Introduction: The prevalence of </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae</span></i><span style="font-family:Verdana;"> has rapidly incr...Introduction: The prevalence of </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae</span></i><span style="font-family:Verdana;"> has rapidly increased in recent years and the distribution differed greatly by region, We aimed to study the relationship between antibiotic resistance and </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;">, especially carbapenem-resistant </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae</span></i><span style="font-family:Verdana;"> (CRKP) in our tertiary hospitals from 2014 to 2018.</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Methodology: The antibiotic consumption data of </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> were expressed as the defined daily dose (DDD) per 100 inpatient days</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">(DDDs). </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> which isolated from clinical samples in</span><span style="font-family:Verdana;"> hospital between January 2014 and December 2018 were retrospectively analyzed, and the correlation between antibiotic resistance rate and antibiotic frequency was analyzed.</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Results: From 2014 to 2018, a total of 2295 strains of </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> were isolated, with the detection rates of 8.2%, 9.2%, 11.9%, 13.4% and 14.0%. There were 423 strains of CRKP, with the detection rates of 7.5%, 5.8%, 17</span></span><span style="font-family:Verdana;">.</span><span style="font-family:""><span style="font-family:Verdana;">8% 24.2% and 25.2% respectively. </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> showed di</span></span><span style="font-family:Verdana;">fferent degrees of resistance to antibiotics and showed an increasing trend year by year to carbapenems. The resistance rate of imipenem was 2.5%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">2.8%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">9.9%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">12.3%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">13.4%, and the resistance rate of meropenem was 2.0%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">3.0%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">8.8%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">12.6%</span><span style="font-family:Verdana;">, </span><span style="font-family:""><span style="font-family:Verdana;">12.7%, respectively. The resistance rate of most other drugs decreased. The DDDs values of cefoperazone/sulbactam, piperacillin-tazobactam and gentamicin showed a strong positive correlation with </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> drug resistance rate</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">(r</span><span style="font-family:""> </span><span style="font-family:Verdana;">></span><span style="font-family:""> </span><span style="font-family:Verdana;">0.8, P</span><span style="font-family:""> </span><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.05)</span><span style="font-family:Verdana;">. </span><span style="font-family:""><span style="font-family:Verdana;">Conclusions: The detection rate of </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> and CRKP increased year by year, which was closely related to the dose of antibiotics. Strengthening the management of antimicrobial drugs and standardising the use of antimicrobial prescriptions were of great significance for delaying the emergence of drug-resistant bacteria.展开更多
Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrob...Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。展开更多
Insertion sequences(ISs)promote the transmission of antimicrobial resistance genes(ARGs)across bacterial populations.However,their contributions and dynamics during the transmission of resistance remain unclear.In thi...Insertion sequences(ISs)promote the transmission of antimicrobial resistance genes(ARGs)across bacterial populations.However,their contributions and dynamics during the transmission of resistance remain unclear.In this study,we selected is26 as a representative transposable element to decipher the relationship between ISs and ARGs and to investigate their transfer features and transmission trends.We retrieved 2656 translocatable IS26-bounded units with ARGs(tiS26-bUs-ARGs)in complete bacterial genomes from the NCBI RefSeq database.In total,124 ARGs spanning 12 classes of antibiotics were detected,and the average contribution rate of IS26 to these genes was 41.2%.We found that IS26-bounded units(IS26-bUs)mediated extensive ARG dissemination within the bacteria of the Gammaproteobacteria class,showing strong transfer po-tential between strains,species,and even phyla.The Is26-bUs expanded in bacterial populations over time,and their temporal expansion trend was significantly correlated with antibiotic usage.This wide dissemination could be due to the nonspecific target site preference of is26.Finally,we experimentally confirmed that the introduction of a single copy of is26 could lead to the formation of a composite transposon mediating the transmission of“passenger”genes.These observations extend our knowledge of the IS26 and provide new insights into the mediating role of ISs in the dissemination of antibiotic resistance.展开更多
