Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: a nested case-control study
Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: a nested case-control study
复制标题
DOI：
10.1093/jac/dku077
复制
发表时间：
2014-07-01
影响因子：
5.2
通讯作者：
Peleg, Anton Y.
中科院分区：
文献类型：
--
作者：
Lim, Ching Jou;Cheng, Allen C.;Peleg, Anton Y.
长期护理设施（ltcf）是耐多药（MDR）生物的潜在重要储存库；然而，现有的数据有限。在澳大利亚的四个同址的ltcf中进行了一项点患病率研究。鼻腔和直肠拭子培养耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌（VRE）和耐多药革兰氏阴性杆菌（GNB）。进行分子分型和耐药性检测。采用巢式病例对照研究确定了耐多药病原菌定植的危险因素。136名符合条件的参与者中有115人（85%）同意。41名（36%）居民携带至少一种耐多药耐药菌。MRSA患病率为16% (naEuroS=aEuroS18)， VRE患病率为6% (naEuroS=aEuroS7)， MDR GNB患病率为21% [naEuroS=aEuroS24；包括产生广谱β -内酰胺酶（ESBL）的大肠杆菌（naeuro =aEuroS12）和鲍曼不动杆菌（naeuro =aEuroS6）]。产esbl的大肠杆菌和鲍曼不动杆菌多数为无性系。当前伤口管理[调整后的OR (AOR) 8.81 (95% CI 2.78 ~ 27.94), PaEuroS < aEuroS0.001]、医疗器械就地放置[AOR 5.58 (95% CI 1.34 ~ 23.32), paeuro =aEuroS0.018]和压疮[AOR 3.69 (95% CI 1.06 ~ 12.86), paeurs0.04]是耐多药菌定植的独立危险因素。晚期痴呆[AOR 3.54 (95% CI 1.23-10.23), paeuro =aEuroS0.02]和长期使用抗生素[AOR 2.95 (95% CI 1.01-8.60), paeuro =aEuroS0.047]与MRSA定植独立相关，而当前的伤口处理[AOR 15.59 (95% CI 4.85-50.10), paeuro < aEuroS0.001]和氟喹诺酮类药物使用[AOR 4.27 (95% CI 1.20-15.25), paeuro =aEuroS0.025]是MDR GNB定植的危险因素。ltcf是耐多药微生物的重要储存库，人际传播是一个潜在的问题。我们已经确定了几种耐多药生物定植的预测因素，从而允许对高风险居民进行更有针对性的管理。
Long-term care facilities (LTCFs) are a potentially important reservoir of multidrug-resistant (MDR) organisms; however, limited data exist.A point-prevalence study was conducted in four co-located LTCFs in Australia. Nasal and rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and MDR Gram-negative bacilli (GNB). Molecular typing and resistance detection were performed. Risk factors for colonization with an MDR organism were determined using a nested case-control study.Consent was obtained from 115 (85%) of 136 eligible participants. Forty-one (36%) residents carried at least one type of MDR organism. The prevalence was 16% MRSA (naEuroS=aEuroS18), 6% VRE (naEuroS=aEuroS7) and 21% MDR GNB [naEuroS=aEuroS24; including extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (naEuroS=aEuroS12) and Acinetobacter baumannii (naEuroS=aEuroS6)]. The majority of ESBL-producing E. coli and A. baumannii were clonal. Current wound management [adjusted OR (AOR) 8.81 (95% CI 2.78-27.94), PaEuroS < aEuroS0.001], medical device in situ [AOR 5.58 (95% CI 1.34-23.32), PaEuroS=aEuroS0.018] and pressure ulcer [AOR 3.69 (95% CI 1.06-12.86), PaEuroS=aEuroS0.04] were independent risk factors for MDR organism colonization. Advanced dementia [AOR 3.54 (95% CI 1.23-10.23), PaEuroS=aEuroS0.02] and prolonged antibiotic use [AOR 2.95 (95% CI 1.01-8.60), PaEuroS=aEuroS0.047] were independently associated with MRSA colonization, whilst current wound management [AOR 15.59 (95% CI 4.85-50.10), PaEuroS < aEuroS0.001] and fluoroquinolone use [AOR 4.27 (95% CI 1.20-15.25), PaEuroS=aEuroS0.025] were risk factors for MDR GNB colonization.LTCFs are an important reservoir of MDR organisms, with person-to-person transmissions being a potential issue. We have identified several predictors of colonization with MDR organisms, allowing a more targeted management of high-risk residents.