Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan
Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan
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DOI：
10.1086/675611
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发表时间：
2014-04-01
影响因子：
4.5
通讯作者：
Kaye, Keith S.
中科院分区：
文献类型：
--
作者：
Brennan, Brenda M.;Coyle, Joseph R.;Kaye, Keith S.
背景：碳青霉烯类耐药肠杆菌科细菌(CRE)具有临床挑战性，威胁患者安全，是一个新的公共卫生问题。密歇根州没有强制要求报告CRE。方法：密歇根州社区卫生部领导的CRE监测和预防倡议在全州范围内招募了21家机构(17家急性护理机构和4家长期急性护理机构)。基准数据收集从2012年9月1日开始，2013年2月28日结束(持续6个月)。登记的设施根据监测算法自愿报告肺炎克雷伯菌和大肠埃希菌病例。患者的人口统计特征、实验室测试、微生物学、临床和抗菌药物信息通过标准化的数据收集表格获得。结果：报告了102例957,220个病人日，平均每10,000病人日的粗发病率为1.07例。89例患者的检测结果对肺炎克雷伯菌呈阳性，而13例患者对大肠杆菌的检测结果呈阳性。CRE患者的平均年龄为63岁，其中51%为男性。尿液培养(61%)是最常见的标本来源。35%的病例是住院发病；65%的病例是社区发病(CO)，尽管75%的CO病例患者报告在之前90天内暴露于医疗保健。心血管疾病、肾功能衰竭和糖尿病是最常见的并存疾病。常见的危险因素包括过去90天内的手术，最近的感染或多药耐药菌的定居，以及最近接触抗菌剂，特别是第三代或第四代头孢菌素。结论：CRE在密歇根州的医疗机构中都有发现。实施地区性、协调的监测和预防计划可能会防止CRE在密歇根州成为高度流行的疾病。
Background.Carbapenem-resistant Enterobacteriaceae (CRE) are clinically challenging, threaten patient safety, and represent an emerging public health issue. CRE reporting is not mandated in Michigan.Methods.The Michigan Department of Community Health--led CRE Surveillance and Prevention Initiative enrolled 21 facilities (17 acute care and 4 long-term acute care facilities) across the state. Baseline data collection began September 1, 2012, and ended February 28, 2013 (duration, 6 months). Enrolled facilities voluntarily reported cases of Klebsiella pneumoniae and Escherichia coli according to the surveillance algorithm. Patient demographic characteristics, laboratory testing, microbiology, clinical, and antimicrobial information were captured via standardized data collection forms. Facilities reported admissions and patient-days each month.Results.One-hundred two cases over 957,220 patient-days were reported, resulting in a crude incidence rate of 1.07 cases per 10,000 patient-days. Eighty-nine case patients had test results positive for K. pneumoniae, whereas 13 had results positive for E. coli. CRE case patients had a mean age of 63 years, and 51% were male. Urine cultures (61%) were the most frequently reported specimen source. Thirty-five percent of cases were hospital onset; sixty-five percent were community onset (CO), although 75% of CO case patients reported healthcare exposure within the previous 90 days. Cardiovascular disease, renal failure, and diabetes mellitus were the most frequently reported comorbid conditions. Common risk factors included surgery within the previous 90 days, recent infection or colonization with a multidrug-resistant organism, and recent exposures to antimicrobials, especially third- or fourth-generation cephalosporins.Conclusions.CRE are found throughout Michigan healthcare facilities. Implementing a regional, coordinated surveillance and prevention initiative may prevent CRE from becoming hyperendemic in Michigan.