (0.87; 0.78-0.96) and CR-Acinetobacter sp. (0.79; 0.62-0.97). Group 3 was inversely associated to Pseudomonas aeruginosa (0.69; 0.45-0.98), MRSA (0.85; 0.72-0.97) and VRE (0.48; 0.21-0.84). No association was observed for third generation cephalosporin-resistant Klebsiella pneumoniae and Escherichia coli. Conclusions: The association between entire antibiotic use and resistance in ICU was poor and not consistent for all combinations of antimicrobial groups and pathogens even after adjusted by socioeconomic indexes. Selective pressure exerted at the community level seemed not to affect the incidences of MDRO infection observed in intensive care setting.
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Humans , Cross Infection , Anti-Bacterial Agents , Brazil/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Drug Resistance, Bacterial , Hospitals , Intensive Care Units , Anti-Bacterial Agents/pharmacologyABSTRACT
Objective To analyze the correlation between antimicrobial use density (AUD) and change in antimicrobial resistance rate of Stenotrophomonas maltophilia (SM), and explore the influencing factors of antimicrobial resistance of SM. Methods Antimicrobial resistance rate of SM and AUD of commonly used antimicrobial agents in patients in a hospital from 2012 to 2017 were summarized, correlation was analyzed with Pearson correlation method. Results A total of 23 994 strains of gram-negative bacteria were isolated, of which 1 331 strains (5.55％) were SM, mainly from sputum (54.02％) and distributed in intensive care unit (21.49％). Resistance rates of SM to ceftazidime, levofloxacin, and compound sulfamethoxazole were 21.79％, 7.66％, and 13.37％ respectively, resistance rates to levofloxacin showed an increasing trend year by year (P＜0.05). Resistance rate of SM to levofloxacin was positively correlated with the use intensity of β-lactamase inhibitors, carbapenems, fluoroquinolones, and oxazolidinones (all P＜0.05); resistance rate to compound sulfamethoxazole was positively correlated with the use intensity of macrolides (P＜0.05).Conclusion Change in resistance rates of SM to levofloxacin and compound sulfamethoxazole are positively correlated with the use intensity of some commonly used antimicrobial agents, reducing AUD is beneficial to the control and reducing of the resistance of SM.
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Objective To understand clinical distribution and antimicrobial resistance characteristics of Pseudomonas aeruginosa(P.aeruginosa)isolated from hospitalized patients, so as to provide reference for the empiric use of antimicrobial agents and control of healthcare-associated infection(HAI).Methods Clinical distribution and antimicrobial susceptibility testing results of P.aeruginosaisolated from patients in a hospital between 2012 and 2016 were analyzed retrospectively, statistical analysis were conducted based on different wards, specimen types and age groups.Results A total of 2 432 strains of P.aeruginosa were isolated from2012 to 2016, most of which were isolated from intensive care unit(ICU)(n=727, 29.89％), the main specimen was sputum(n=2 064, 84.87％). Resistance rates of P.aeruginosa to other antimicrobial agents except piperacillin/tazobactam in each year from 2012 to 2016 were significantly different(all P＜0.05).Resistance to piperacillin, ceftazidime, cefepime, imipenem, meropenem, levofloxacin, and ciprofloxacin decreased after peaked in2014;resistance rates to amikacin, gentamicin, and tobramycin were all low, showing decreased trend year by year(all P＜0.05).Except resistance rates to cefepime and tobramycin, resistance rates of P.aeruginosafrom sputum specimen were all higher than other specimens(all P＜0.05).Resistance rates of P.aeruginosaisolated from patients aged≥65 years to most antimicrobial agents were significantly higher than those isolated from patients aged＜65 years(all P＜0.05).Except resistance rates to gentamicin and tobramycin, resistance rates of P.aeruginosaisolated from ICU were higher than those isolated from other departments, which were 7.71％-66.02％.Resistance rate of P.aeruginosaisolated from department of surgery were relatively low, which were 1.69％-11.86％.Conclusion Clinical distribution of antimicrobial resistance of P.aeruginosais obviously heterogeneity, empiric antimicrobial use and formulation of HAI monitoring measures should be based on the data of antimicrobial resistance in different wards, different infection sites, and different age.
