索马里摩加迪沙某三级护理医院重症监护室患者分离的ESKAPEE病原体抗菌素耐药性趋势：一项回顾性研究（2020-2024年）

摘要(中文译文)

ESKAPEE病原体（包括屎肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、肠杆菌属和阴沟肠杆菌）是医院感染的主要致病菌，并因其多重耐药性（MDR）而臭名昭著。关于其在索马里的流行率和耐药模式的数据仍然匮乏。本研究旨在描述摩加迪沙索马里土耳其雷杰普·塔伊普·埃尔多安医院重症监护室（ICU）患者中ESKAPEE分离株在5年期间的流行病学和抗菌药物耐药谱。基于2020年1月至2024年10月期间收治的ICU患者的微生物学数据进行了回顾性分析。临床标本采用标准微生物学技术处理，分离株通过生化试验进行鉴定。抗菌药物敏感性试验采用Kirby-Bauer纸片扩散法，依照CLSI指南进行。MDR定义为对三类或以上抗菌药物类别耐药。数据使用R软件v4.1.2进行分析。共从1,632份临床标本中获得1,632株ESKAPEE分离株。肺炎克雷伯菌是最常见的病原体（42.16%），其次为鲍曼不动杆菌（17.77%）、铜绿假单胞菌（17.65%）和金黄色葡萄球菌（11.89%）。MDR率在鲍曼不动杆菌（85%）和肺炎克雷伯菌（78%）中较高。值得注意的是，碳青霉烯类耐药存在于70%的鲍曼不动杆菌和55%的肺炎克雷伯菌分离株中。屎肠球菌分离株对万古霉素的耐药率较低，2024年耐药率约为6%；总体敏感性仍为94%。金黄色葡萄球菌分离株中万古霉素耐药率为12.5%。耐甲氧西林金黄色葡萄球菌（MRSA）在2023年急剧上升至峰值78.8%，随后在2024年下降，凸显了不稳定但令人担忧的耐药动态。MDR模式因病原体而异，多重耐药在革兰阴性菌种中最为常见。MDR ESKAPEE病原体的高流行率，尤其是碳青霉烯类耐药的鲍曼不动杆菌和肺炎克雷伯菌，凸显了在索马里ICU中迫切需要强有力的抗菌药物管理和感染控制策略。持续监测和量身定制的经验性治疗方案对于在资源有限的环境中应对日益严峻的抗菌药物耐药威胁至关重要。

Abstract

The ESKAPEE pathogens , , , , , spp. and are the leading causes of nosocomial infections and are notorious for their multidrug resistance (MDR). Data on their prevalence and resistance patterns in Somalia remain scarce. This study aims to delineate the epidemiology and antimicrobial resistance profiles of ESKAPEE isolates from the intensive care unit (ICU) patients over 5 years at Somali Turkish Recep Tayyip Erdogan Hospital, Mogadishu. A retrospective review was conducted based on microbiological data from ICU patients admitted between January 2020 and October 2024. Clinical specimens were processed using standard microbiological techniques, and isolates were identified via biochemical assays. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method in accordance with CLSI guidelines. MDR was defined as resistance to three or more antimicrobial classes. Data were analyzed using R software v4.1.2. A total of 1,632 ESKAPEE isolates were obtained from 1,632 clinical specimens. was the most common pathogen (42.16%), followed by (17.77%), (17.65%), and (11.89%). The rate of MDR was higher in . (85%) and . (78%). Notably, carbapenem resistance was present in 70% of . and 55% of . isolates. There was low resistance to vancomycin among isolates resistance reached approximately 6% in 2024; overall susceptibility remained 94%. Resistance to vancomycin was found in 12.5% of isolates. Methicillin-resistant (MRSA) increased sharply to a peak of 78.8% in 2023 before declining in 2024, highlighting unstable but concerning resistance dynamics. MDR patterns differed across pathogens, with multi-drug resistance most common among Gram-negative species. The high prevalence of MDR ESKAPEE pathogens, particularly carbapenem-resistant . and . , underscores the urgent need for robust antimicrobial stewardship and infection control strategies in Somali ICUs. Continuous surveillance and tailored empiric therapy protocols are critical to combating the mounting AMR threat in resource-limited settings.

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