A Candida auris Outbreak and Its Control in an Intensive Care Setting
A Candida auris Outbreak and Its Control in an Intensive Care Setting
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DOI：
10.1056/nejmoa1714373
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发表时间：
2018-10-04
影响因子：
158.5
通讯作者：
Jeffery, Katie J. M.
中科院分区：
文献类型：
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作者：
Eyre, David W.;Sheppard, Anna E.;Jeffery, Katie J. M.
背景：耳念珠菌是一种新兴的多重耐药病原菌。在这里，我们报告了一次医院爆发的金黄色葡萄球菌定植和感染的流行病学。方法在英国牛津大学医院神经科学重症监护病房（ICU）发现一群金黄色葡萄球菌感染后，我们制定了强化的患者和环境筛查计划和一揽子干预措施。采用多变量logistic回归确定金黄色葡萄球菌定植和感染的预测因素。通过全基因组测序对患者和环境分离株进行分析。结果2015年2月2日至2017年8月31日，共有70例患者被鉴定为金黄色葡萄球菌定植或感染；其中66例（94%）在诊断前曾入住神经科ICU。7例患者出现侵袭性耳念珠菌感染。在控制神经科ICU的住院时间、患者生命体征和实验室结果后，可重复使用的皮肤表面腋窝温度探头可预测耳球菌定植或感染(多变量优势比为6.80；95%可信区间[CI]， 2.96 ~ 15.63
BACKGROUNDCandida auris is an emerging and multidrug-resistant pathogen. Here we report the epidemiology of a hospital outbreak of C. auris colonization and infection.METHODSAfter identification of a cluster of C. auris infections in the neurosciences intensive care unit (ICU) of the Oxford University Hospitals, United Kingdom, we instituted an intensive patient and environmental screening program and package of interventions. Multivariable logistic regression was used to identify predictors of C. auris colonization and infection. Isolates from patients and from the environment were analyzed by whole-genome sequencing.RESULTSA total of 70 patients were identified as being colonized or infected with C. auris between February 2, 2015, and August 31, 2017; of these patients, 66 (94%) had been admitted to the neurosciences ICU before diagnosis. Invasive C. auris infections developed in 7 patients. When length of stay in the neurosciences ICU and patient vital signs and laboratory results were controlled for, the predictors of C. auris colonization or infection included the use of reusable skin-surface axillary temperature probes (multivariable odds ratio, 6.80; 95% confidence interval [CI], 2.96 to 15.63; P