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Objective To investigate antimicrobial resistance of Escherichia coli (E.coli)and Klebsiella pneumoniae (K.pneumoniae),antimicrobial use density(AUD),as well as relation between antimicrobial resistance and AUD in a ter-tiary first-class hospital.Methods Antimicrobial resistance rates of clinically-isolated E.coli and K.pneumoniae,AUD of carbapenems and quinolones,as well as relation between resistance and AUD in 2013-2015 were statistically analyzed. Results Correlation analysis of antimicrobial resistance of bacteria and AUD showed that the decrease in resistance rate of E.coli to levofloxacin was related to the decrease in the use density of quinolones(r=0.61,P=0.03);increase in resist-ance rate of K.pneumoniae to imipenem was related to the increase in the use density of carbapenems(r=0.78,P<0.01). Conclusion Antimicrobial use is one of the causes of bacterial resistance,management on antimicrobial use needs to be strengthened to reduce the threat of bacterial resistance to human health.
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Objective To survey the clinical application of glycopeptide antibiotics in hospitalized patients, and evaluate the rationality of drug use, so as to provide reference for rational clinical drug use.Methods A retrospective study was conducted to investigate the application of glycopeptide antibiotics among inpatients in a hospital from January to December in 2014, relevant clinical data were recorded.Results A total of 727 cases were included , 471 (64.79%) of which were infected cases.Respiratory tract infection was the main site of both healthcare-associated infection and community-associated infection (39.17% and 45.98%, respectively).The average days of glycopeptide antibiotic use were 6.06 day (4 403/727).Patients who used glycopeptide antibiotics were mainly from intensive care unit, department of oncology, and department of neurosurgery, accounting for 20.36%(n=148) , 12.10%(n=88), and 11.14%(n=81) respectively.Glycopeptide was used in 338 patients(46.49%),the average types of combined use was 4.43, triple and above was used in 99 patients(13.62%),combination of the second generation cephalosporins was the highest(20.48%).450(61.90%) patients used vancomycin, 260(35.76%)used teicoplanin,17(2.34%)used both vancomycin and teicoplanin.A total of 847 pathogenic strains were isolated, the major were Acinetobacter baumannii (n=111, 13.10%), Klebsiella pneumoniae (n=80, 9.45%), Pseudomonas aeruginosa (n=68, 8.03%), and Staphylococcus aureus (n=54 , 6.37%), methicillin-resistant Staphylococcus aureus was 50 strains.490 (67.40%) patients treated with glycopeptide antibiotics were effective.Of 727 patients, 86 (11.83%) used antibiotics rationally, 315(43.33%) basically rational,and 326 (44.84%) irrationally.Conclusion Application of glycopeptide antibiotics in this hospital is basically rational, but indications should be paid attention.
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Objective To explore clinical features and antimicrobial resistance of Klebsiella pneumoniae (K.pneumoniae) lower respiratory tract infection(LRTI) in children.Methods Clinical data of 107 children with K.pneumoniae LRTI confirmed by sputum culture from January to December 2015 were analyzed retrospectively.Results 62.62% of children with LRTI were aged less than 6 months and 64.49% episodes occurred in autumn and winter.All cases had cough and 39 had fever, the main complications were type I respiratory failure, type Ⅱ respiratory failure, cardiac insufficiency, and electrolyte disturbance, 39 cases(36.45%) had complications involving two systems, 5 cases(4.67%)had complications involving three systems,47 cases (43.93%) met the diagnostic criteria of severe pneumonia.43 cases (40.19%) had primary underlying diseases, the major were congenital heart disease, preterm and low birth weight, and malnutrition.Children with imipenem-resistant bacteria infection were more prone to develop extrapulmonary complications than those with non-resistant pathogenic infection.The resistance rate of K.pneumoniae to amikacin was the lowest(9.35%).90 cases were recovered and markedly effective, 11 cases were effective, 4 cases were not healed and voluntarily discharged from hospital, and 2 cases died.Conclusion Children aged less than 6 months and with underlying diseases are prone to develop LRTI, and complications are more.
