Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon
Carriage of beta-lactamase-producing Enterobacteriaceae among nursing home residents in north Lebanon
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黎巴嫩北部养老院居民产β-内酰胺酶肠杆菌携带情况
DOI：
10.1016/j.ijid.2016.02.007
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发表时间：
2016-04-01
影响因子：
8.4
通讯作者：
Daoud, Ziad
中科院分区：
文献类型：
--
作者：
Dandachi, Iman;Sokhn, Elie Salem;Daoud, Ziad
背景：多重耐药（MDR）肠杆菌科细菌可引起严重感染，具有高发病率、死亡率和医疗费用。个体可以是这些耐药生物的粪便携带者。关于黎巴嫩社区环境中MDR肠杆菌科粪便携带程度的数据非常缺乏。本研究的目的是调查位于北部黎巴嫩的两个养老院的老年居民之间的MDR肠杆菌科的粪便携带情况。方法：在4个月的时间内，收集5个粪便拭子样本，每个68名老年人在定期的间隔3-4周。粪便拭子在选择性培养基上传代培养，以筛选耐药微生物。使用β-内酰胺酶抑制剂乙二胺四乙酸、苯硼酸和氯唑西林对超广谱β-内酰胺酶（ESBL）、AmpC、金属β-内酰胺酶（MBL）和肺炎克雷伯菌碳青霉烯酶（KPC）进行表型检测。替莫西林片用于OXA-48。多重PCR用于ESBL和碳青霉烯酶基因的基因型检测，并进行测序以鉴定CTX-M-15。每个主题的医疗记录进行了定期审查，以评估与MDR肠杆菌科粪便carriage.Results相关的风险因素：在研究期间，76.5%的招募老年人至少有一次载体。共获得178个分离株。表型检测结果显示，产ESBL菌占91.5%，产AmpC菌占4%，产ESBL和AmpC菌共占2.8%，产OXA-48和ESBL菌共占1.7%。最近的抗生素摄入量被认为是唯一的独立危险因素与粪便携带的MDR Enterobacteriaceae.Conclusions：在这项研究中检测到的MDR Enterobacteriaceae的高患病率和碳青霉烯耐药的出现是令人震惊的。在这些环境中迫切需要有效的感染控制措施和抗生素管理计划，以限制耐药菌株的传播。(C)2016年6月，作者。由Elsevier Ltd代表国际传染病学会出版。这是一个在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Background: Multidrug-resistant (MDR) Enterobacteriaceae can cause severe infections with high morbidity, mortality, and health care costs. Individuals can be fecal carriers of these resistant organisms. Data on the extent of MDR Enterobacteriaceae fecal carriage in the community setting in Lebanon are very scarce. The aim of this study was to investigate the fecal carriage of MDR Enterobacteriaceae among the elderly residents of two nursing homes located in north Lebanon.Methods: Over a period of 4 months, five fecal swab samples were collected from each of 68 elderly persons at regular intervals of 3-4 weeks. Fecal swabs were subcultured on selective media for the screening of resistant organisms. The phenotypic detection of extended-spectrum beta-lactamase (ESBL), AmpC, metallo-beta-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) production was performed using the beta-lactamase inhibitors ethylenediaminetetraacetic acid, phenylboronic acid, and cloxacillin. A temocillin disk was used for OXA-48. Multiplex PCRs were used for the genotypic detection of ESBL and carbapenemase genes, and sequencing was performed to identify CTX-M-15. The medical records of each subject were reviewed on a regular basis in order to assess the risk factors associated with MDR Enterobacteriaceae fecal carriage.Results: Over the study period, 76.5% of the recruited elderly persons were at least one-time carriers. A total of 178 isolates were obtained. Phenotypic testing revealed that 91.5% of them were ESBL producers, 4% were AmpC producers, 2.8% were co-producers of ESBL and AmpC, and 1.7% were co-producers of OXA-48 and ESBL. Recent antibiotic intake was found to be the only independent risk factor associated with the fecal carriage of MDR Enterobacteriaceae.Conclusions: The high prevalence of MDR Enterobacteriaceae detected in this study and the emergence of carbapenem resistance is alarming. Efficient infection control measures and antibiotic stewardship programs are urgently needed in these settings in order to limit the spread of resistant strains. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).