美国住院患者中耐多药细菌感染，2012-2017 年。
Multidrug-Resistant Bacterial Infections in U.S. Hospitalized Patients, 2012-2017.
机构信息
From the Division of Healthcare Quality Promotion (J.A.J., K.M.H., H.W., B.O., S.C.R., N.M., P.P., L.C.M., A.K., A.F., M.C., J.B.) and the Office of Antimicrobial Resistance (M.C.), Centers for Disease Control and Prevention, Atlanta; and the IDEAS Center, Veterans Affairs Salt Lake City Health Care System, and the Department of Internal Medicine, University of Utah School of Medicine - both in Salt Lake City (R.E.N.).
出版信息
N Engl J Med. 2020 Apr 2;382(14):1309-1319. doi: 10.1056/NEJMoa1914433.
BACKGROUND
Multidrug-resistant (MDR) bacteria that are commonly associated with health care cause a substantial health burden. Updated national estimates for this group of pathogens are needed to inform public health action.
METHODS
Using data from patients hospitalized in a cohort of 890 U.S. hospitals during the period 2012-2017, we generated national case counts for both hospital-onset and community-onset infections caused by methicillin-resistant (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum cephalosporin resistance in Enterobacteriaceae suggestive of extended-spectrum beta-lactamase (ESBL) production, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant acinetobacter species, and MDR .
RESULTS
The hospital cohort in the study accounted for 41.6 million hospitalizations (>20% of U.S. hospitalizations annually). The overall rate of clinical cultures was 292 cultures per 1000 patient-days and was stable throughout the time period. In 2017, these pathogens caused an estimated 622,390 infections (95% confidence interval [CI], 579,125 to 665,655) among hospitalized patients. Of these infections, 517,818 (83%) had their onset in the community, and 104,572 (17%) had their onset in the hospital. MRSA and ESBL infections accounted for the majority of the infections (52% and 32%, respectively). Between 2012 and 2017, the incidence decreased for MRSA infection (from 114.18 to 93.68 cases per 10,000 hospitalizations), VRE infection (from 24.15 to 15.76 per 10,000), carbapenem-resistant acinetobacter species infection (from 3.33 to 2.47 per 10,000), and MDR infection (from 13.10 to 9.43 per 10,000), with decreases ranging from -20.5% to -39.2%. The incidence of carbapenem-resistant Enterobacteriaceae infection did not change significantly (from 3.36 to 3.79 cases per 10,000 hospitalizations). The incidence of ESBL infection increased by 53.3% (from 37.55 to 57.12 cases per 10,000 hospitalizations), a change driven by an increase in community-onset cases.
CONCLUSIONS
Health care-associated antimicrobial resistance places a substantial burden on patients in the United States. Further work is needed to identify improved interventions for both the inpatient and outpatient settings. (Funded by the Centers for Disease Control and Prevention.).
背景
与医疗保健相关的多药耐药（MDR）细菌会对健康造成重大负担。需要更新此类病原体的全国估计数据，以为公共卫生行动提供信息。
方法
我们利用 2012-2017 年期间在 890 家美国医院住院患者的数据，计算了耐甲氧西林金黄色葡萄球菌（MRSA）、万古霉素耐药肠球菌（VRE）、产超广谱β-内酰胺酶（ESBL）的肠杆菌科中扩展谱头孢菌素耐药、碳青霉烯类耐药肠杆菌科、碳青霉烯类耐药不动杆菌属和 MDR 的医院获得性和社区获得性感染的全国病例数。
结果
该研究中的医院队列占 4160 万例住院患者（每年占美国住院患者的 20%以上）。临床培养的总体率为每 1000 个患者日 292 个培养物，整个时间段内保持稳定。2017 年，这些病原体估计导致住院患者发生 622390 例感染（95%置信区间[CI]，579125-665655）。其中 517818 例（83%）感染发生在社区，104572 例（17%）感染发生在医院。MRSA 和 ESBL 感染占大多数感染（分别为 52%和 32%）。2012 年至 2017 年间，MRSA 感染的发病率下降（从每 10000 例住院患者的 114.18 例降至 93.68 例）、VRE 感染（从每 10000 例住院患者的 24.15 例降至 15.76 例）、碳青霉烯类耐药不动杆菌属感染（从每 10000 例住院患者的 3.33 例降至 2.47 例）和 MDR 感染（从每 10000 例住院患者的 13.10 例降至 9.43 例），降幅范围为 -20.5%至 -39.2%。碳青霉烯类耐药肠杆菌科感染的发病率没有显著变化（每 10000 例住院患者 3.36 例至 3.79 例）。ESBL 感染的发病率增加了 53.3%（从每 10000 例住院患者的 37.55 例增加到 57.12 例），这一变化是由社区获得性病例的增加驱动的。
结论
与医疗保健相关的抗菌药物耐药性给美国患者带来了重大负担。需要进一步努力，为住院和门诊环境确定改进的干预措施。（由疾病控制和预防中心资助）。
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