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Objective To investigate the distribution and antimicrobial susceptibility of pathogens causing maxillofacial infection in patients,and provide evidence for rational use of antimicrobial agents in clinical practice.Methods Specimens of patients infected with oral and maxillofacial infection in a hospital between January 2012 and December 2016 were performed microbial culture,pathogens were identified and performed antimicrobial susceptibility testing,distribution of pathogens and antimicrobial resistance were analyzed.Results Of 882 patients with maxillofacial infection,male and female accounted for 32.20％ and 67.80％ respectively;35.38％ and 32.65％ of patients aged ～40 years and ～60 years respectively;a total of 145 strains were isolated,88(60.69 ％) of which were gram-negative bacteria,mainly Klebsiella pneumoniae and Pseudomonas aeruginosa;56 (38.62 ％) of which were gram-positive bacteria,mainly Staphylococcus aureus.Resistance rates of Klebsiella pneumoniae to 16 kinds of an timicrobial agents were a11＜50％,resistance rates to imipenem and meropenem were the lowest,both were 3.45％,1 1 strains were extended-spectrum β-lactamases-producing strains;resistance rates of Pseudomonas aeruginosa to 10 kinds of antimicrobial agents were all＜40％.Staphylococcus aureus was susceptible to tigecycline,linezolid,and vancomycin,resistance rate to penicillin was the highest (66.67％),resistance rate to oxacillin was 20.83％.Conclusion The main pathogens causing oral and maxillofacial infection are gram negative bacteria,different pathogens have different antimicrobial resistance,antimicrobial agents should be used rationally during clinical treatment according to antimicrobial susceptibility testing result.
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Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture of children in a pediatric intensive care unit (PICU),provide reference for empirical treatment of bloodstream infection in critically ill children.Methods Pathogenic bacteria isolated from blood culture of children in a PICU in 2011-2015 were identified and performed antimicrobial susceptibility testing.Results A total of 180 strains of pathogens were isolated from 3 215 blood specimens,the positive rate was 5.60 ％,153 (85.00 ％) of which were grampositive bacteria and 27 (15.00 ％) were gram-negative bacteria.The top five isolated pathogens were Staphylococcus epidermidis (26.67 ％),Staphylococcus hominis (25.00 ％),Staphylococcus haemolyticus (11.66 ％),Escherichia coli (5.55 ％),and Staphylococcus aureus (3.89 ％).The resistance rates of Staphylococcus spp.to linezolid,vancomycin,and quinupristin/dalfopristin were all 0;the detection rates of methicillin-resistant coagulase-negative staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus(MRSA) were 70.18％ and 42.68％ respectively;Escherichia coli had high resistance rates to ampicillin,cefazolin,ceftriaxone,gentamycin,and compound sulfamethoxazole (50.00 ％-80.00 ％).Conclusion CNS and Escherichia coli are the main pathogens in blood culture of children in PICU,differences in antimicrobial resistance exist among different types of CNS.
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Objective To investigate the change in distribution and antimicrobial resistance of Acinetobacter baumannii (AB) in an intensive care unit(ICU),and provide basis for rational use of antimicrobial agents in the clinical practice.Methods Using retrospective investigation study,data about pathogenic bacteria isolated from patients who were hospitalized in ICU in 2010-2014 were collected,distribution and antimicrobial resistance of AB were statistically analyzed.Results A total of 3 807 bacterial strains were isolated from ICU patients in 2010-2014,488 (12.82％) of which were AB,isolation rate increased from 6.94％ in 2010 to 17.33％ in 2014 (x2 =45.58,P＜0.01).AB was mainly isolated from sputum,accounting for 72.13％,followed by wound secretion,blood,catheter,urine and so on;AB had the lowest resistance rate to amikacin(＜30 ％),resistance rates to imipenem and meropenem increased significantly year by year (value of trend x2 test were 42.99 and 53.91 respectively,both P＜0.001);resistance rates of AB to other antimicrobial agents were all＞50％.Conclusion Detection rate and antimicrobial resistance rate of AB increased year by year,clinical surveillance on bacterial resistance should be paid more attention,patients should be isolated by effective measures,so as to control and prevent the prevalence of AB in ICU.
