Antimicrobial-Resistant Klebsiella pneumoniae Carriage and Infection in Specialized Geriatric Care Wards Linked to Acquisition in the Referring Hospital.
Antimicrobial-Resistant Klebsiella pneumoniae Carriage and Infection in Specialized Geriatric Care Wards Linked to Acquisition in the Referring Hospital.
复制标题
DOI：
10.1093/cid/ciy027
复制
发表时间：
2018-07-02
期刊：
影响因子：
--
通讯作者：
Holt KE
中科院分区：
文献类型：
--
作者：
Gorrie CL;Mirceta M;Wick RR;Judd LM;Wyres KL;Thomson NR;Strugnell RA;Pratt NF;Garlick JS;Watson KM;Hunter PC;McGloughlin SA;Spelman DW;Jenney AWJ;Holt KE
患者自身肠道菌群是肺炎克雷伯菌的主要来源，但超广谱β-内酰胺酶菌株是在转诊医院获得的。这突出了直肠筛查的潜力，以及更广泛的医院网络对当地风险管理的重要性。 肺炎克雷伯菌是产超广谱β-内酰胺酶（ESBL）的医院相关感染的主要原因，老年患者的风险增加。我们进行了一项为期1年的前瞻性队列研究，其中三分之一的患者在一家专科医院的2个老年病房被招募和筛查携带K。pneumoniae通过微生物培养。通过医院实验室监测临床分离株。对定植和临床分离株进行全基因组测序和抗菌药物敏感性测试。 K.肺炎克雷伯菌咽部携带率为4.1%，直肠携带率为10.8%，ESBL携带率为1.7%。肺炎感染率为1.2%。分离株是多样的，大多数患者被殖民或感染了一个独特的系统发育谱系，没有证据表明在病房传播。ESBL菌株携带blaCTX-M-15，属于与其他国家医院获得性ESBL感染相关的克隆（序列类型[ST] 29、ST 323和ST 340）。1例还携带碳青霉烯酶blaIMP-26。基因组和流行病学数据提供证据表明，ESBL菌株是在转诊医院获得的。纳米孔测序还在转诊医院中鉴定了blaCTX-M-15 FIBK/FIIK质粒的菌株间传播。这些数据表明，钾的主要来源。肺炎是患者自身的肠道微生物组，但ESBL菌株是在转诊医院获得的。这凸显了更广泛的医院网络对于了解K的重要性。肺炎风险和感染预防。在进入老年病房时进行ESBL微生物的直肠筛查有助于为此类设施的患者管理和感染控制提供信息。
Patients’ own gut microbiota were the major source of Klebsiella pneumoniae, but extended-spectrum β-lactamase strains were acquired in the referring hospital. This highlights the potential for rectal screening, and the importance of the wider hospital network, for local risk management. Klebsiella pneumoniae is a leading cause of extended-spectrum β-lactamase (ESBL)–producing hospital-associated infections, for which elderly patients are at increased risk. We conducted a 1-year prospective cohort study, in which a third of patients admitted to 2 geriatric wards in a specialized hospital were recruited and screened for carriage of K. pneumoniae by microbiological culture. Clinical isolates were monitored via the hospital laboratory. Colonizing and clinical isolates were subjected to whole-genome sequencing and antimicrobial susceptibility testing. K. pneumoniae throat carriage prevalence was 4.1%, rectal carriage 10.8%, and ESBL carriage 1.7%, and the incidence of K. pneumoniae infection was 1.2%. The isolates were diverse, and most patients were colonized or infected with a unique phylogenetic lineage, with no evidence of transmission in the wards. ESBL strains carried blaCTX-M-15 and belonged to clones associated with hospital-acquired ESBL infections in other countries (sequence type [ST] 29, ST323, and ST340). One also carried the carbapenemase blaIMP-26. Genomic and epidemiological data provided evidence that ESBL strains were acquired in the referring hospital. Nanopore sequencing also identified strain-to-strain transmission of a blaCTX-M-15 FIBK/FIIK plasmid in the referring hospital. The data suggest the major source of K. pneumoniae was the patient’s own gut microbiome, but ESBL strains were acquired in the referring hospital. This highlights the importance of the wider hospital network to understanding K. pneumoniae risk and infection prevention. Rectal screening for ESBL organisms on admission to geriatric wards could help inform patient management and infection control in such facilities.
登录
查看更多内容
影响因子：
3.7
作者：
Donker T;Wallinga J;Slack R;Grundmann H
通讯作者：
Grundmann H
DOI：
10.1016/j.ijantimicag.2012.07.016
发表时间：
2012-12-01
影响因子：
10.8
作者：
Dolejska, Monika;Brhelova, Eva;Sterba, Jaroslav
通讯作者：
Sterba, Jaroslav
DOI：
10.1093/cid/cix270
发表时间：
2017-07-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Gorrie CL;Mirceta M;Wick RR;Edwards DJ;Thomson NR;Strugnell RA;Pratt NF;Garlick JS;Watson KM;Pilcher DV;McGloughlin SA;Spelman DW;Jenney AWJ;Holt KE
通讯作者：
Holt KE
影响因子：
5.2
作者：
Lim, Ching Jou;Cheng, Allen C.;Peleg, Anton Y.
通讯作者：
Peleg, Anton Y.
过度抗呼吸和多药的肺炎克隆基团的基因组定义。
影响因子：
11.8
作者：
Bialek-Davenet S;Criscuolo A;Ailloud F;Passet V;Jones L;Delannoy-Vieillard AS;Garin B;Le Hello S;Arlet G;Nicolas-Chanoine MH;Decré D;Brisse S
通讯作者：
Brisse S