Analysis Of Distribution And Antimicrobial Resistance Of Clinical Isolates During 2015-2018 Based On Clinical Decision Support System In A Tertiary Hospital

Background:In order to control antimicrobial resistance,continuous management of antimicrobial use has been conducted in the world,resulting in some achievements in prophylactic use of antimicrobials during surgery and intravenous antimicrobial use in outpatients and in the emergency department.While,unreasonable use of antimicrobials for treatment is still common and difficult to be stewarded.One of the key reasons is that the microbiological specimen samplings are largely unstandardized,which contributes to low reliability of antimicrobial resistance surveillance data and compromises target antibacterial therapy.Objective:The purpose of this study was to provide a reliable clinical microbial data for the rational use of antimicrobials and to provide a new insight for the monitoring of antimicrobial resistance by analyzing the distribution and resistance profiles of clinical isolates detected before and after the use of antimicrobials based on hospital's clinical decision support system.Materials and methods:The hospital uses clinical decision support system to assist antimicrobial stewardship,which has a major function of ensuring sampling microbial specimens before antimicrobial prescription for treatment.The system automatically generates relevant data related with timing of antimicrobial use and specimens sampling.Data of clinical isolates detected from various specimens in hospital from 2015 to 2018 were collected from the hospital laboratory information system,and matched that of timing of antimicrobial use and specimens sampling in the clinical decision support system.The information of clinical non-repetitive isolates detected before and after antimicrobial use was therefore generated,allowing for analysis of isolates' distribution,antimicrobial resistance and the trend of antimicrobial resistance of common clinical bacteria in the past 4 years.Result:1.A total of 69037 strains of bacteria and fungi were detected from 2015 to 2018,including 17900 strains of Gram-positive bacteria(25.9%),44055 strains of Gram-negative bacteria(63.8%)and 7082 strains of fungi(10.3%).15017 strains were detected before therapeutic antimicrobial use,of which 4661 strains(31.1%)were Gram-positive bacteria,9451 strains(62.9%)were Gram-negative bacteria,which was more than those in the whole hospital(P<0.01),and 905 strains(6.0%)were fungi,which was lower than those in the whole hospital(P<0.01).2.The most commonly detected five bacteria were Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus,Pseudomonas aeruginosa and Coagulase-negative staphylococci among specimens sampled before therapeutic antimicrobial use.After antimicrobial use,in contrast,the top five detected bacteria were Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,Candida species and Escherichia coli,and the proportion of fastidous bacteria such as Streptococcus,Haemophilus influenzae and Moraxella catarrhalis decreased significantly(P<0.01).3.The clinical isolates were mainly detected from non-aseptic specimens,sputum accounted for the first place.The antimicrobial resistance of Staphylococcus aureus,Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii significantly varied in different specimens.4.The overall antimicrobial resistance of the hospital-wide unduplicated isolates detected during hospitalization was significantly higher than that before the use of antimicrobials.5.In the past 4 years,the antimicrobial resistance of Staphylococcus aureus and Acinetobacter baumannii improved by trend;the resistance of Escherichia coli to quinolones remained high,and the resistance rate to other antimicrobials decreased steadily.The antimicrobial resistance of Klebsiella pneumoniae tended to increased,and the resistance of to antimicrobial was stable.Conclusion:This study is the first to accurately construct the database of clinical isolates which are detected before the use of therapeutic antimicrobials based on the clinical decision support system.The data is more close to the clinical practice,more operable to guide the clinical use of antimicrobials.