NEJM:全美与医疗保健相关的多药耐药菌感染负担评估

2020-04-02 MedSci原创 MedSci原创

在美国,与医疗保健相关的抗菌药物耐药给患者带来了沉重的负担

近日研究人员就美国与医疗保健有关多药耐药(MDR)细菌负担进行了考察。
 
研究人员利用2012-2017年期间890家美国医院住院患者的数据,考察了由于甲氧西林耐药金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、可产生超广谱 β-内酰胺酶(ESBL)的超广谱头孢菌素抗药性肠道细菌、耐碳青霉烯类肠杆菌科、耐碳青霉烯类不动杆菌和MDR绿浓杆菌引起的院内和社区感染病例数。
 
本次研究中,总计4160万住院患者参与(>每年美国住院患者的20%)。2017年,多药耐药病原体估计在住院患者中造成622390例感染,在这些感染中,517818人(83%)在社区发病,104572人(17%)在医院发病,其中MRSA和ESBL感染占大多数(分别为52%和32%)。2012年至2017年期间,MRSA感染(每10000例住院病例从114.18例降至93.68例)、VRE感染(每10000例24.15例降至15.76例)、耐碳青霉烯类不动杆菌感染(每10000例3.33例降至2.47例)和MDR铜绿假单胞菌感染(每10000例13.10例降至9.43例)的发病率均有所下降,下降幅度在20.5%-39.2%之间。耐碳青霉烯类肠道细菌感染的发生率没有显著变化(从每10000人中3.36例变为3.79例)。ESBL感染的发生率增加了53.3%(从每10000例住院37.55例增加到57.12例),这一变化是由社区感染病例数增加导致的。
 
在美国,与医疗保健相关的抗菌药物耐药给患者带来了沉重的负担。
 
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