Epidemiology of Pseudomonas aeruginosa and risk factors for carriage acquisition in an intensive care unit
Epidemiology of Pseudomonas aeruginosa and risk factors for carriage acquisition in an intensive care unit
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DOI：
10.1053/jhin.2002.1370
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发表时间：
2003-04-01
影响因子：
6.9
通讯作者：
Régnier, B
中科院分区：
文献类型：
--
作者：
Thuong, M;Arvaniti, K;Régnier, B
由于铜绿假单胞菌感染的高患病率，我们进行了一项流行病学研究，以评估系统监测的必要性，以及对铜绿假单胞菌携带者应用屏障预防措施的价值。从1997年7月到1998年2月，我们在一家拥有1200张床位的三级护理教学医院的传染病科的18张床位的重症监护病房（ICU）进行了一项前瞻性队列研究。在入院时和每周两次采集直肠和口咽拭子。获得的菌株进行基因型特征的脉冲场凝胶电泳（PFGE）。进行了携带、定植和感染的风险因素分析。在269名符合条件的患者中，116名（43%）为铜绿假单胞菌携带者，其中46名（17%）在入院时检测到，70名（26%）在ICU住院期间获得携带。在这70名患者中，29名患者定植（N = 13）或发生感染（N = 16）。相反，在121名保持无携带的患者中，未检测到定植或感染。使用PFGE对67例患者的81/85（95%）获得性菌株进行基因分型分析。从47例患者中观察到58/81（70%）的这些菌株具有相同的基因型I，另外2例患者（3种菌株）具有不同的基因型II。最后20个菌株没有遗传相关性。在多变量模型中，机械通气与铜绿假单胞菌携带的获得相关。对铜绿假单胞菌无效的抗生素显著增加了ICU中定植或感染的风险。虽然最近的几项研究得出结论，内源性来源占大多数铜绿假单胞菌定殖或感染，我们得出结论，流行病学可能会有所不同，根据ICU，交叉定殖（即，外源）可能发生，需要加强屏障预防措施。(C)2003年，医院感染协会。
Because of a high prevalence of Pseudomonas aeruginosa infections, we conducted an epidemiological study to assess the need for systematic surveillance, as well as the value of applying barrier precautions to P. aeruginosa carriers. From July 1997 to February 1998, we conducted a prospective cohort study in an 18-bed medical intensive care unit (ICU), which is part of the infectious diseases department in a 1200-bed tertiary-care teaching hospital. Rectal and oropharyngeal swabs were obtained on admission and twice weekly. Acquired strains were genotypically characterized by pulsed-field gel electrophoresis (PFGE). A risk factor analysis for carriage, colonization and infection was performed. Among 269 eligible patients, 116 (43%) were P. aeruginosa carriers, with 46 (17%) detected on admission and 70 (26%) who acquired carriage during their stay in ICU. Among these 70 patients, 29 became colonized (N = 13) or developed infection (N = 16). Conversely, in the 121 patients who remained free of carriage, no colonization or infection were detected. Genotyping analysis using PFGE was performed for 81/85 (95%) acquired strains in 67 patients. The same genotype I was observed for 58/81 (70%) of these strains issued from 47 patients, and a distinct genotype II affected two other patients (three strains). The last 20 strains were not genetically related. In a multivariate model, mechanical ventilation was associated with the acquisition of P. aeruginosa carriage. Antibiotics ineffective against P. aeruginosa significantly increased the risk of colonization or infection in ICU. Although several recent studies concluded that endogenous sources account for the majority of P. aeruginosa colonizations or infections, we conclude that epidemiology may vary, according to the ICU, and that cross-colonization (i.e., exogenous source) may occur and warrant reinforced barrier precautions. (C) 2003 The Hospital Infection Society.