文摘大家译：长期住院病人多重耐药菌感染流行病学分析

潮水

Infect Control Hosp Epidemiol 2007;28:1255-1260
Epidemiology of Multidrug-Resistant Bacteria in Patients With Long Hospital Stays

Cagri Buke, MD; Laurence Armand-Lefevre, PharmD; Isabelle Lolom, RT; Waafa Guerinot, RT; Claude Deblangy, RN; Raymond Ruimy, MD, PhD; Antoine Andremont, MD, PhD; Jean-Christophe Lucet, MD, PhD


OBJECTIVE.     To determine rates of colonization with multidrug-resistant (MDR) bacteria (ie, methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus [VRE], extended-spectrum -lactamase [ESBL]-producing Enterobacteriaceae, and Acinetobacter baumannii) after prolonged hospitalization and to assess the yield of surveillance cultures and variables associated with colonization with MDR bacteria.

DESIGN.     Prospective observational cohort study conducted from February 6 to May 26, 2006.

METHODS.     All patients who spent more than 30 days in our university hospital (Paris, France) were included. Rectal and nasal swab samples obtained during day 30 screening were examined for MRSA, VRE, ESBL-producing Enterobacteriaceae, and A. baumannii.

RESULTS.     Of 470 eligible patients, 439 had surveillance culture samples available for analysis, including 51 patients (11.6%) with a history of colonization or infection due to 1 or more types of MDR bacteria (MRSA, recovered from 35 patients; ESBL-producing Enterobacteriaceae, from 16 patients; A. baumannii, from 6 patients; and VRE, from 0 patients) and 37 patients (9.5% of the 388 patients not known to have any of the 4 MDR bacteria before day 30 screening) newly identified as colonized by 1 or more MDR bacteria (MRSA, recovered from 20 patients; ESBL-producing Enterobacteriaceae, from 16 patients; A. baumannii, from 1 patient; and VRE, from 0 patients). A total of 87 (19.8%) of 439 patients were identified as colonized or infected with MDR bacteria at day 30. Factors that differed between patients with and without MRSA colonization included age, McCabe score, comorbidity score, receipt of surgery, and receipt of fluoroquinolone treatment. Patients with ESBL-producing Enterobacteriaceae colonization were younger than patients with MRSA colonization.

CONCLUSIONS.     Differences in the variables associated with MRSA colonization and ESBL-producing Enterobacteriaceae colonization suggest differences in the epidemiology of these 2 organisms. Day 30 screening resulted in a 72.5% increase in the number of patients identified as colonized with at least 1 type of MDR bacteria.

David

BJECTIVE.     To determine rates of colonization with multidrug-resistant (MDR) bacteria (ie, methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus [VRE], extended-spectrum -lactamase [ESBL]-producing Enterobacteriaceae, and Acinetobacter baumannii) after prolonged hospitalization and to assess the yield of surveillance cultures and variables associated with colonization with MDR bacteria.(目的: 确定长期住院病人多重耐药菌的定植率[如，MRSA，VRE，产ESBL肠杆菌和鲍曼不动杆菌)以及评估监测培养的效果和与多重耐药菌相关的影响因素。
DESIGN.     Prospective observational cohort study conducted from February 6 to May 26, 2006. （实验设计：回顾性观察性队列研究，时间从2006年2月日至5月26日。）
METHODS.     All patients who spent more than 30 days in our university hospital (Paris, France) were included. （方法：所有在本院<法国巴黎一所大学教学医院>住院时间超过30天的病人均包括在内。）Rectal and nasal swab samples obtained during day 30 screening were examined for MRSA, VRE, ESBL-producing Enterobacteriaceae, and A. baumannii. （获取病人的肛拭子和鼻试子样本，筛查是否有MRSA，VRE，产ESBL肠杆菌和鲍曼不动杆菌。）
RESULTS.     Of 470 eligible patients, 439 had surveillance culture samples available for analysis, including 51 patients (11.6%) with a history of colonization or infection due to 1 or more types of MDR bacteria (MRSA, recovered from 35 patients; ESBL-producing Enterobacteriaceae, from 16 patients; A. baumannii, from 6 patients; and VRE, from 0 patients) and 37 patients (9.5% of the 388 patients not known to have any of the 4 MDR bacteria before day 30 screening) newly identified as colonized by 1 or more MDR bacteria (MRSA, recovered from 20 patients; ESBL-producing Enterobacteriaceae, from 16 patients; A. baumannii, from 1 patient; and VRE, from 0 patients). （结果：在全部470个患者中，共有439个患者拭子可以用于分析。其中包括51名患者[11.6%]有被一种或多种多重耐药菌感染或定植的病史[35人]检查出MRSA，16人有产ESBL肠杆菌，6人有鲍曼，无人被查出VRE。其余388人中有37人[9.5%]在本实验前没有发现携带有这4种多重耐药菌），但在筛查中发现定植有一种或多种MDR[20人检出MRSA，16人检出产ESBL肠杆菌，1人检出鲍曼，无人检出VRE。]）A total of 87 (19.8%) of 439 patients were identified as colonized or infected with MDR bacteria at day 30.（在全部439名患者中，总计87人[19.8%]在第30天筛查时被发现有MDR定植或感染。） Factors that differed between patients with and without MRSA colonization included age, McCabe score, comorbidity score, receipt of surgery, and receipt of fluoroquinolone treatment.（影响患者是存在MRSA定植的因素包括年龄，McCabe积分，并发症积分，是否接受外科手术，是否接受过氟喹诺酮类药物治疗。） Patients with ESBL-producing Enterobacteriaceae colonization were younger than patients with MRSA colonization. （定植有产ESBL肠杆菌的患者比定植有MRSA的患者更年轻。）
CONCLUSIONS.     Differences in the variables associated with MRSA colonization and ESBL-producing Enterobacteriaceae colonization suggest differences in the epidemiology of these 2 organisms. （结论：影响MRSA和产ESBL肠杆菌定植的不同因素表明这两种细菌在流行病学上的差异。）Day 30 screening resulted in a 72.5% increase in the number of patients identified as colonized with at least 1 type of MDR bacteria.（第30天筛查携带至少1种多重耐药菌的患者人数增加了72.5%。）

楚楚

主动监测+接触隔离