The hospital environment versus carriage: transmission pathways for third-generation cephalosporin-resistant bacteria in blood in neonates in a low-resource country healthcare setting.
The hospital environment versus carriage: transmission pathways for third-generation cephalosporin-resistant bacteria in blood in neonates in a low-resource country healthcare setting.
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DOI：
10.1038/s41598-022-11626-6
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发表时间：
2022-05-19
影响因子：
4.6
通讯作者：
中科院分区：
文献类型：
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作者：
新生儿血流感染（BSI）可导致败血症，发病率和死亡率很高，特别是在低收入环境中。第三代头孢菌素耐药微生物（3GC-RO）的高患病率使BSI的管理复杂化。BSI是否与3GC-RO的携带或从医院环境中获得有关，对于感染预防和控制很重要，但这种关系仍不清楚，特别是在低收入环境中。在坦桑尼亚姆万扎的一家三级医院，我们筛选了200名新生儿的新生儿血液和直肠样本，以及400份（医院）环境样本。我们使用逻辑回归来确定风险因素，并使用Kolmogorov-Smirnov检验和随机化分析来比较物种分布和耐药模式，以评估潜在的传播途径。我们发现3GC-RO引起的BSI很常见（59例BSI中，55例由3GC-RO引起），携带3GC-RO也很常见，尤其是大肠埃希菌、肺炎克雷伯菌和不动杆菌属。在28名携带携带和血液分离株的婴儿中，有更多（4/28）的分离株对具有相同的物种和敏感性特征，而不是偶然的（p <0.05），但大多数对是不一致的（24/28）。Logistic回归模型发现BSI与携带3GC-RO或仅携带3GC-R K之间无关联。肺炎。这些分析表明，在这种情况下，3GC-RO的携带不是3GC-RO引起BSI的主要驱动因素。与环境菌株的比较表明，在车厢，BSI和环境中的物种和耐药模式的分布非常相似。这些相似的分布，高频率的不动杆菌属。分离，缺乏强关联之间的运输和BSI，以及高比例的3GC-RO在BSI都表明，这些新生儿获得多重耐药的运输和血液分离株直接从医院环境。
Neonatal bloodstream infections (BSI) can lead to sepsis, with high morbidity and mortality, particularly in low-income settings. The high prevalence of third-generation cephalosporin-resistant organisms (3GC-RO) complicates the management of BSI. Whether BSI is linked to carriage of 3GC-RO, or to acquisition from the hospital environment is important for infection prevention and control, but the relationship remains unclear, especially in low-income settings. At a tertiary hospital in Mwanza, Tanzania, we screened neonatal blood and rectal samples from 200 neonates, and 400 (hospital) environmental samples. We used logistic regression to identify risk factors, and Kolmogorov–Smirnov tests and randomisation analyses to compare distributions of species and resistance patterns to assess potential routes of transmission. We found that BSIs caused by 3GC-RO were frequent (of 59 cases of BSI, 55 were caused by 3GC-RO), as was carriage of 3GC-RO, particularly Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species. In the 28 infants with both a carriage and blood isolate, there were more (4 of 28) isolate pairs of the same species and susceptibility profile than expected by chance (p < 0.05), but most pairs were discordant (24 of 28). Logistic regression models found no association between BSI and carriage with either 3GC-RO or only 3GC-R K. pneumoniae. These analyses suggest that carriage of 3GC-RO is not a major driver of BSI caused by 3GC-RO in this setting. Comparison with environmental isolates showed very similar distributions of species and resistance patterns in the carriage, BSI, and the environment. These similar distributions, a high frequency of Acinetobacter spp. isolations, the lack of strong association between carriage and BSI, together with the high proportion of 3GC-RO in BSI all suggest that these neonates acquire multidrug-resistant carriage and blood isolates directly from the hospital environment.
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影响因子：
1.1
作者：
Ampaire L;Muhindo A;Orikiriza P;Mwanga-Amumpaire J;Bebell L;Boum Y
通讯作者：
Boum Y
低收入和中等收入国家的早期发作的新生儿败血症：当前的挑战和未来的机会。
影响因子：
3.9
作者：
Sands K;Spiller OB;Thomson K;Portal EAR;Iregbu KC;Walsh TR
通讯作者：
Walsh TR
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：
1.8
作者：
Manyahi, Joel;Matee, Mecky I;Lyamuya, Eligius F
通讯作者：
Lyamuya, Eligius F
影响因子：
7.2
作者：
Petrova, A;Demissie, K;Ananth, CV
通讯作者：
Ananth, CV