Nosocomial infections with metallo-beta-lactamase-producing Pseudomonas aeruginosa: molecular epidemiology, risk factors, clinical features and outcomes
Nosocomial infections with metallo-beta-lactamase-producing Pseudomonas aeruginosa: molecular epidemiology, risk factors, clinical features and outcomes
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DOI：
10.1016/j.jhin.2014.05.007
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发表时间：
2014-08-01
影响因子：
6.9
通讯作者：
Raboni, S. M.
中科院分区：
文献类型：
--
作者：
Lucena, A.;Dalla Costa, L. M.;Raboni, S. M.
背景：金属- β -内酰胺酶（MBLs）已成为最重要的细菌耐药机制之一，因为它们具有水解几乎所有β -内酰胺类药物的能力。产生mbl的铜绿假单胞菌（MBL-PA）是院内感染的一个重要原因，特别是在重症监护病房（icu），在那里它们与严重感染相关，并具有显著的临床风险。目的：了解巴西南部某教学医院MBL-PA致医院感染的分子流行病学、危险因素及预后。方法：2001年1月至2008年12月，从住院患者不同临床标本中分离出142株耐碳青霉烯类铜绿假单胞菌。筛选这些分离株的MBLs，并进行聚合酶链反应、测序和脉冲场凝胶电泳（PFGE）。感染耐碳青霉烯MBL-PA的患者作为病例，感染非MBL-PA的患者作为对照。结果：142例碳青霉烯耐药P.铜绿假单胞菌培养阳性患者中有84例符合疾病控制和预防中心的感染标准。58例患者感染MBL-PA(69%)， 26例患者感染非MBL-PA（31%）。多因素分析显示，ICU住院时间[P = 0.003，优势比（OR） 4.01, 95%可信区间（CI） 1.15 ~ 14.01]和尿路感染（P = 0.001, OR 9.67, 95% CI 1.72 ~ 54.48）是MBL-PA感染的重要危险因素。感染MBL-PA的患者发病更快（P = 0.002），死亡进展更快（P = 0.04）。结论：这些结果显示了MBL-PA感染的严重程度，并表明迫切需要改善感染控制措施的策略，以防止这些医院感染的增加。(C) 2014卫生保健感染学会。Elsevier Ltd.出版。版权所有。
Background: Metallo-beta-lactamases (MBLs) have emerged as one of the most important bacterial resistance mechanisms because of their ability to hydrolyse virtually all beta-lactam agents. MBL-producing Pseudomonas aeruginosa (MBL-PA) are an important cause of nosoconnial infections, particularly in intensive care units (ICUs), where they are associated with serious infections and present a significant clinical risk.Aim: To assess the molecular epidemiology, risk factors and outcomes of nosocomial infections caused by MBL-PA in a teaching hospital in Southern Brazil.Methods: From January 2001 to December 2008, 142 carbapenem-resistant P. aeruginosa strains were isolated from distinct clinical samples from hospitalized patients. These isolates were screened for MBLs, and underwent polymerase chain reaction, sequencing and pulsed-field gel electrophoresis (PFGE). Patients infected with carbapenem-resistant MBL-PA were considered as cases, and patients infected with non-MBL-PA were considered as controls.Findings: Eighty-four of 142 patients with positive carbapenem-resistant P. aeruginosa cultures met the criteria of the Centers for Disease Control and Prevention for infection. Fifty-eight patients were infected with MBL-PA (69%) and 26 patients were infected with non-MBL-PA (31%). Multi-variate analysis revealed that ICU stay [P = 0.003, odds ratio (OR) 4.01, 95% confidence interval (CI) 1.15-14.01] and urinary tract infection (P = 0.001, OR 9.67, 95% CI 1.72-54.48) were important risk factors for MBL-PA infection. Patients infected with MBL-PA showed faster onset of infection (P = 0.002) and faster progression to death (P = 0.04).Conclusions: These results showed the severity of MBL-PA infections, and demonstrated the urgent need for strategies to improve infection control measures to prevent an increase in these nosocomial infections. (C) 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.