Risk factors for colonisation of newborn infants during an outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit
Risk factors for colonisation of newborn infants during an outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit
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DOI：
10.1016/j.jhin.2008.11.019
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发表时间：
2009-04-01
影响因子：
6.9
通讯作者：
Menezes, P. R.
中科院分区：
文献类型：
--
作者：
Cassettari, V. C.;da Silveira, I. R.;Menezes, P. R.
我们描述了一项横断面调查，以确定由广谱p -内酰胺酶（ESBL）产生肺炎克雷伯菌定植新生儿的危险因素。这是在一名中等风险新生儿爆发期间接触到一名殖民化的卫生保健工作者后发生的。单位。在三个月内连续入院的120名新生儿通过直肠拭子筛查产生esbl的肺炎克雷伯菌，其中27名被确定为定植。多变量分析显示，定植与抗生素的使用和缺乏母乳喂养独立相关。既往使用抗生素的优势比（OR）为12.3[95%可信区间]。（Cl）： 3.66 ~ 41.2, P < 0.001]。最常用的抗生素是青霉素和阿米卡星。母乳喂养与降低定植风险相关（OR: 0.22; 95% Cl: 0.05-0.99; P = 0.049）。在疫情暴发的第一阶段回收了9株分离株，此后通过脉冲场凝胶电泳对监测培养的27株分离株进行了分型，揭示了6种不同的特征（A-F）。克隆A、C和E与暴发的第一阶段有关，而在从监测培养中恢复的27株毒株中，已确定了所有6个克隆。在一名患甲癣的护理辅助人员的手上也发现克隆A。我们得出结论，先前使用抗菌素易导致定植。母乳喂养作为一种保护因素的可能作用需要进一步阐明。对产生ESBL的肺炎克雷伯菌不同基因型的检测表明，在疫情期间，携带ESBL基因的移动遗传元件的传播可能叠加在克隆的简单传播上。(c) 2008年医院感染学会。Elsevier Ltd.出版。版权所有。
We describe a cross-sectional, survey to identify risk factors for colonisation of neonates by extended-spectrum P-Lactamase (ESBL)-producing Klebsiella pneumoniae. This occurred following exposure to a colonised healthcare worker during an outbreak in an intermediate-risk neonatal. unit. In total, 120 neonates admitted consecutively during a three-month period were screened for ESBL-producing K. pneumoniae by rectal swabbing and 27 were identified as colonised. Multivariate analysis showed colonisation to be independently associated with use of antibiotics and absence of breastfeeding. Previous use of antibiotics presented an odds ratio (OR) of 12.3 [95% confidence interval. (Cl): 3.66-41.2, P < 0.001]. The most commonly used antibiotics were penicillin and amikacin. Breastfeeding was associated with reduced risk for colonisation (OR: 0.22; 95% Cl: 0.05-0.99; P = 0.049). Nine isotates recovered during the first stage of the outbreak and 27 isolates from surveillance cultures were typed thereafter by pulsed-field gel electrophoresis, revealing six different profiles (A-F). Clones A, C, and E were implicated in the first stage of the outbreak, whereas among the 27 strains recovered from surveillance cultures, all six clones were identified. Clone A was also found on the hand of a nursing auxiliary with onychomycosis. We concluded that prior antimicrobial use predisposed to colonisation. The possible role of breastfeeding as a protective factor needs to be further elucidated. Detection of different genotypes of ESBL-producing K. pneumonioe suggests that dissemination of mobile genetic elements bearing the ESBL gene may have been superimposed on the simple dissemination of a clone during the outbreak. (c) 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.