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Objective To investigate the change in antimicrobial susceptibility of Enterococcus faecalis (E.faecalis) and Enterococcus faecium (E.faecium) isolated from clinical urine specimens, so as to provide laboratory evidence for clinical anti-infective treatment.Methods Antimicrobial susceptibility of E.faecalis and E.faecium isolated from urine specimens from 20 tertiary hosptials in China between 2004 and 2014 were analyzed, drug-resistant genes of vancomycin-resistant Enterococcus(VRE)were detected with polymerase chain reaction (PCR).Results A total of 788 Enterococcus strains were isolated in 2004-2014, 371 strains were E.faecalis strains, 417 were E.faecium strains.Susceptibility rates of E.faecalis to ampicillin, nitrofurantoin, fosfomycin, vancomycin, and teicoplanin were all>90%, susceptibility rates to rifampin, minocycline, and erythromycin were all<20%, there was significant difference in the susceptibility rate of E.faecalis to fosfomycin betwen July 2011-June 2012 and July 2009-June 2010(P<0.0167).Susceptibility rates of E.faecium to vancomycin and teicoplanin were 96.9% and 97.4% respectively, susceptibility rates to nitrofurantoin, minocycline, and fosfomycin were 41.7%, 51.8%, and 78.2% respectively, susceptibility rates to ampicillin, levofloxacin, rifampicin, and erythromycin were all<10%;susceptibility rates of E.faecium to nitrofurantoin had decreased tendency in different years (any two group comparison, all P<0.0167), susceptibility rates to fosfomycin in July 2011-June 2012 and July 2013-June 2014 both decreased compared with July 2009-June 2010(both P<0.0167),there were no significant changes in antimicrobial usceptibility rates in different years.14 strains of VRE all carried vanA resistance gene.Conclusion E.faecalis strains isolated from urine are susceptible to ampicillin, nitrofurantoin, and fosfomycin, E.faecium are not susceptible to most antimicrobial agents;E.faecalis and E.faecium are both susceptible to vancomycin and teicoplanin, only a few strains are resistant to antimicrobial agents.
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Objective To evaluate the effect of multidisciplinary intervention on antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection.Methods By standardizing preoperative disinfection and surgical procedures, training and education of antimicrobial use, conducting quality control activities, and performing periodic feedback of supervised results, efficacy of improvement of antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection in a hospital was observed.Results In 2013 and 2014, incidences of surgical site infection(SSI) were 7.66%(17/222)and 6.80%(27/397) respectively,there was no significant difference between two groups(X2 =0.158,P>0.05).Prophylactic use of antimicrobial agents in surgical patients were as follows: cefuroxime(n=495), cefazolin(n=103), cefathiamidine(n=9), clindamycin(n=8), and cefotaxime(n=4), types of used antimicrobial agents were rational.In 2014, the implementation rate of necessary intra-operative antimicrobial adding was 95.02%, which was higher than 87.66% in 2013(X2=7.969,P48 hours, which was lower than 57.66% in 2013, difference was significant(X2=42.88,P<0.05).Conclusion Multi-intervention measures, including standard preoperative disinfection and surgical procedures, education and training, quality control circle, and feedback of supervised results can improve standard antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection.
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Objective To explore the effect of antimicrobial use density (AUD) on the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and antimicrobial resistance rate of healthcare-associated Staphylococcus aureus (HA-SA) half a year later.Methods From 2012 to 2015,all types of AUD,detection rate of MRSA,and antimicrobial resistance rate of HA-SA were calculated semiannually,correlation between antimicrohial resistance rate of HA-SA and all types of AUD in the same first half of year were analyzed with correlation analysis and multiple linear regression.Results From the first half of 2012 to the latter half of 2015,the total AUD declined from 128.2 to 49.0,except the AUD of carbapenems rose,AUD of other antimicrobial agents declined.From the latter half of 2012 to the latter half of 2015,104 249 patients were admitted to the hospital,and 1 008 strains of SA were isolated from 40 884 specimens,857 (85.02％) of which were community-associated SA(CA SA) and 151 (14.98％) were HA-SA.Isolation rate of HA-MRSA declined from 31.25％ in the latter half of 2012 to 12.50％ in the latter half of 2015;isolation rate of CA-MRSA rose from 7.08％ to 16.08％,resistance rate of HA-SA was generally higher than that of CA-SA.Antimicrobial resistance rate of HA-SA to ciprofloxacin remained the same,to levofloxacin increased,to 8 other antimicrobial agents all declined;resistance rates of CA-SA to oxacillin,ciprofloxacin,clindamycin,gentamicin,and levofloxacin increased,but to other antimicrobial agents declined;no SA strains was found to be resistant to vancomycin and linezolid.The resistance rate of HA-SA to azithromycin and erythrocin was correlated with the AUD of macrolides,resistance rate of HA-SA to clindamycin was correlated wvith the AUD of aminoglycosides,to gentamicin was correlated with the AUD of macrolides and the total AUD.Conclusion The selective pressure of antimicrobial agents is still the important cause of the occurrence of antimicrobial resistance,decreasing the AUD of antimicrobial agents will help for reducing the detection rate of HA-MRSA and drug resistance rate of HA-SA.