文摘Introduction: The prevalence of </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae</span></i><span style="font-family:Verdana;"> has rapidly increased in recent years and the distribution differed greatly by region, We aimed to study the relationship between antibiotic resistance and </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;">, especially carbapenem-resistant </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae</span></i><span style="font-family:Verdana;"> (CRKP) in our tertiary hospitals from 2014 to 2018.</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Methodology: The antibiotic consumption data of </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> were expressed as the defined daily dose (DDD) per 100 inpatient days</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">(DDDs). </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> which isolated from clinical samples in</span><span style="font-family:Verdana;"> hospital between January 2014 and December 2018 were retrospectively analyzed, and the correlation between antibiotic resistance rate and antibiotic frequency was analyzed.</span></span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">Results: From 2014 to 2018, a total of 2295 strains of </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> were isolated, with the detection rates of 8.2%, 9.2%, 11.9%, 13.4% and 14.0%. There were 423 strains of CRKP, with the detection rates of 7.5%, 5.8%, 17</span></span><span style="font-family:Verdana;">.</span><span style="font-family:""><span style="font-family:Verdana;">8% 24.2% and 25.2% respectively. </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> showed di</span></span><span style="font-family:Verdana;">fferent degrees of resistance to antibiotics and showed an increasing trend year by year to carbapenems. The resistance rate of imipenem was 2.5%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">2.8%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">9.9%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">12.3%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">13.4%, and the resistance rate of meropenem was 2.0%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">3.0%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">8.8%</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">12.6%</span><span style="font-family:Verdana;">, </span><span style="font-family:""><span style="font-family:Verdana;">12.7%, respectively. The resistance rate of most other drugs decreased. The DDDs values of cefoperazone/sulbactam, piperacillin-tazobactam and gentamicin showed a strong positive correlation with </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> drug resistance rate</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">(r</span><span style="font-family:""> </span><span style="font-family:Verdana;">></span><span style="font-family:""> </span><span style="font-family:Verdana;">0.8, P</span><span style="font-family:""> </span><span style="font-family:Verdana;"><</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.05)</span><span style="font-family:Verdana;">. </span><span style="font-family:""><span style="font-family:Verdana;">Conclusions: The detection rate of </span><i><span style="font-family:Verdana;">K. pneumoniae</span></i><span style="font-family:Verdana;"> and CRKP increased year by year, which was closely related to the dose of antibiotics. Strengthening the management of antimicrobial drugs and standardising the use of antimicrobial prescriptions were of great significance for delaying the emergence of drug-resistant bacteria.
基金the project:the Science and Technology Planning Project of Zhuhai City of China(No.20191206F060001)。
文摘Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。
基金supported by the National Key R&D Program of China(grant No.2021YFC2302005)the National Natural Science Foundation of China(grant Nos.32300162 and 32070075).
文摘Insertion sequences(ISs)promote the transmission of antimicrobial resistance genes(ARGs)across bacterial populations.However,their contributions and dynamics during the transmission of resistance remain unclear.In this study,we selected is26 as a representative transposable element to decipher the relationship between ISs and ARGs and to investigate their transfer features and transmission trends.We retrieved 2656 translocatable IS26-bounded units with ARGs(tiS26-bUs-ARGs)in complete bacterial genomes from the NCBI RefSeq database.In total,124 ARGs spanning 12 classes of antibiotics were detected,and the average contribution rate of IS26 to these genes was 41.2%.We found that IS26-bounded units(IS26-bUs)mediated extensive ARG dissemination within the bacteria of the Gammaproteobacteria class,showing strong transfer po-tential between strains,species,and even phyla.The Is26-bUs expanded in bacterial populations over time,and their temporal expansion trend was significantly correlated with antibiotic usage.This wide dissemination could be due to the nonspecific target site preference of is26.Finally,we experimentally confirmed that the introduction of a single copy of is26 could lead to the formation of a composite transposon mediating the transmission of“passenger”genes.These observations extend our knowledge of the IS26 and provide new insights into the mediating role of ISs in the dissemination of antibiotic resistance.
