Screening for extended-spectrum beta-lactamase-producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia.
Screening for extended-spectrum beta-lactamase-producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia.
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发表时间：
2007
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通讯作者：
P. Reddy;M. Malczynski;A. Obias;S. Reiner;N. Jin;J. Huang;G. Noskin;T. Zembower
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作者：
P. Reddy;M. Malczynski;A. Obias;S. Reiner;N. Jin;J. Huang;G. Noskin;T. Zembower
背景产超广谱β-内酰胺酶(ESBL)的肠杆菌科细菌引起的血流感染与增加的住院费用、住院时间和患者死亡率有关。然而，常规住院监测ESBL菌定植在预测相关感染中的作用尚不清楚。方法从2000年到2005年，我们使用选择性培养基对17872名在指定高危病区住院的患者进行了直肠定植的筛选，其中包括耐万古霉素肠球菌和产超广谱β-内酰胺酶肠杆菌。在研究期间，对产超广谱β-内酰胺酶肠杆菌科细菌(ESBL-BI)引起血流感染的患者的监测结果进行评估，以寻找先前产超广谱β-内酰胺酶肠杆菌科细菌定植的证据。结果产超广谱β-内酰胺酶肠杆菌科细菌的定植率在6年内翻了一番，从2000年的1.33%上升到2005年的3.21%。在产超广谱β-内酰胺酶肠杆菌科细菌定植的患者中，49.6%的患者同时携带万古霉素耐药肠球菌。ESBL-BIS的数量在5年内增加了4倍，从2001年的9例增加到2005年的40例。在413名感染产超广谱β-内酰胺酶肠杆菌的患者中，35名患者(8.5%)随后发生超广谱β-内毒素感染。值得关注的是，超过一半的ESBL-BIS发生在未经筛查的患者中。这56名患者在急诊科、在低风险医疗单位住院或从急性或长期卫生保健机构转院时被诊断为ESBL-BI。结论产超广谱β-内酰胺酶肠杆菌科细菌的定植正在迅速增加，对产超广谱β-内酰胺酶肠杆菌科细菌的常规直肠监测可能具有临床意义。然而，根据我们的经验，超过一半的ESBL-BI患者没有通过我们目前的监测措施进行筛查。因此，在更多的患者群体中对产生ESBL的肠杆菌科细菌进行有针对性的筛查可能是未来ESBL-BI预防和管理工作不可或缺的一部分。
BACKGROUND Bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been associated with increased hospital costs, length of stay, and patient mortality. However, the role of routine inpatient surveillance for ESBL colonization in predicting related infection is unclear. METHODS From 2000 through 2005, we screened 17,872 patients hospitalized in designated high-risk units for rectal colonization with vancomycin-resistant enterococci and ESBL-producing Enterobacteriaceae using a selective culture medium. In patients with a bloodstream infection due to ESBL-producing Enterobacteriaceae (ESBL-BI) during the study period, surveillance results were evaluated for evidence of antecedent ESBL-producing Enterobacteriaceae colonization. RESULTS The rate of ESBL-producing Enterobacteriaceae colonization doubled during the 6-year study period, increasing from 1.33% of high-risk patients in 2000 to 3.21% in 2005. Among patients with ESBL-producing Enterobacteriaceae colonization, 49.6% also carried vancomycin-resistant enterococci. The number of ESBL-BIs increased >4-fold in 5 years, from 9 cases in 2001 to 40 cases in 2005. Of 413 patients colonized with ESBL-producing Enterobacteriaceae, 35 (8.5%) developed a subsequent ESBL-BI. Of concern, more than one-half of all ESBL-BIs occurred in patients who were not screened. These 56 patients received a diagnosis of ESBL-BI in the emergency department, when hospitalized in low-risk medical units, or at transfer from an acute or long-term health care facility. CONCLUSIONS Colonization with ESBL-producing Enterobacteriaceae is increasing at a rapid rate, and routine rectal surveillance for ESBL-producing Enterobacteriaceae may have clinical implications. However, in our experience, over one-half of patients with an ESBL-BI did not undergo screening through our current surveillance measures. As a result, targeted screening for ESBL-producing Enterobacteriaceae among additional patient populations may be integral to future ESBL-BI prevention and management efforts.