Carbapenem-Resistant Klebsiella pneumoniae in Post-Acute-Care Facilities in Israel
Carbapenem-Resistant Klebsiella pneumoniae in Post-Acute-Care Facilities in Israel
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DOI：
10.1086/661279
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发表时间：
2011-09-01
影响因子：
4.5
通讯作者：
Schwaber, Mitchell J.
中科院分区：
文献类型：
--
作者：
Ben-David, Debby;Masarwa, Samira;Schwaber, Mitchell J.
客观的。旨在评估以色列急性后护理机构 (PACF) 患者中耐碳青霉烯类肺炎克雷伯菌 (CRKP) 携带的流行率和危险因素。设计、环境和患者。在 12 个 PACF 中进行了横断面患病率调查。直肠拭子样本取自 33 个病房的 1,144 名患者。在队列中评估了 CRKP 携带的危险因素。接下来，进行了一项巢式匹配病例对照研究，以确定定植的个体风险因素。最后，对具有 CRKP 携带史的患者队列进行特征分析，以确定持续携带 CRKP 的危险因素。在 1,004 名无 CRKP 携带史的患者中，直肠 CRKP 携带率为 12.0%。 CRKP 携带的独立危险因素是住院时间延长（比值比 [OR]，1.001；P < .001）、与已知携带者共用一个房间（OR，3.09；P = .02）以及病房内已知携带者患病率增加（OR，1.02；P = .013）。入院时携带筛查的政策具有保护作用（OR，0.41；P = .03）。巢式病例对照研究中确定的危险因素是前 3 个月内的抗生素暴露（OR，1.66；P = .03）和其他耐药病原体的定植（OR，1.64；P = .03）。在 140 名有 CRKP 携带史的患者中，47% 被定植。持续携带 CRKP 的独立危险因素是前 3 个月内接触抗生素（OR，3.05；P = .04）、接受阿莫西林克拉维酸（OR，4.18；P = .007）以及首次培养 CRKP 后 90 天内进行筛查（OR，2.9；P = .012）。结论。我们在 PACF 中发现了大量的 CRKP 库。感染控制政策和抗生素暴露与患者定植有关。感染控制医院流行病学 2011；32(9):845-853
OBJECTIVE. To assess the prevalence of and risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) carriage among patients in post-acute-care facilities (PACFs) in Israel.DESIGN, SETTING, AND PATIENTS. A cross-sectional prevalence survey was conducted in 12 PACFs. Rectal swab samples were obtained from 1,144 patients in 33 wards. Risk factors for CRKP carriage were assessed among the cohort. Next, a nested, matched case-control study was conducted to define individual risk factors for colonization. Finally, the cohort of patients with a history of CRKP carriage was characterized to determine risk factors for continuous carriage.RESULTS. The prevalence of rectal carriage of CRKP among 1,004 patients without a history of CRKP carriage was 12.0%. Independent risk factors for CRKP carriage were prolonged length of stay (odds ratio [OR], 1.001; P < .001), sharing a room with a known carrier (OR, 3.09; P = .02), and increased prevalence of known carriers on the ward (OR, 1.02; P = .013). A policy of screening for carriage on admission was protective (OR, 0.41; P = .03). Risk factors identified in the nested case-control study were antibiotic exposure during the prior 3 months (OR, 1.66; P = .03) and colonization with other resistant pathogens (OR, 1.64; P = .03). Among 140 patients with a history of CRKP carriage, 47% were colonized. Independent risk factors for continued CRKP carriage were antibiotic exposure during the prior 3 months (OR, 3.05; P = .04), receipt of amoxicillin-clavulanate (OR, 4.18; P = .007), and screening within 90 days of the first culture growing CRKP (OR, 2.9; P = .012).CONCLUSIONS. We found a large reservoir of CRKP in PACFs. Infection-control polices and antibiotic exposure were associated with patient colonization. Infect Control Hosp Epidemiol 2011;32(9):845-853