本帖最后由 胡杨 于 2014-6-18 11:23 编辑
耐碳青霉烯肺炎克雷伯菌的英文缩写是 CRKP ； 英文是：Carbapenem-Resistant Klebsiella Pneumoniae
看一段来自丁香园的文章：【原文的翻译不怎么样，修改第一段凑合看吧】
On January 27, 2011, a West Virginia county health department was notified of a cluster of carbapenem-resistant klebsiella pneumoniae (CRKP) cases detected by a local hospital (hospital A). CRKP infections frequently are resistant to a majority of antimicrobial agents and have an increased risk for morbidity and mortality.[1] The West Virginia Bureau for Public Health (WVBPH) conducted field investigations to identify all cases, characterize risk factors for infection, and abstract data for a matched case-control study. Nineteen case-patients and 38 control patients were identified. Infection with CRKP was associated with admission from or prior stay at a local long-term–care facility (LTCF A). Pulsed-field gel electrophoresis (PFGE) analysis indicated that all five hospital A clinical specimens and all 11 point prevalence survey isolates from LTCF A were closely related. This is the first outbreak of CRKP identified in West Virginia. Recommendations to LTCF A included the following: 1) initiate surveillance for multidrug resistant organisms; 2) revise and improve infection prevention and control activities within the facility; 3) educate residents and their families, physicians, and staff members about CRKP; and 4) identify qualified personnel to coordinate infection control functions within the facility. Although LTCF A has made significant improvements, the outbreak investigation is ongoing. Additional site visits have been conducted, and additional colonized residents have been identified; the last clinical case was detected in July. These findings demonstrate the interconnectedness of the health-care system and factors potentially contributing to transmission of infection. Interventions targeting all levels of care are needed to prevent further CRKP transmission.
In collaboration with the local health department and hospital A, WVBPH conducted an initial field investigation during February 7–9 to identify all cases and characterize infection risk factors. A case was defined as the first detection of CRKP in a patient admitted to a hospital A unit during April 2009–February 2011. Descriptive analysis was conducted to evaluate patient demographics, admitting hospital unit, reason for admission, admitting source for patient, and time between admission and collection of culture specimen.
A second field investigation was conducted during February 21–24 to complete data abstraction for a matched case-control study. Control patients were identified among patients admitted to a hospital A unit with a clinical culture of carbapenem-susceptible K. pneumoniae during April 2009–February 2011. Where possible, each case-patient was matched within 10 years of age with two control patients and by date of specimen collection within 14 days. Data regarding patient demographics, initial admission to hospital A, indwelling devices and procedures, history of multidrug-resistant organisms (MDROs), history of stays in hospital A and LTCFs, and comorbid medical conditions (reported as Charlson comorbidity index scores*) were collected for both case-patients and controls.
Site visits to hospital A and LTCF A were conducted during the initial field investigation. Surveillance data and practices and infection control policies and practices of both facilities were reviewed. A point prevalence survey to identify the baseline prevalence of CRKP was conducted according CDC's recommended protocol[2] in the oncology and medical/surgical units at hospital A and facilitywide at LTCF A.
Data from the field investigation and matched case-control study were analyzed using statistical software. Risk factors for CRKP were assessed by performing exact conditional logistic regression to calculate exact odds ratio (OR) estimates and 95% confidence intervals for dichotomous variables. Because of nonnormal distribution of continuous variables, median two-sample tests were used to estimate statistically significant differences between case-patients and control patients.
A total of 19 cases were identified with specimen collection dates of April 4, 2009–February 21, 2011. Among those cases, 16 patients had been admitted from LTCFs, 14 of whom were from LTCF A (Table 1). Cultures were collected from 10 of the 14 LTCF A case-patients ≤2 calendar days after admission to hospital A, indicating they likely arrived at the hospital with infection.
A total of 38 control patients were identified. Multiple characteristics of case-patients and control patients were compared (Table 1). Age, race, and Charlson comorbidity scores were similar for both groups, but case-patients (58%) were more likely than control patients (16%) to be male. Case-patients had a longer length of hospital stay (mean = 11.4 days) and a higher number of previous hospitalizations (mean = 2.5).
Because of the small number of case-patients, risk factors for CRKP infection (Table 2) were evaluated by exact conditional logistic regression. Risk for CRKP infection was most strongly associated with a prior stay at LTCF A (OR = 46.6) and being admitted from LTCF A (OR = 35.1). Case-patients were significantly less likely than control patients to be ambulatory at the time of diagnosis and to have spent time at home during the previous year.
Hospital A surveillance and infection control practices were determined to be sufficient, whereas evaluation of surveillance and infection control practices at LTCF A revealed deficiencies. The infection preventionist position at LTCF A had been vacant for 9 months. An electronic surveillance system was available, but the facility did not record laboratory reports or MDRO status of residents in this system. LTCF A used a medical laboratory that does not report carbapenem resistance, and no record existed of CRKP infection among LTCF A residents. Staff hand hygiene stations were not conveniently located, and supplies (e.g., gloves, gowns, and waste containers) were missing for compliance with contact precautions. Point prevalence surveys were conducted; none of 29 hospital A patient samples were positive for CRKP, whereas 11 (9%) of 118 resident samples, including eight from residents with previously unrecognized CRKP colonization, were positive from LTCF A. Five clinical isolates from hospital A and 11 surveillance isolates from LTCF A's point prevalence survey were forwarded to CDC for confirmation and PFGE analysis. All 16 isolates were confirmed as carbapenemase (KPC)-producing K. pneumoniae and shared >88% similarity in their PFGE patterns.
