Germs of thrones - spontaneous decolonization of Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) in Western Europe: is this myth or reality?
Germs of thrones - spontaneous decolonization of Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) in Western Europe: is this myth or reality?
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权力的细菌-西欧碳青霉烯类耐药肠杆菌科（CRE）和万古霉素耐药肠球菌（VRE）的自发去殖民化：这是神话还是现实？
DOI：
10.1186/s13756-018-0390-5
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发表时间：
2018-08-13
影响因子：
5.5
通讯作者：
Salomon, Jerome
中科院分区：
文献类型：
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作者：
Davido, Benjamin;Moussiegt, Aurore;Salomon, Jerome
背景资料：在法国，耐碳青霉烯类肠杆菌科（CRE）和耐万古霉素肠球菌（VRE）被认为是广泛耐药（XDR）细菌。他们的管理需要加强医院的卫生政策，目前很少有一致的数据关于XDR殖民患者的自发殖民。我们的目的是研究随着时间的推移，在一个低患病率的国家的医院环境中的XDR载体的非殖民化的自然史材料和方法：回顾性多中心研究超过2年（2015-2016年）在2个不同的三级保健医院网站和单位有一个协议，永久cohort的这种XDR载体。我们收集了患者随访期间的微生物类型、定植风险因素和直肠拭子。结果：我们纳入了125例患者，年龄63+/-19岁，包括72.8%的CRE（n = 91），24.8%的VRE（n = 31）和2.4%（n = 3）与CRE和VRE共定植。CRE主要为E. coli（n = 54）、K. pneumoniae（n = 51）和E. clopidogrel（n = 6）。耐药机制主要为OXA-48（n = 69）、NDM-1（n = 11）、OXA-232（n = 8）和KPC（n = 3）。相反地，17.6%（n = 22）的患者在随访期间接受了抗生素治疗，16.4%的患者在最初30天内出现了自发的非殖民化（n = 19/116）的病例中，在90天后高达48.2%，中位随访时间为96天（0-974）。我们估计，13.6%（n = 17）的患者携带XDR与更大的护理负担相关。的情况下，特别是由于延长住院32.5天（15-300）。结论：我们的研究表明，自发的殖民地增加，随着时间的推移（高达48.2%）。我们遗憾的是，只有少数患者在1年后接受筛查，强调需要更多的监测和前瞻性研究。
Background: In France, Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) are considered as Extensively Drug-Resistant (XDR) bacteria. Their management requires reinforcement of hospital's hygiene policies, and currently there is few consistent data concerning the spontaneous decolonization in XDR colonized patients. Our aim is to study the natural history of decolonization of XDR carriers over time in a hospital setting in a low prevalence country.Material and methods: Retrospective multicenter study over 2 years (2015-2016) in 2 different tertiary care hospital sites and units having an agreement for permanent cohorting of such XDR carriers. We gathered the type of microorganisms, risk factors for colonization and rectal swabs from patient's follow-up. We also evaluated patient care considering isolation precautions.Results: We included 125 patients, aged 63+/-19y, including 72.8% of CRE (n = 91), 24.8% of VRE (n = 31) and 2.4% (n = 3) co-colonized with CRE and VRE. CRE were mainly E. coli (n = 54), K. pneumoniae (n = 51) and E. cloacae (n = 6). Mechanisms of resistance were mainly OXA-48 (n = 69), NDM-1 (n = 11), OXA-232 (n = 8) and KPC (n = 3).Prior antibiotic therapy was reported in 38.4% (n = 48) of cases. Conversely, 17.6% (n = 22) received antibiotics during follow-up.Spontaneous decolonization occurred within the first 30 days in 16.4% (n = 19/116) of cases and up to 48.2% after day-90 with a median follow-up of 96 days (0-974).We estimated that XDR carriage was associated with a larger care burden in 13.6% (n = 17) of cases, especially due to a prolongation of hospitalization of 32.5 days (15-300).Conclusions: Our study shows that spontaneous decolonization is increasing over time (up to 48.2%). We can regret that only few patients underwent screening after 1 year, emphasizing the need for more monitoring and prospective studies.