Risk factors for colonization and infection by Pseudomonas aeruginosa in patients hospitalized in intensive care units in France.
Risk factors for colonization and infection by Pseudomonas aeruginosa in patients hospitalized in intensive care units in France.
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DOI：
10.1371/journal.pone.0193300
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Thiébaut R
中科院分区：
文献类型：
--
作者：
Hoang S;Georget A;Asselineau J;Venier AG;Leroyer C;Rogues AM;Thiébaut R
铜绿假单胞菌是导致重症监护病房(ICU)病死率较高的主要医院病原菌。众所周知，铜绿假单胞菌的传播部分是内源性的，也有外源性的。已经强调了主要因素，但环境在抗生素使用方面的确切作用仍不清楚。评估环境、医疗护理和个体风险因素对铜绿假单胞菌定植和感染的作用。法国的一项多中心前瞻性研究涉及10个ICU，为期5个月。纳入入院后48小时内未携带铜绿假单胞菌的ICU中新入院的成年患者，并在出院或死亡前每周进行筛查。筛查拭子为直肠、痰或口咽样本。每周对氢气环境进行采样。定期收集患者临床特征、环境和设备暴露以及抗生素支持的数据。采用多态模型进行多变量分析。铜绿假单胞菌携带率为15.3%(201/1314)。与患者定植有关的危险因素有：对铜绿假单胞菌使用非活性抗生素(HR=1.6[1.15-2.21]p<；0.01)、房间入口处自来水污染(HR=1.66[1.01-2.27]p<；0.05)和机械有创呼吸机(HR=4.7[2.66-8.31]p<；0.0001)。预防活性抗生素定植(HR=0.67[0.48-0.93]P=0.02)和预防感染(HR=0.64[0.41-1.01]P=0.05)。氢环境抗生素支持之间的相互作用与患者的定植没有统计学上的相关性。氢气污染和抗生素压力似乎仍然是铜绿假单胞菌定植的关键独立危险因素。这些结果表明，有必要对医疗保健相关感染进行预防性和有针对性的干预。
Pseudomonas aeruginosa (P.aeruginosa) remains a prominent nosocomial pathogen responsible for high morbi-mortality in intensive care units (ICUs). P.aeruginosa transmission is known to be partly endogenous and exogenous. Main factors have been highlighted but the precise role of environment in regard to antibiotics use remained unclear. To assess the role of environment, medical care and individual risks factors for P. aeruginosa colonization and infection. A French multicentric prospective study involved ten ICUs for a five months period. Every adult patient newly hospitalized in ICUs with no P. aeruginosa carriage up to 48 hours after admission was included and weekly screened before discharge or death. Screening swabs were either rectal, sputum or oropharyngeal samples. Hydric environment was also sampled each week. Data on patient clinical features, environmental and device exposures, and antibiotics supports were regularly collected. Multivariate analysis was performed with a multistate model. The overall prevalence of P. aeruginosa carriage was 15.3% (201/1314). Risk factors associated with patient colonization were: use of inactive antibiotics against P. aeruginosa (HR = 1.60 [1.15–2.21] p<0.01), tap water contamination at the entry in the room (HR = 1.66 [1.01–2.27] p<0.05) and mechanical invasive ventilation (HR = 4.70 [2.66–8.31] p<0.0001). Active antibiotics prevented from colonization (HR = 0.67 [0.48–0.93] p = 0.02) and from infection (HR = 0.64 [0.41–1.01] p = 0.05). Interaction between hydric environment antibiotics support was not statistically associated with patient colonization. Hydric contamination and antibiotics pressure seem to remain key independent risk factors in P. aeruginosa colonization. These results advocate the need to carry on preventive and targeted interventions toward healthcare associated infections.
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