Epidemiological and Microbiome Associations Between Klebsiella pneumoniae and Vancomycin-Resistant Enterococcus Colonization in Intensive Care Unit Patients
Epidemiological and Microbiome Associations Between Klebsiella pneumoniae and Vancomycin-Resistant Enterococcus Colonization in Intensive Care Unit Patients
复制标题
DOI：
10.1093/ofid/ofaa012
复制
发表时间：
2020-01-01
影响因子：
4.2
通讯作者：
Bachman, Michael A.
中科院分区：
文献类型：
--
作者：
Collingwood, Abigail;Blostein, Freida;Bachman, Michael A.
背景。肺炎克雷伯菌和耐万古霉素肠球菌（VRE）的先前定植与随后的感染有关，特别是在重症监护病房（ICU）人群中。在一些卫生保健系统中，常规筛查VRE定植，但不筛查肺炎克雷伯菌。确定与肺炎克雷伯菌定植相关的患者因素可以预防感染。2014年7月- 10月（n = 1209）和2016年1月- 5月（n = 1243） 2个时间段对ICU患者进行直肠拭子培养筛查VRE和肺炎克雷伯菌。分析患者人口统计学、基线实验室数据、合并症和结果。对一部分患者（n = 248）进行了基于16S rRNA基因的分析，以确定与VRE和肺炎克雷伯菌定植相关的微生物群特征。在多变量分析中，肺炎克雷伯菌定植（2014年为17.3%，2016年为7.3%）与VRE定植显著相关（2016年P = 0.03； 2014年P = 0.08）。VRE定植与潜在健康状况不佳有关，而肺炎克雷伯菌定植与高龄有关。最常见的操作分类单位是大肠杆菌/志贺氏菌、克雷伯菌和肠球菌，与培养检出的肺炎克雷伯菌和VRE的高检出率一致。非定植患者的微生物群落结构与VRE、肺炎克雷伯菌或两者均有显著差异，这可归因于克雷伯菌和肠球菌的相对丰度差异。肺炎克雷伯菌与VRE共定植，是ICU患者的主要分类群，但定植与显著合并症无关。同时筛查肺炎克雷伯菌和VRE可能是新的感染预防策略的有效途径。
Background. Prior colonization by Klebsiella pneumoniae and vancomycin-resistant Enterococci (VRE) is associated with subsequent infection, particularly in intensive care unit (ICU) populations. Screening for VRE colonization, but not K. pneumoniae, is routinely performed in some health care systems. Identification of patient factors associated with K. pneumoniae colonization could enable infection prevention.Methods. ICU patients were screened for VRE and K. pneumoniae by rectal swab culture over 2 time periods: July-October 2014 (n = 1209) and January-May 2016 (n = 1243). Patient demographics, baseline laboratory data, comorbidities, and outcomes were analyzed. 16S rRNA gene-based analysis was performed on a subset of patients (n = 248) to identify microbiota characteristics associated with VRE and K. pneumoniae colonization.Results. K. pneumoniae colonization (17.3% of patients in the 2014 cohort, 7.3% in 2016) was significantly associated with VRE colonization in multivariable analysis (P = .03 in 2016; P = .08 in 2014). VRE colonization was associated with poor underlying health, whereas K. pneumoniae colonization was associated with advanced age. The most prevalent operational taxonomic units were Escherichia coli/Shigella spp., Klebsiella, and Enterococcus, consistent with high rates of detectable K. pneumoniae and VRE by culture. Microbial community structure in noncolonized patients was significantly different from those with VRE, K. pneumoniae, or both, attributable to differences in the relative abundance of Klebsiella and Enterococcus.Conclusions. K. pneumoniae co-colonizes with VRE and is a predominant taxon in ICU patients, but colonization was not associated with significant comorbidities. Screening for K. pneumoniae and VRE simultaneously could be an efficient approach for novel infection prevention strategies.