Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3175
Peer-review started: June 23, 2019
First decision: July 31, 2019
Revised: August 23, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 26, 2019
Processing time: 126 Days and 14.9 Hours
Antibiotic resistance has become a global threat for human health, calling for rational use of antibiotics.
The premise of rational drug use is to understand the distribution of pathogens and the trends and characteristics of drug resistance.
In this study, we analyzed the distribution characteristics and drug resistance to different antibiotics of the bacteria isolated from the emergency department specimens in our hospital from 2013 to 2017. This study is of great significance for the selection of drugs for initial empirical treatment in the emergency department and the careful selection of antibiotics to reduce the generation of drug-resistant strains.
The isolation media including China-blue plate and blood agar plate were purchased from Oxoid, United Kingdom. The bacterial identification was then performed using VITEK 2 Compact automatic microorganism analysis system (bioMerieux, France) and BD-Bruker MALDI Biotyper microorganism mass spectrometry rapid identification system (BD, United Kingdom). Data were analyzed using the R 3.5.1 software. The rate was expressed as a percentage. The Cochran-Armitage trend test was used to analyze the change trend of drug resistance rates with time. P < 0.05 was considered to be statistically significant.
The top six bacteria isolated from emergency patients were Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans. From 2013 to 2017, the isolation rates of common pathogens in the emergency department decreased, including Acinetobacter baumannii (25.5% to 17.4%), Staphylococcus aureus (21. 0% to 7.1%), Pseudomonas aeruginosa (12.3% to 10.3. %), and Escherichia coli (7.6% to 6.5%). However, the isolation rate of Klebsiella pneumoniae increased from 7.1% to 12.1%. The drug with the lowest resistance rate of Acinetobacter baumannii to common clinical antibiotics was tigecycline, followed by minocycline, but the sensitivity to the two drugs has been also decreasing each year (P < 0.01). The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam and imipenem were higher, with the resistance to cefoperazone/sulbactam increasing year over year (P < 0.01). But its resistance rate to amikacin was below 10%. Klebsiella pneumoniae had higher resistance rates to imipenem, cefoperazone/sulbactam, amikacin, and ciprofloxacin, with the lowest resistance rate to tigecycline. The resistance rate to minocycline was also high but it decreased year over year (P < 0.01). For Escherichia coli, the resistance to ciprofloxacin was high, and the resistance rate to cefoperazone/sulbactam showed an upward trend year after year (P < 0.01). the resistance rates of Staphylococcus aureus to levofloxacin, penicillin G, and tetracycline were high, but the resistance rates to penicillin G and tetracycline showed a downward trend (P < 0.01).
The pathogenic bacteria isolated from the emergency department were mainly Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans, with high detection rates of drug-resistant bacteria. When critically ill patients are admitted to the emergency department, initial antibiotic treatment should be selected empirically according to the distribution characteristics of bacteria in this area while bacteriological examination should be conducted on the clinical samples as soon as possible, and the later drug regimen should be adjusted timely according to the results of pathogen culture and drug sensitivity. For patients with extremely serious infections and life risk at any time, multi-drug regimens can be considered to achieve early control of the disease. These findings provided a good basis for the early delivery of empirical medication for critically ill patients. There is a certain course of treatment with antibiotics, which should be administered on time once adopted to maintain sufficient concentration of drugs in patients to reduce the generation of drug-resistant strains. Some recent studies offer some hope for tackling bacterial resistance. Bacteriophages have many advantages over antibiotics in their use to treat and prevent infection by drug-resistant bacteria. Their therapeutic effects are significantly different from those of antibiotics, making them still sensitive to multidrug-resistant bacteria. A total of 2048 critically ill patients were enrolled. The clinical examination specimens of these patients were collected, including deep sputum retained after adequate gargling (secretions from deep respiratory tract in patients with tracheotomy or intubation), urine, localized secretions, and blood from the apical segment of the catheter in patients with central venous catheterization. As mentioned above, Klebsiella pneumoniae has been the only bacteria with the increasing detection rate among the most common bacteria at the emergency department for the past five years, and the resistance to antibiotics such as meropenem and imipenem was also gradually increasing. The pathogenic bacteria isolated from the emergency department were mainly Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans, with high detection rates of drug-resistant bacteria. Phages are currently seen as a potential effective treatment for many multidrug-resistant bacteria. However, at the present stage, it is still of great significance to strengthen the pathogenic examination and monitoring in the emergency department and understand the distribution and drug resistance trends of the prevalent strains, so as to guide the rational use of drugs, reduce the production of multidrug-resistant bacteria, reduce the hospital infection rate and improve the success rate of patient treatment.
There may be bias in data collection of retrospective studies. The future research direction is the rational use of antibiotics.