Surveillance cultures and duration of carriage of multidrug-resistant Acinetobacter baumannii
Surveillance cultures and duration of carriage of multidrug-resistant Acinetobacter baumannii
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DOI：
10.1128/jcm.02424-06
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发表时间：
2007-05-01
影响因子：
9.4
通讯作者：
Carmeli, Yehuda
中科院分区：
文献类型：
--
作者：
Marchaim, Dror;Navon-Venezia, Shiri;Carmeli, Yehuda
隔离多重耐药鲍曼不动杆菌携带者是预防其传播的主要措施。识别携带者并采取接触预防措施至关重要。我们的目的是确定适当的监测采样点和 MDR 鲍曼不动杆菌的携带持续时间。我们前瞻性地研究了两组先前分离出 MDR 鲍曼不动杆菌的患者：(i) 最近进行临床隔离（= 6 个月）的患者。从六个部位进行携带筛查：鼻孔、咽部、皮肤、直肠、伤口和气管内抽吸物。使用脉冲场凝胶电泳对从不同位点同时回收的菌株进行基因分型。最近临床分离出 MDR 鲍曼不动杆菌的 22 例患者中，有 12 例的筛选培养物呈≥ 1 例阳性，因此当对 6 个身体部位进行采样时，敏感性为 55%。单个站点的敏感性范围为 13.5% 至 29%。在 30 名远程临床隔离患者中，5 名（17%）筛查培养呈阳性，距离最后一次临床培养平均持续时间为 17.5 个月。远程携带者的皮肤和咽部培养结果呈阳性，但鼻子、直肠、伤口或气管内抽吸物的培养结果却没有。对来自 5 名患者的 11 株菌株进行了基因分型。除一例外，在所有情况下，来自特定患者不同部位的分离株都是克隆的。目前的方法不足以检测 MDR 鲍曼不动杆菌携带情况。即使对六个不同的身体部位进行了采样，监测培养的敏感性也很低。先前分离出 MDR 鲍曼不动杆菌的个体中，长期保持携带者的比例相当大。在设计限制耐多药鲍曼不动杆菌传播的措施时应考虑这些数据。
Isolating carriers of multidrug-resistant (MDR) Acinetobacter baumannii is the main measure to prevent its spread. Identification of carriers accompanied by contact precautions is essential. We aimed to determine the appropriate surveillance sampling sites and the duration of carriage of MDR A. baumannii. We studied prospectively two groups of patients from whom MDR A. baumannii was previously isolated: (i) those with recent clinical isolation (= 6 months). Screening for carriage was conducted from six sites: nostrils, pharynx, skin, rectum, wounds, and endotracheal aspirates. Strains recovered concurrently from different sites were genotyped using pulsed-field gel electrophoresis. Twelve of 22 with recent clinical isolation of MDR A. baumannii had >= 1 positive screening culture, resulting in a sensitivity of 55% when six body sites were sampled. Sensitivities of single sites ranged from 13.5% to 29%. Among 30 patients with remote clinical isolation, screening cultures were positive in 5 (17%), with a mean duration of 17.5 months from the last clinical culture. Remote carriers had positive screening cultures from the skin and pharynx but not from nose, rectum, wounds, or endotracheal aspirates. Eleven strains from five patients were genotyped. In all but one case, isolates from different sites in a given patient were clonal. Current metholodology is suboptimal to detect MDR A. baumannii carriage. The sensitivity of surveillance cultures is low, even when six different body sites are sampled. The proportion of individuals with previous MDR A. baumannii isolation who remain carriers for prolonged periods is substantial. These data should be considered when designing measures to limit the spread of MDR A. baumannii.