  抗生素类药物曾是人类对抗诸多疾病的一个“秘密武器”，19世纪末20世纪初，由于一系列抗生素的发现，人类寿命得以大大提高。但发明还不到一百年，由于细菌对抗生素耐药性的不断增强，抗生素也逐渐走下了“神坛”，甚至成为未来医疗卫生领域的一个重大挑战。由于对抗生素产生了耐药性，一些常见的病原体正在变成所谓的“超级细菌”。一旦抗生素失效，我们的生活中就将充满危险——轻微的擦伤都有可能带来死亡，轻微的耳部感染可能就会引起耳聋。因此为尽可能的避免耐药性细菌感染免疫力较低的病人，需要及时更新对这些多重耐药病原体的研究，以便为医疗救治过程中针对性的采取防控措施提供信息。 NEJM上4月2日发表的最新回顾性研究提示了耐药性细菌感染新变化：耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、耐碳青霉烯类肠杆菌科、耐碳青霉烯类不动杆菌属和耐多药铜绿假单胞菌发病率均降低，仅耐超广谱头孢菌素的肠杆菌(ESBL)的发病率上升近50% ！ 0 1 方法 使用2012-2017年期间在890家美国医院住院的患者的数据，研究者生成了由耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、肠杆菌科中提示产超广谱β-内酰胺酶的超广谱头孢菌素(ESBL)、耐碳青霉烯类肠杆菌科、耐碳青霉烯类不动杆菌属和耐多药铜绿假单胞菌引起的医院感染和社区感染的全国病例数。 0 2 结果 该研究中的医院队列占了4160万住院患者(每年超过美国住院患者的20%)。临床培养的总比率为每1000个患者日292个培养物，并且在整个时间段内保持稳定。2017年，这些病原体在住院患者中导致了约622390例感染(95%置信区间[置信区间为579125至665655)。在这些感染中，517818人(83%)在社区发病，104572人(17%)在医院发病。 耐甲氧西林金黄色葡萄球菌和ESBL病毒感染占感染的大多数(分别为52%和32%)。在2012年至2017年期间，耐甲氧西林金黄色葡萄球菌感染(每10000名住院患者中从114.18例降至93.68例)、VRE感染(每10000名住院患者中从24.15例降至15.76例)、耐碳青霉烯类不动杆菌感染(每10000名住院患者中从3.33例降至2.47例)和耐多药铜绿假单胞菌感染(每10000名住院患者中从13.10例降至9.43例)的发病率均有所下降，降幅从耐碳青霉烯的肠杆菌科感染的发病率没有显著变化(每10000住院患者中从3.36例到3.79例)。ESBL感染的发病率增加了53.3%(从每10000住院患者中的37.55例增加到57.12例)，这一变化是由社区发病病例的增加所驱动的。 0 3 结论 在美国，医疗保健相关的抗菌药物耐药性给患者带来了沉重负担。需要进一步的工作来确定改善住院和门诊环境的干预措施。 原文 原文阅读 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 Staphylococcus aureus (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 Pseudomonas aeruginosa. 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 P. aeruginosa 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.  参考文献 1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013 (https://www./drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf). 2. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019 (https://www./drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf). 3.Tabak YP, Zilberberg MD, Johannes RS, Sun X, McDonald LC. Attributable burden of hospital-onset Clostridium difficile infection: a propensity score matching study. Infect Control Hosp Epidemiol 2013;34:588-96 4.John A. Jernigan etc.Multidrug-Resistant Bacterial Infections in U.S. Hospitalized Patients, 2012–2017。N Engl J Med 2020;382:1309-19.DOI: 10.1056/NEJMoa1914433 The end |
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