Epidemics of nosocomial urinary tract infection caused by multiply resistant gram-negative bacilli: epidemiology and control.
Epidemics of nosocomial urinary tract infection caused by multiply resistant gram-negative bacilli: epidemiology and control.
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多重耐药革兰氏阴性杆菌引起的院内尿路感染的流行：流行病学和控制。
DOI：
10.1093/infdis/133.3.363
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发表时间：
1976
期刊：
影响因子：
--
通讯作者：
W. Stamm
中科院分区：
文献类型：
--
作者：
D. Schaberg;R. Weinstein;W. Stamm
对现有抗菌药物高度耐药的医院病原体的出现是任何医院关注的原因。革兰氏阴性菌作为医院病原体的频率越来越高[1-3]，抗菌治疗的选择性压力有利于更耐药菌株的持续存在。此外，这些生物体引起疾病的能力由于医院中宿主防御受损的患者的日益普遍而增强。在过去五年中疾病控制中心调查的医院感染爆发中，七次大规模的尿路感染流行（过去两年中有五次）引起了我们的注意，因为病原体的耐药性非常高。我们回顾了这些流行病学调查的结果和所采取的控制措施。这七起疫情是由三种不同的微生物引起的：肺炎克雷伯氏菌、粘质沙雷氏菌和雷氏变形杆菌（表1）。我们没有调查任何由于假单胞菌引起的暴发，假单胞菌是一种经常引起多重耐药医院感染的微生物。这一事实可能反映了假单胞菌很少引起流行病的趋势[4]，或者更普遍地接受对抗生素的耐药性作为这种病原体的特征。在所有七种流行病中，医院工作人员最初的一个主要关切是缺乏有效的抗菌治疗，或担心在选择性压力下，会对唯一有效的药物产生耐药性。一种单一的抗菌药物敏感性模式在每一种中占主导地位-
The emergence of nosocomial pathogens highly resistant to available antimicrobial agents is a cause for concern in any hospital. Gram-negative organisms are being encountered as nosocomial pathogens with increasing frequency [1-3], and selective pressures of antimicrobial therapy favor the persistence of more resistant strains. Further-more, the ability of these organisms to cause disease is enhanced by the increasing prevalence in hospitals of patients with impaired host defenses. Among the outbreaks of nosocomial infection in-vestigated by the Center for Disease Control during the last five years, seven large epidemics of urinary tract infection (five in the last two years) came to our attention because of the ex-tremely high level of drug resistance of the causa-tive organisms. We have reviewed the results of these epidemiologic investigations and the control measures that were instituted.The seven outbreaks were caused by three different organisms: Klebsiella pneumoniae, Serratia marcescens, and Proteus rettgeri (table 1). We did not investigate any outbreaks due to Pseu-domonas, an organism that often causes multi-drug-resistant nosocomial infections. This fact may reflect the tendency of Pseudomonas to cause epidemics infrequently [4] or a greater general acceptance of resistance to antibiotics as a characteristic of this pathogen. In all seven epidemics, a major initial concern of hospital personnel was the lack of effective antimicrobial therapy or fear that, with selective pressure, resistance to the only effective agent would develop. A single pattern of antimicrobial sensitivity predominated in each out-