The importance of colonization pressure in multiresistant Acinetobacter baumannii acquisition in a Greek intensive care unit.
The importance of colonization pressure in multiresistant Acinetobacter baumannii acquisition in a Greek intensive care unit.
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DOI：
10.1186/cc11383
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发表时间：
2012-06-13
期刊：
影响因子：
--
通讯作者：
Miyakis S
中科院分区：
文献类型：
--
作者：
Arvaniti K;Lathyris D;Ruimy R;Haidich AB;Koulourida V;Nikolaidis P;Matamis D;Miyakis S
我们研究了定植压力对多重耐药鲍曼不动杆菌获得的作用，并定义了重症监护病房（ICU）患者入院时携带和住院期间获得的患者相关预测因素。这是一项为期12个月的前瞻性队列研究，研究对象为三级医院单一ICU收治的所有患者。在ICU入院时收集筛选样本以识别输入的携带者，并在住院期间每周收集筛选样本以识别获得。每周计算定植压力（携带者患者-天× 100/所有患者患者-天）和携带者的绝对数量，并探索这些参数与采集之间的统计学相关性。进行多变量分析以确定A.入院时和住院期间获得鲍曼不动杆菌。A.通过重复基因外回文聚合酶链反应（PCR; rep-PCR）对鲍曼不动杆菌分离株进行基因分型。在ICU入院时，对284名患者进行了携带筛查。A.鲍曼不动杆菌输入性感染16例（5.6%），获得性感染32例（15.7%）。采集与每周定植压力（相关系数，0.379; P = 0.004）和每周携带者数量（相关系数，0.499; P <0.001）显著相关。每周超过一个携带者显著增加了获得风险（两到三个携带者，比值比（OR），12.66; P = 0.028;超过四个携带者，OR，25.33; P = 0.004）。入院时感染（OR 11.03; CI 3.56 ~ 34.18; P < 0.01）和ICU前住院天数（OR 1.09; CI 1.01 ~ 1.16; P = 0.02）是入院时携带的预测因素。获得的预测因素是ICU入院的医学原因（OR，5.11; CI，1.31至19.93; P = 0.02），单位内抗生素给药持续时间（OR，1.24; CI，1.12 ~ 1.38; P < 0.001）和机械通气持续时间（OR，1.08; CI，1.04 ~ 1.13; P = 0.001）。所有菌株均为多重耐药。Rep-PCR分析显示一个优势聚类。获得多抗性A. ICU患者中的鲍曼不动杆菌与定植压力密切相关。高水平的殖民压力和每周超过两个载体独立增加收购风险。与患者相关的因素，如入院时的感染和进入ICU前的长时间住院，可以识别输入性A。鲍曼不动杆菌。在ICU中长期使用抗生素和长时间机械通气的内科患者最容易感染。
We investigated the role of colonization pressure on multiresistant Acinetobacter baumannii acquisition and defined patient-related predictors for carriage at admission and acquisition during hospitalization in intensive care unit (ICU) patients. This was a 12-month, prospective, cohort study of all patients admitted to a single ICU of a tertiary hospital. Screening samples were collected at ICU admission to identify imported carriers, and weekly during hospitalization to identify acquisition. Colonization pressure (carriers' patient-days × 100/all patients' patient-days) and the absolute number of carriers were calculated weekly, and the statistical correlation between these parameters and acquisition was explored. Multivariable analysis was performed to identify predictors for A. baumannii carriage at admission and acquisition during hospitalization. A. baumannii isolates were genotyped by repetitive-extragenic-palindromic polymerase chain reaction (PCR; rep-PCR). At ICU admission, 284 patients were screened for carriage. A. baumannii was imported in 16 patients (5.6%), and acquisition occurred in 32 patients (15.7%). Acquisition was significantly correlated to weekly colonization pressure (correlation coefficient, 0.379; P = 0.004) and to the number of carriers per week (correlation coefficient, 0.499; P <0.001). More than one carrier per week significantly increased acquisition risk (two to three carriers, odds ratio (OR), 12.66; P = 0.028; more than four carriers, OR, 25.33; P = 0.004). Predictors of carriage at admission were infection at admission (OR, 11.03; confidence interval (CI), 3.56 to 34.18; P < 0.01) and hospitalization days before ICU (OR, 1.09; CI, 1.01 to 1.16; P = 0.02). Predictors of acquisition were a medical reason for ICU admission (OR, 5.11; CI, 1.31 to 19.93; P = 0.02), duration of antibiotic administration in the unit (OR, 1.24; CI, 1.12 to 1.38; P < 0.001), and duration of mechanical ventilation (OR, 1.08; CI, 1.04 to 1.13; P = 0.001). All strains were multiresistant. Rep-PCR analysis showed one dominant cluster. Acquisition of multiresistant A. baumannii in ICU patients is strongly correlated to colonization pressure. High levels of colonization pressure and more than two carriers per week independently increase acquisition risk. Patient-related factors, such as infection at admission and long hospitalization before the ICU, can identify imported A. baumannii carriers. Medical patients with extended administration of antibiotics and long duration of mechanical ventilation in the ICU were the most vulnerable to acquisition.
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