Đặc điểm vi sinh ở người bệnh được đặt thông tiểu lưu có kết quả cấy nước tiểu dương tính tại Bệnh viện Bệnh Nhiệt đới giai đoạn 2022-2023=Microbiology of catheter associated urinary tract infection in hospital for tropical diseases, Vietnam, from 2022 to 2023

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Tác giả: Đặng Trung Nghĩa Hồ, Phú Hương Lan Nguyễn, Thành Dũng Nguyễn, Thanh Phong Nguyễn, Thái Bảo Phan, Băng Huyền Trần, Ngọc Trung Trương, Triều Lý Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.45788

Bộ sưu tập: Báo, Tạp chí

ID: 478176

Thêm vào giỏ

Catheter-associated urinary tract infection (CAUTI) is one of the most common types of infection in patients admitted to intensive care units (ICU). Understanding common pathogens with susceptibility data is vital to guiding an appropriate empirical antibiotic regimen. Our study aims to analyze the microbiological characteristics of CAUTI. Method: This is a retrospective descriptive study. Medical record data was collected from adult ICU patients admitted to the Hospital for Tropical Diseases, Vietnam, from January 2022 to September 2023 who had a urinary catheter in place for more than 48 hours and a positive urine culture. Results: A total of 149 CAUTI cases with positive bacterial urine culture were studied. The median age was 57 years old, and the female/male ratio was 1/1. The median duration from catheterization to positive culture was 9 days. Gram-negative bacteria accounted for 73.8%, with Enterobacterales accounting for 83.6%. Carbapenem resistance was observed in 36.4% of Gram-negative, with resistance rates among A. baumannii, K. pneumoniae, P. aeruginosa, and E. coli being 83.3%, 65.8%, 33.3%, and 2.6%, respectively. Gram-positive bacteria accounted for 26.2%, with Enterococcus spp. accounting for 24.2%. Vancomycin resistance was observed in 38.9% of Enterococcus spp., with resistance rates in E. faecium and E. faecalis being 60.9% and 0.0%. There were 66 cases of funguria, 95.5% of which were Candida spp., most commonly C. albicans and C. tropicalis. Fluconazole resistance was observed in 24.2%. Conclusion: Enterobacterales and Enterococcus spp. should be targeted when selecting empirical antibiotics for CAUTI. The high rates of carbapenem-resistant Gramnegative bacteria, vancomycin-resistant Enterococcus spp., and fluconazole-resistant Candida spp. pose a challenge in clinical practice.Nhiễm khuẩn tiết niệu liên quan ống thông tiểu (CAUTI) là một trong những nhiễm khuẩn phổ biến nhất ở người bệnh nhập Đơn vị Hồi sức tích cực (ICU). Để lựa chọn được kháng sinh kinh nghiệm phù hợp thì dữ liệu quần thể vi sinh và đặc điểm đề kháng kháng sinh đóng vai trò rất quan trọng. Nghiên cứu nhằm mô tả đặc điểm vi sinh ở người bệnh CAUTI. Phương pháp: Nghiên cứu mô tả hàng loạt ca bệnh người lớn được đặt ống thông tiểu lưu  48 giờ có kết quả cấy nước tiểu dương tính tại các khoa ICU Bệnh viện Bệnh Nhiệt đới từ 01/2022 đến 09/2023. Kết quả: Có 149 trường hợp cấy nước tiểu dương tính với vi khuẩn được thu nhận vào nghiên cứu. Độ tuổi mắc bệnh có trung vị là 57 tuổi, tỷ lệ nữ/nam 1/1. Thời gian từ lúc lưu ống thông tiểu đến khi cấy nước tiểu dương tính có trung vị 9 ngày. Vi khuẩn Gram âm chiếm 73,8%, trong đó Enterobacterales chiếm 61,7%. Có 36,4% vi khuẩn Gram âm đề kháng carbapenem, cụ thể tỷ lệ đề kháng ở A. baumannii, K. pneumoniae, P. aeruginosa và E. coli lần lượt là 83,3%, 65,8%, 33,3% và 2,6%. Vi khuẩn Gram dương chiếm 26,2%, trong đó Enterococcus spp. chiếm 24,2%. Có 38,9% Enterococcus spp. đề kháng vancomycin, cụ thể tỷ lệ đề kháng ở E. faecium và E. faecalis là 60,9% và 0,0%. Nghiên cứu cũng thu nhận 66 trường hợp cấy nước tiểu dương tính với vi nấm, trong đó Candida spp. chiếm 95,5%. Có 24,2% Candida spp. đề kháng fluconazole. Kết luận: Enterobacterales và Enterococcus spp. là các tác nhân cần được hướng tới khi sử dụng kháng sinh kinh nghiệm trong điều trị CAUTI. Tỷ lệ vi khuẩn Gram âm đề kháng carbapenem, Enterococcus spp. đề kháng vancomycin và Candida spp. đề kháng fluconazole cao là một thách thức trong thực hành lâm sàng.

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