Carbapenem-Resistant Enterobacterales in Long-Term Care Facilities: A Global and Narrative Review.
Carbapenem-Resistant Enterobacterales in Long-Term Care Facilities: A Global and Narrative Review.
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DOI：
10.3389/fcimb.2021.601968
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发表时间：
2021
影响因子：
5.7
通讯作者：
Hsueh PR
中科院分区：
文献类型：
--
作者：
Chen HY;Jean SS;Lee YL;Lu MC;Ko WC;Liu PY;Hsueh PR
耐碳青霉烯肠杆菌（CRE）的出现已成为一个主要的公共卫生问题。此外，其在长期护理机构（ltcf）居民中的定植与随后的感染和死亡有关。为了进一步探讨长期护理设施中CRE的各个方面，我们对长期护理设施中CRE的定植和/或感染进行了文献综述。研究人员确定了常住社区居民，尤其是加州、意大利中部、西班牙、日本和台湾居民的CRE习得率和发生率。CRE在ltcf中占明显优势，特别是在机械通气的高敏度ltcf中，因此可能成为爆发中心。ltcf的CRE患病率显著高于急性护理机构和社区，这表明ltcf是CRE的重要储存库。在美国、西班牙和台湾的ltcf中，肺炎克雷伯菌是CRE的主要种类和基因组分析。序列型258的含kpc -2肺炎克雷伯菌菌株是美国ltcf中最常见的产kpc肺炎克雷伯菌序列型。产IMP-11和imp -6的CRE在日本的ltcf中普遍报道。OXA-48是西班牙ltcf中主要的碳青霉烯酶。发现与ltcf中CRE获得风险增加相关的多种危险因素，如合并症、免疫抑制状态、依赖功能状态、胃肠道装置或留置导管的使用、机械通气、既往抗生素暴露和既往培养报告。殖民化后，ltcf居民的CRE获取率较高，CRE携带时间延长。此外，被定植或感染CRE的ltcf患者临床结果较差，感染患者的死亡率高达75%。采取感染预防和控制措施以减少ltcf的CRE很重要，可能通过积极监测、接触预防措施、队列人员配置、每日洗必泰沐浴、卫生保健工作者教育和坚持手卫生来控制CRE。
The emergence of carbapenem-resistant Enterobacterales (CRE) has become a major public health concern. Moreover, its colonization among residents of long-term care facilities (LTCFs) is associated with subsequent infections and mortality. To further explore the various aspects concerning CRE in LTCFs, we conducted a literature review on CRE colonization and/or infections in long-term care facilities. The prevalence and incidence of CRE acquisition among residents of LTCFs, especially in California, central Italy, Spain, Japan, and Taiwan, were determined. There was a significant predominance of CRE in LTCFs, especially in high-acuity LTCFs with mechanical ventilation, and thus may serve as outbreak centers. The prevalence rate of CRE in LTCFs was significantly higher than that in acute care settings and the community, which indicated that LTCFs are a vital reservoir for CRE. The detailed species and genomic analyses of CRE among LTCFs reported that Klebsiella pneumoniae is the primary species in the LTCFs in the United States, Spain, and Taiwan. KPC-2-containing K. pneumoniae strains with sequence type 258 is the most common sequence type of KPC-producing K. pneumoniae in the LTCFs in the United States. IMP-11- and IMP-6-producing CRE were commonly reported among LTCFs in Japan. OXA-48 was the predominant carbapenemase among LTCFs in Spain. Multiple risk factors associated with the increased risk for CRE acquisition in LTCFs were found, such as comorbidities, immunosuppressive status, dependent functional status, usage of gastrointestinal devices or indwelling catheters, mechanical ventilation, prior antibiotic exposures, and previous culture reports. A high CRE acquisition rate and prolonged CRE carriage duration after colonization were found among residents in LTCFs. Moreover, the patients from LTCFs who were colonized or infected with CRE had poor clinical outcomes, with a mortality rate of up to 75% in infected patients. Infection prevention and control measures to reduce CRE in LTCFs is important, and could possibly be controlled via active surveillance, contact precautions, cohort staffing, daily chlorhexidine bathing, healthcare-worker education, and hand-hygiene adherence.
影响因子：
4.5
作者：
Johnson JK;Wilson LE;Zhao L;Richards K;Thom KA;Harris AD;Maryland Multidrug-Resistant Organism Prevention Collaborative
通讯作者：
Maryland Multidrug-Resistant Organism Prevention Collaborative