Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand
Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand
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DOI：
10.1128/aac.00341-18
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发表时间：
2018-06
影响因子：
4.9
通讯作者：
Anong Kiddee;Kanit Assawatheptawee;Anamai Na-udom;P. Treebupachatsakul;Apirath Wangteeraprasert;T. Walsh;P. Niumsup
中科院分区：
文献类型：
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作者：
Anong Kiddee;Kanit Assawatheptawee;Anamai Na-udom;P. Treebupachatsakul;Apirath Wangteeraprasert;T. Walsh;P. Niumsup
本研究旨在调查泰国北方两家三级医院重症监护室（ICU）收治的患者中碳青霉烯类耐药（CR）革兰氏阴性菌（GNB）定植和获得的患病率和风险因素。在ICU入院和出院时对患者进行直肠拭子标本的CR-GNB筛查。摘要本研究旨在调查泰国北方两家三级医院重症监护室（ICU）患者中碳青霉烯类耐药（CR）革兰氏阴性菌（GNB）定植和获得的患病率和风险因素。在ICU入院和出院时对患者进行直肠拭子标本的CR-GNB筛查。测定了所有菌株的表型和基因型。危险因素分析采用Logistic回归分析。入院时CR-GNB的总携带率为11.6%（32/275），最主要的菌种为鲍曼不动杆菌（n = 15），其次为肺炎克雷伯菌（n = 9）。CR-GNB定植的危险因素是前6个月内住院（P = 0.002）。在ICU期间，CR-GNB的获得率为25.2%（52/206），最主要的携带种为A。baumannii（n = 28）和K.肺炎（n = 13）。与CR-GNB获得相关的风险因素是肠内营养管的使用（P = 0.008）和第三代头孢菌素（P = 0.032）和碳青霉烯类（P = 0.045）的管理。A. baumannii和K. pneumoniae的blaOXA-23/51和blaNDM。在3例病例中证实了患者间传播，导致获得CR A。鲍曼不动杆菌（2例）和克雷伯菌（2例）。肺炎（1例）分离自同期收治的其他患者。这是第一个印度支那研究筛查患者，检查患者携带CR-GNB，并进一步证明CR-GNB分离株在ICU中的转移。我们的研究表明，需要采取有效的感染控制措施，以限制CR-GNB在医院内的传播。
This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. ABSTRACT This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. The phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. The overall carriage rate of CR-GNB at admission was 11.6% (32/275), with the most predominant species carried being Acinetobacter baumannii (n = 15), followed by Klebsiella pneumoniae (n = 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months (P = 0.002). During the ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), with the most predominant species carried being A. baumannii (n = 28) and K. pneumoniae (n = 13). Risk factors associated with CR-GNB acquisition were the use of an enteral feeding tube (P = 0.008) and administration of third-generation cephalosporins (P = 0.032) and carbapenems (P = 0.045). The most common carbapenemase genes in A. baumannii and K. pneumoniae were blaOXA-23/51 and blaNDM, respectively. Patient-to-patient transmission was demonstrated in three cases, resulting in the acquisition of CR A. baumannii (2 cases) and K. pneumoniae (1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients, examining patients for the carriage of CR-GNB, and further demonstrating the transfer of CR-GNB isolates in ICUs. Our study suggests that effective infection control measures are required to limit the spread of CR-GNB within hospitals.