Asymptomatic rectal colonization with carbapenem-resistant Enterobacteriaceae and Clostridium difficile among residents of a long-term care facility in New York City
Asymptomatic rectal colonization with carbapenem-resistant Enterobacteriaceae and Clostridium difficile among residents of a long-term care facility in New York City
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DOI：
10.1016/j.ajic.2015.11.021
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发表时间：
2016-05-01
影响因子：
4.9
通讯作者：
Segal-Maurer, Sorana
中科院分区：
文献类型：
--
作者：
Prasad, Nishant;Labaze, Georges;Segal-Maurer, Sorana
背景资料：长期护理机构（LTCF）的居民面临着更高的多重耐药微生物定植和感染风险。本研究旨在确定艰难梭菌无症状直肠定植的患病率（和027/NAP 1/BI核糖型的比例）或碳青霉烯类耐药肠杆菌科（CRE）。在一个320张病床的301名居民中进行了艰难梭菌和CRE直肠定植的主动监测。（80床呼吸机单位），医院附属LTCF与患者人口统计学和潜在的危险因素的回顾性图表审查。这些患者中有三分之一既往患有艰难梭菌相关感染（CDI）。58例患者（19.3%，一半为NAP 1+）发生艰难梭菌无症状直肠定植，57例患者（18.9%）发生CRE，17例患者（5.7%）均发生CRE。近期CDI与艰难梭菌+/- CRE定植风险增加显著相关。多变量逻辑回归分析显示气管造口颈圈的存在对于艰难梭菌定植是显著的，机械通气对于CRE定植是显著的，并且先前的CDI对于艰难梭菌和CRE定植都是显著的。艰难梭菌或CRE定植与机械通气、肠内喂养、之前的CDI对该人群的感染控制干预具有重要意义。(C)2016年协会专业人员在感染控制和流行病学，公司。爱思唯尔公司出版All rights reserved.
Background: Residents of long-term care facilities (LTCFs) are at increased risk for colonization and development of infections with multidrug-resistant organisms. This study was undertaken to determine prevalence of asymptomatic rectal colonization with Clostridium difficile (and proportion of 027/NAP1/BI ribotype) or carbapenem-resistant Enterobacteriaceae (CRE) in an LTCF population.Methods: Active surveillance was performed for C difficile and CRE rectal colonization of 301 residents in a 320-bed (80-bed ventilator unit), hospital-affiliated LTCF with retrospective chart review for patient demographics and potential risk factors.Results: Over 40% of patients had airway ventilation and received enteral feeding. One-third of these patients had prior C difficile-associated infection (CDI). Asymptomatic rectal colonization with C difficile occurred in 58 patients (19.3%, one-half with NAP1+), CRE occurred in 57 patients (18.9%), and both occurred in 17 patients (5.7%). Recent CDI was significantly associated with increased risk of C difficile +/- CRE colonization. Multivariate logistic regression analysis revealed presence of tracheostomy collar to be significant for C difficile colonization, mechanical ventilation to be significant for CRE colonization, and prior CDI to be significant for both C difficile and CRE colonization.Conclusions: The strong association of C difficile or CRE colonization with disruption of normal flora by mechanical ventilation, enteral feeds, and prior CDI carries important implications for infection control intervention in this population. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.