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Objective To understand the distribution and antimicrobial resistance of pathogens causing wound in-fection in army officers and soldiers following military training injury,and provide reference for antimicrobial use in clinical anti-infection treatment.Methods Wound secretion from injured army patients who were admitted to a mili-tary hospital between January 2014 and June 2015 was performed bacterial culture and antimicrobial susceptibility testing.Results 647 pathogenic bacteria strains were isolated from 1 029 wound secretion specimens ,isolation rate was 62.88%,the top 6 isolated bacteria were Staphylococcus aureus (S .aureus ,29.99%,n =194),Escherichia coli (E.coli,19.32%,n=125),Pseudomonas aeruginosa (19.17%,n=124),Enterococcus spp .(13.60%,n=88), Klebsiella pneumoniae (K .pneumoniae ,7.73%,n =50),and Acinetobacter baumannii (A.baumannii,5.87%, n=38).S .aureus and Enterococcus spp .had high susceptibility to vancomycin,linezolid ,and daptomycin (resist-ance rates ≤3.41 %),44.33% of S .aureus were methicillin-resistant,2.27% of Enterococcus spp .were vancomy-cin-resistant .E.coli and K .pneumoniae had high susceptibility rates to piperacillin/ tazobactam (resistance rates were 1 .60% and 0 respectively),except A.baumannii,resistance rates of gram-negative bacteria to carbapenems were all low (resistance rates ≤4.00%).Conclusion Military clinicians should select appropriate antimicrobial agents according to antimicrobial susceptibility testing results,reduce the disability rate due to infection in trauma patients,and provide clinical support for the treatment of the wounded.
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Objective To understand the antimicrobial resistance of common clinical pathogens to antimicrobial disks containing different ratios of cefoperazone/sulbactam,so as to provide basis for rational application of cefoper-azone/sulbactam in clinic.Methods 1 141 pathogens isolated from clinical specimens in a hospital in the first half year of 2014 were collected,disk diffusion method was adopted to detect antimicrobial activity of two kinds of cef-operazone/sulbactam disks (70/35 μg and 75/75 μg).Results Of 1 141 pathogenic strains,675 (59.16%)were En-terobacteriaceae,447 (39.18%)were non-fermentative bacteria,and 19 (1 .66%)were other gram-negative bacilli. Resistance rates of pathogens to 70/35μg and 75/75 μg cefoperazone/sulbactam antimicrobial disks were as follows:extended-spectrumβ-lactamases(ESBLs)-producing Escherichia coli (n=221)were 7.69% and 2.26% respective-ly,ESBLs-producing Klebsiella pneumoniae (n=92)10.87% and 3.26% respectively,imipenem-resistant Acineto-bacter baumannii (IRAB,n=295)54.92% and 11 .19%respectively;there were significant differences in antimicrobial activity between two ratios of antimicrobial disks(P 0.05).Conclusion Antimicrobial activity of two different ratios of cefoperazone/sulbactam antimicrobial disks to ESBLs-producing Enterobacteriaceae and IRAB is different,attention should be paid to ratios of cefoperazone/sulbactam during the treatment ,so as to achieve the desired therapeutic effect.
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Objective To understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens(S .marcescens ),and provide basis for rational use of antimicrobial agents,as well as prevention and control of infection.Methods 427 S .marcescens strains isolated between January 1 ,2012 and December 31 ,2015 were analyzed,antimicrobial susceptibility testing were performed by disk diffusion method.Results 427 S . marcescens strains were mainly from respiratory tract (70.26%),among which the majority were from sputum (64.87%).S .marcescens were primarily from intensive care unit(ICU,19.44%),department of integrated tradi-tional Chinese and Western medicine(15.46%)as well as rehabilitation department (13.58%).The resistance rates of S .marcescens to cefoperazone/sulbactam,ertapenem,cefepime,ceftazidime,amikacin,imipenem,levofloxacin, and piperacillin/tazobactam were all<10%;resistance rates to ciprofloxacin,gentamicin,tobramycin,ceftriaxone, sulfamethoxazole/trimethoprim (SMZ/TMP),and aztreonam were 10%-30%.Difference in the resistance rates of S .marcescens to cefoperazone/sulbactam,ciprofloxacin,ceftriaxone,amikacin,aztreonam,and SMZ/TMP dur-ing 4 years were statistically significant (P <0.05).In 2012-2013,resistance rates of S .marcescens to cefopera-zone/sulbactam,ciprofloxacin,ceftriaxone,aztreonam,and SMZ/TMP increased obviously,then resistance rates tend to be stable,while resistance rates to cefoperazone/sulbactam decreased.Conclusion Susceptibility of S.marcescens to most antimicrobial agents are high,but resistance had increasing tendency;susceptible rates of S .marcescens to ertapenem,ceftazidime,levofloxacin,and piperacillin/tazobactam are all high,and can be used as the empirical medication for the treatment of related infection.
