Prospective surveillance for antibiotic-resistant organisms in patients with spinal cord injury admitted to an acute rehabilitation unit
Prospective surveillance for antibiotic-resistant organisms in patients with spinal cord injury admitted to an acute rehabilitation unit
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DOI：
10.1067/mic.2000.107424
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发表时间：
2000-08-01
影响因子：
4.9
通讯作者：
Goodnough, S
中科院分区：
文献类型：
--
作者：
Mylotte, JM;Kahler, L;Goodnough, S
方法：对1997年1月至1998年7月收治的63例脊髓损伤患者在知情同意后，分别于入院时和入院后每隔2周进行一次监测培养(鼻孔、尿液、伤口或溃疡、会阴)，直至出院或最长达6周。结果：在4个监测点中，会阴培养最常见的是一种或多种潜在致病菌；然而，耐药菌大多是从伤口或溃疡中分离出来的，很少是在尿培养中分离出来的。金黄色葡萄球菌(甲氧西林敏感和耐甲氧西林)和肠球菌占监测培养中分离的所有微生物的44%。耐甲氧西林的S金黄色葡萄球菌是最常见的耐药菌。在分离出的革兰氏阴性杆菌中，只有不到30%的菌株被认为是耐药菌株。由任何耐药细菌引起的医院感染并不常见。在Logistic回归模型中调整了各种混杂因素后，只有压疮的存在才能预测康复单元入院时携带任何耐药生物体。在36例非入院时定植的患者中，8例(22%)在入院后在一个或多个监测点获得耐药菌。结论：耐甲氧西林S金黄色葡萄球菌是脊髓损伤患者入院时和整个住院期间最常见的耐药菌。然而，在入院后获得任何耐药微生物在这个病房是不常见的，它在患者的常规护理中使用标准预防措施。这些发现对急性康复病房的隔离程序类型有一定的影响。入院后的低获得率和MRSA感染率反对将根除作为一种控制方法。
Background: The objective of this study was to evaluate the epidemiology of antibiotic-resistant organisms among patients with spinal cord injury admitted to an acute rehabilitation unit for the first time.Methods: After informed consent, 63 patients with spinal cord injury admitted to an acute rehabilitation unit between January 1997 and July 1998 had surveillance cultures (nares, urine, wounds or ulcers, and perineum) done on admission and every 2 weeks thereafter until discharge or as long as 6 weeks after admission.Results: Of the 4 surveillance sites, perineal cultures most commonly grew one or more potential pathogens; however, antibiotic-resistant organisms were most often isolated fi om wounds or ulcers and least often in urine cultures. Staphylococcus aureus (methicillin-sensitive plus methicillin-resistant) and enterococci represented 44% of all organisms isolated in surveillance cultures. Methicillin-resistant S aureus was the most common resistant organism isolated. Less than 30% of the gram-negative bacilli isolated were considered antibiotic-resistant strains. Nosocomial infection as a result of any resistant organism was infrequent. After adjusting for various confounding factors in a logistic regression model, only the presence of a pressure ulcer predicted carriage of any resistant organism on admission to the rehabilitation unit. Acquisition of a resistant organism after admission to the unit at one or more surveillance sites occurred in 8 (22%) of 36 patients not colonized on admission.Conclusions: Methicillin-resistant S aureus was the most common resistant organism colonizing patients with spinal cord injury at the time of admission to an acute rehabilitation unit and throughout their stay. However, acquisition of any resistant organism after admission was uncommon on this unit, which used Standard Precautions in the routine care of patients. These findings have implications for the type of isolation procedures on acute rehabilitation units. The low rate of acquisition and infection with MRSA after admission argues against attempts at eradication as a method of control.