Implementation of global antimicrobial resistance surveillance system (GLASS) in patients with bacteremia

被引:62
作者
Sirijatuphat, Rujipas [1 ]
Sripanidkulchai, Kantarida [1 ]
Boonyasiri, Adhiratha [2 ]
Rattanaumpawan, Pinyo [1 ]
Supapueng, Orawan [2 ]
Kiratisin, Pattarachai [3 ]
Thamlikitkul, Visanu [1 ]
机构
[1] Mahidol Univ, Siriraj Hosp, Fac Med, Dept Med, Bangkok, Thailand
[2] Mahidol Univ, Siriraj Hosp, Fac Med, Dept Res & Dev, Bangkok, Thailand
[3] Mahidol Univ, Siriraj Hosp, Fac Med, Dept Microbiol, Bangkok, Thailand
来源
PLOS ONE | 2018年 / 13卷 / 01期
关键词
BETA-LACTAMASE PRODUCTION; MOLECULAR EPIDEMIOLOGY; ESCHERICHIA-COLI; MORTALITY; THAILAND; METAANALYSIS; INFECTIONS;
D O I
10.1371/journal.pone.0190132
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
The global antimicrobial resistance surveillance system (GLASS) was launched by the World Health Organization (WHO) in 2015. GLASS is a surveillance system for clinical specimens that are sent to microbiology laboratory for clinical purposes. The unique feature of GLASS is that clinical data is combined with microbiological data, and deduplication of the microbiological results is performed. The objective of the study was to determine feasibility and benefit of GLASS for surveillance of blood culture specimens. GLASS was implemented at Siriraj Hospital in Bangkok, Thailand using a locally developed web application program (app) to transfer blood culture specimen data, and to enter clinical data of patients with positive blood culture by infection control nurses and physicians via the app installed in their smart phones. The rate of positive blood culture specimens with true infection was 152%. Escherichia coil was the most common cause of bacteremia. Secondary bacteremia, primary bacteremia, and central line-associated blood stream infection was observed in 61.8%, 30.6%, and 12.6% of cases, respectively. Sepsis was observed in 56.9% of patients. E.coil was significantly more common in community-acquired bacteremia, whereas Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aura us, and Acinetobacter baurnannii were significantly more common in hospital-acquired bacteremia. Hospital-acquired isolates of E. coil, Kpneumoniae, A.baumannii, Paeruginose, S.aureus and Enterococcus faecium were more resistant to antibiotics than community -acquired isolates. In-hospital mortality was significantly higher in patients with antibiotic resistant bacteremia than in patients with antibiotic non-resistant bacteremia (40.5% vs. 28.5%, p<0.001). The patients with antibiotic-resistant bacteremia consumed more resources than those with antibiotic non-resistant bacteremia. Blood culture results combined with patient clinical data were shown to have more benefit for surveillance of antimicrobial resistance, and to be more applicable for developing local antibiotic treatment guidelines for patients suspected of having bacteremia. However, GLASS consumed more time and more resources than the conventional laboratory-based surveillance system.
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页数:15
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