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Objective To understand antimicrobial resistance and therapeutic efficacy of imipenem/cilastatin and meropenem for treatment of multidrug-resistant Pseudomonas aeruginosa (MDRPA)from patients with mechanical ventilation.Methods From January 2010 to December 2015,78 patients with mechanical ventilation and isolated MDRPA from sputum cultures were selected and divided into imipenem/cilastatin (n=44)and meropenem(n=34) treatment groups,basic condition,time of emergence of drug resistance,and therapeutic efficacy of antimicrobial agents between two groups were compared.Results The basic data of two groups were comparable,before treat-ment by imipenem/cilastatin and meropenem,resistance rates of Pseudomonas aeruginosa (P .aeruginosa )to quinolones,ceftazidime,piperacillin,and amikacin were not significantly different (all P >0.05).After patients received antimicrobial agents for 6 days,difference in antimicrobial resistance between imipenem /cilastatin and meropenem treatment groups were not significantly different (22.73% vs 8.82%,P >0.05).On the 8th,10th,and 12th day of treatment,resistance rates of imipenem treatment group were 40.91%,77.27%,and 97.73%, respectively,which were all higher than meropenem treatment group (17.65%,32.35%,44.12%,respectively,all P <0.05).After the treatment with different antimicrobial agents,the average time for the emergence of resistance in imipenem/cilastatin and meropenem treatment group were 9.0 days and 13.5 days respectively.Therapeutic efficacy between two groups was not significantly different (64.71% vs 74.19%,P =0.41).Conclusion Compared with meropenem,imipenem/cilastatin shows higher risk for the emergence of drug resistance during therapy of P . aeruginosa infection in patients with mechanical ventilation,there is no significant difference in therapeutic efficacy between two groups of patients after 7 days of treatment.
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Objective To understand the development situation of healthcare-associated infection (HAI)manage-ment departments in the rational antimicrobial application and management in hospitals in China.Methods A total of 166 hospitals from 12 provinces,municipalities,autonomous regions,and military hospitals were selected for survey,the participation of HAI management departments in the rational clinical antimicrobial application and man-agement in different years was compared.Results Of 166 hospitals,68(40.96%)in 2005,119(71.69%)in 2010, and 160(96.39%)in 2015 participated in the establishment of management organizations for rational antimicrobial application (χ2 =121.143,P <0.001).The percentage of HAI management departments participating in antimicro-bial management increased from 10.24%(n=17)in 2005 to 22.29%(n=37)in 2010,and 31.33%(n=52)in 2015 (χ2 =22.172,P < 0.001 ).The percentages of HAI management departments participating in formulating cata-logues for antimicrobial varieties and classification,stipulating permission for antimicrobial use,joining antimicrobi-al management teams,monitoring bacterial resistance,managing antimicrobial prophylaxis in clean incision,super-vising clinical antimicrobial use,conducting clinical consultation,and evaluating prescription were 10.87% -30.72% in 2005,25.90%-65.06% in 2010,and 36.14%-95.18% in 2015 (all P <0.01).Intensity of antimicro-bial use (defined daily dose/100 bed-days,DDD/ 100 bed-days)decreased from 69.16 in 2005 to 41.40 in 2015, antimicrobial usage rate decreased from 46.98% in 2005 to 36.90% in 2015,among patients receiving therapeutic antimicrobial use,specimens sending for pathogenic detection increased from 20.58% in 2005 to 49.39% in 2015. Conclusion Departments of HAI management in China play important role in management of rational antimicrobial application.