Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli
Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli
复制标题
DOI：
10.1093/ofid/ofv011
复制
发表时间：
2015-12-01
影响因子：
4.2
通讯作者：
Banerjee, Ritu
中科院分区：
文献类型：
--
作者：
Burgess, Mary J.;Johnson, James R.;Banerjee, Ritu
背景新出现的数据表明，长期护理机构（LTCF）是序列类型131（ST 131）的氟喹诺酮耐药（EST-R）大肠杆菌的储存库。我们在LTCF居民中筛选ST 131，分子特征分离株，并确定定植的危险因素。2013年4月至7月，我们在明尼苏达州奥姆斯特德县的2个LTCF中使用每位居民的单个肛周拭子或粪便样本进行了一项横断面研究。已确认的E.R.E.大肠杆菌分离株进行聚合酶链反应为基础的RT-PCR分型，检测ST 131及其H30和H30-Rx亚克隆，扩展毒力基因分型，和脉冲场凝胶电泳（PFGE）分析。从病历中收集流行病学资料。在133份粪便样品中，33份（25%）产生了Escherichia coli。大肠埃希菌32株（97%）为ST 131。ST 131肠道定植的总体比例为133例中的32例（24%），这因设施而异：设施1中的41例中有17例（42%），而设施2中的92例中有15例（16%）（P = 0.002）。所有ST 131分离株均代表H30亚克隆，毒力基因和PFGE图谱与先前描述的ST 131临床分离株相似。通过PFGE，某些菌株在LTCF内和LTCF之间聚集。ST 131定植的多变量预测因子包括无法签署同意书（优势比[OR]，4.16 [P = .005]）、褥疮（OR，4.87 [P = .04]）和大便失禁（OR，2.59 [P = .06]）。大约四分之一的LTCF居民携带ST 131 E。大肠杆菌类似于ST 131临床分离株。脉冲场凝胶电泳表明内和设施间的传输。已确定的风险因素表明，需要增加护理的LTCF居民ST 131定植的风险最大，可能是由于医疗保健相关的传播。
Background. Emerging data implicate long-term care facilities (LTCFs) as reservoirs of fluoroquinolone-resistant (FQ-R) Escherichia coli of sequence type 131 (ST131). We screened for ST131 among LTCF residents, characterized isolates molecularly, and identified risk factors for colonization.Methods. We conducted a cross-sectional study using a single perianal swab or stool sample per resident in 2 LTCFs in Olmsted County, Minnesota, from April to July 2013. Confirmed FQ-R E. coli isolates underwent polymerase chain reaction-based phylotyping, detection of ST131 and its H30 and H30-Rx subclones, extended virulence genotyping, and pulsed-field gel electrophoresis (PFGE) analysis. Epidemiological data were collected from medical records.Results. Of 133 fecal samples, 33 (25%) yielded FQ-R E. coli, 32 (97%) of which were ST131. The overall proportion with ST131 intestinal colonization was 32 of 133 (24%), which differed by facility: 17 of 41 (42%) in facility 1 vs 15 of 92 (16%) in facility 2 (P = .002). All ST131 isolates represented the H30 subclone, with virulence gene and PFGE profiles resembling those of previously described ST131 clinical isolates. By PFGE, certain isolates clustered both within and across LTCFs. Multivariable predictors of ST131 colonization included inability to sign consent (odds ratio [OR], 4.16 [P = .005]), decubitus ulcer (OR, 4.87 [P = .04]), and fecal incontinence (OR, 2.59 [P = .06]).Conclusions. Approximately one fourth of LTCF residents carried FQ-R ST131 E. coli resembling ST131 clinical isolates. Pulsed-field gel electrophoresis suggested intra-and interfacility transmission. The identified risk factors suggest that LTCF residents who require increased nursing care are at greatest risk for ST131 colonization, possibly due to healthcare-associated transmission.