编译：
2011年1月27日，西维吉尼亚州卫生部公布了一组地区医院（A医院）检测到的耐碳青霉烯类肺炎克雷伯杆菌（CRKP）病例。CRKP感染通常对大多数抗菌药物耐药，这使得发病率及死亡率风险增加。西维吉尼亚公共卫生局（WVBPH）开展实地调查，找出感染危险因素，采用配对病例对照研究选出19例病例组病人和38例对照组病人。结果CRKP感染与曾经和正在某长期照护医院A入住（LTCF A ）有关。脉冲场凝胶电泳（PFGE）分析提示所有的5个医院 A临床标本和从照护院LTCF A 中分离出来的11个标本，时点患病率研究密切相关。确认这是西维吉尼亚州首次CRKP暴发。卫生局对照护院LTCF A 有以下建议：
1）开展对多耐药微生物的监测；
2）完善医院内感染预防控制措施，
3）给住院医师及其他工作人员提供关于CRKP的培训，
4）安排合格人员协调医院内部感染控制工作。
虽然照护院LTCF A的CRKP感染防控有较大的改善，仍在进行的调查还是发现了定植病例，最后一例临床案例在7月份被检测出。这些发现显示卫生保健体系具有潜在影响感染传播的因素。预防未来CRKP蔓延需要各个级别的护理干预。
在与地区卫生部和A 医院的合作下，WVBPH 在2月7号到9号进行了一项初期的实地调查研究，来确认所有的病例和找出感染的危险因素特点。病例被定义为，在2009.4至2011.2间，收入A医院的病人第一次检测出CRKP的病人。使用描述性统计分析来评估患者一般情况，所住医院，入院原因，住院条件，从入院到收集培养标本所需的时间。
另一实地调查研究是在2月21-24日之间，是为完成配对病例对照研究提取数据。对照组病人选自2009.4-2011.2中A医院住院病人中培养出对碳青霉烯敏感的肺炎克雷伯杆菌。尽可能的将每一例病例组病人同对照组两名病人年龄控制在10岁以内，标本的收集时间控制在14天以内。病例组及对照组病人数据的数据均包括病人的一般情况，初诊医院，留置设备和操作步骤，多耐药微生物史，在A医院和LTCF的停留史，合并疾病状况，（被称为察尔森合并指数）。
在初期实地调查中就已施行对A医院和LTCF A 的地点考察。对这两处场所监测的数据、手段及感染控制措施、手段进行回顾。根据疾病防治中心'提出的推荐草案，在A医院肿瘤科、内科/外科和LTCF A 设施中，开展了应用时点患病率来确定CRKP的基线患病率的研究。
应用统计学软件对从实地调查得到的数据和配对的病例对照研究进行处理。CRKP的危险因素通过准确的 logistic 回归分析进行，从中可以计算出二分法变量的精确比值比和95%可信区间。由于连续变量的非正态分布，所以应用中位数双样本检验来评估病例组病人及对照组病人的重要统计学差异。
所有的19例病例组病人的标本采集日期均在2009年4月4日至2011年2月21日之间。在这些病人之间，16名曾入住LCTFs，其中的14名来自LTCF A 。培养标本从这14名LTCF A 病人中的10位中采集，时间均小于入院后2日，这提示入院当时即已经被感染。
所有的38名对照组病人被选入。将病例组和对照组的多个特征进行列表分析。年龄，种族，察尔森合并指数在这两组中均相似，而病例组病人（58%）较对照组病人（16%）更倾向于男性。病例组病人有较长的住院时间（中位数为11.4天）和较多的先前住院次数（中位数为2.5）。
由于病例组病人样本数较小，CRKP感染的危险因素须用精确的logistic回归来评价。CRKP感染的风险，与先期在LCTF A 的留住（OR=46.6）及住院（OR=35.1）密切相关。病例组病人较对照组病人在诊断时间流动性、及在早年间在家度过时间上有较少的相似性。
A医院监测和感染控制手段证明是充分的，而LTCF A 的监测和感染控制手段是不足的。LCTF的感染预防专家职位空闲达9个月。电子监测系统虽然方便可行，但是这些设施却没有记录下实验室报告或者多重耐药菌状况。LCTF A 使用从未报告过碳青霉烯耐药菌株的医学实验室，以及未感染过CRKP的住院医师。工作人员手部卫生状况监测起来非常困难，手套、手术衣、垃圾桶等供应不当。实施时点患病率调查，29例A 医院的病人样本无一例检查出CRKP阳性，然而118例住院医师的标本中11例（9%），包括8例来自LCTF A 先前未检查出定植CRKP也呈阳性表现。5名A 医院临床隔离、11名LCTF A 的监测隔离的时点患病率调查研究正在等待疾病防治中心的认证以及脉冲凝胶电泳分析。所有的16名隔离病人被证实易感染产碳青霉酶烯类肺炎克雷伯杆菌和在脉冲凝胶电泳中有88%的相似度。
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发表于 2013-8-18 16:54
发表于 2013-10-20 12:00
