South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde · 2019
Analysis and comparison of cumulative antibiograms for the Charlotte Maxeke Johannesburg Academic Hospital adult intensive care and high-care units, 2013 and 2017.
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Law T, Chibabhai V, Nana T
Аннотация
BACKGROUND: Infection is a common complication for patients in intensive care units (ICUs), and increasing antimicrobial resistance (AMR) is a major concern. It is therefore crucial to monitor AMR patterns in order to support clinical decision-making and antimicrobial stewardship strategies. Clinical microbiologists should provide annual cumulative antibiogram reports, which can be used to guide initial empirical antimicrobial therapy for the management of infections.
OBJECTIVES: To analyse the cumulative antibiograms for the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) combined adult multidisciplinary ICU and high-care unit (HCU) for 2013 and 2017, compare the antimicrobial susceptibility testing (AST) patterns between the 2 years, and analyse the subset of blood culture isolates.
METHODS: A retrospective descriptive analysis was performed of routine bacterial and fungal culture and AST data extracted from the National Health Laboratory Service laboratory information system for the ICU/HCU. Only the first diagnostic isolate of a given species per patient per year was included in the analysis. All analysis and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute guidelines.
RESULTS: Enterobacteriaceae predominated in first-isolate cultures in 2013 (60%) and 2017 (56%). There was an overall decrease in extended-spectrum beta-lactamase-producing Enterobacteriaceae from 2013 (42%) to 2017 (30%) (p=0.013), accompanied by an increase in carbapenem-resistant Enterobacteriaceae from 2013 (4%) to 2017 (11%) (p=0.24). Although the total percentage of Acinetobacter spp. decreased in 2017 (p=0.021), the proportion of extensively drug-resistant isolates doubled to 68% in 2017 (p<0.001). The percentage of methicillin-resistant Staphylococcus aureus decreased significantly from 49% to 14% (p<0.001), along with a significant decrease in vancomycin-resistant enterococci from 17% to 0% (p=0.001). Candida auris increased from 0% in 2013 to 11% in 2017 (p=0.002), and non-albicans Candida spp. predominated (80%) in blood cultures in 2017 (p=0.023).
CONCLUSIONS: Appropriate selection of empirical antimicrobial therapy should be guided by the ICU-specific antibiogram. The recommended empirical antimicrobial therapy at the CMJAH ICU/HCU based on the antibiogram analysis would include ertapenem to cover the Enterobacteriaceae. Amikacin is recommended for empirical treatment of suspected pseudomonal infections. Additional empirical antimicrobial therapy for Gram-positive organisms is not routinely advocated, and empirical antifungal therapy with amphotericin B or micafungin is only appropriate in patients at high risk for invasive candidiasis.
OBJECTIVES: To analyse the cumulative antibiograms for the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) combined adult multidisciplinary ICU and high-care unit (HCU) for 2013 and 2017, compare the antimicrobial susceptibility testing (AST) patterns between the 2 years, and analyse the subset of blood culture isolates.
METHODS: A retrospective descriptive analysis was performed of routine bacterial and fungal culture and AST data extracted from the National Health Laboratory Service laboratory information system for the ICU/HCU. Only the first diagnostic isolate of a given species per patient per year was included in the analysis. All analysis and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute guidelines.
RESULTS: Enterobacteriaceae predominated in first-isolate cultures in 2013 (60%) and 2017 (56%). There was an overall decrease in extended-spectrum beta-lactamase-producing Enterobacteriaceae from 2013 (42%) to 2017 (30%) (p=0.013), accompanied by an increase in carbapenem-resistant Enterobacteriaceae from 2013 (4%) to 2017 (11%) (p=0.24). Although the total percentage of Acinetobacter spp. decreased in 2017 (p=0.021), the proportion of extensively drug-resistant isolates doubled to 68% in 2017 (p<0.001). The percentage of methicillin-resistant Staphylococcus aureus decreased significantly from 49% to 14% (p<0.001), along with a significant decrease in vancomycin-resistant enterococci from 17% to 0% (p=0.001). Candida auris increased from 0% in 2013 to 11% in 2017 (p=0.002), and non-albicans Candida spp. predominated (80%) in blood cultures in 2017 (p=0.023).
CONCLUSIONS: Appropriate selection of empirical antimicrobial therapy should be guided by the ICU-specific antibiogram. The recommended empirical antimicrobial therapy at the CMJAH ICU/HCU based on the antibiogram analysis would include ertapenem to cover the Enterobacteriaceae. Amikacin is recommended for empirical treatment of suspected pseudomonal infections. Additional empirical antimicrobial therapy for Gram-positive organisms is not routinely advocated, and empirical antifungal therapy with amphotericin B or micafungin is only appropriate in patients at high risk for invasive candidiasis.