Transmission of carbapenem-resistant pathogens in New York City hospitals: progress and frustration
Transmission of carbapenem-resistant pathogens in New York City hospitals: progress and frustration
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DOI：
10.1093/jac/dks063
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发表时间：
2012-06-01
影响因子：
5.2
通讯作者：
Quale, John
中科院分区：
文献类型：
--
作者：
Landman, David;Babu, Elizabeth;Quale, John
耐碳青霉烯肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌是许多医疗中心的地方性疾病。由于治疗选择有限，了解流行病学和控制这些病原体的传播至关重要。2009年在纽约市14家医院收集了肺炎克雷伯菌、鲍曼假单胞菌和铜绿假单胞菌的分离株，分析了编码重要碳青霉烯酶的基因的存在。该研究与2006年进行的一项类似研究进行了比较。收集了医院的人口统计和感染控制相关信息。总体而言，29例肺炎克雷伯菌具有碳青霉烯酶KPC，与2006年观察到的38例相比显著改善（P0.001）。然而，鲍曼不动杆菌（主要是由于出现oxa型碳青霉烯酶菌株）和铜绿假单胞菌（P. aeruginosa）对碳青霉烯酶的耐药性恶化。在所有医院中，携带kpc的肺炎克雷伯菌的下降并不一致。在9家医院的亚群分析中，bla（KPC）患病率下降的医院平均住院时间较短。在减少携带kpc的肺炎克雷伯菌的传播方面已经出现了可测量的改善，减少平均住院时间可能会加强感染控制工作。然而，耐碳青霉烯的鲍曼假单胞菌和铜绿假单胞菌的问题仍然存在。需要研究新的方法，包括呼吸道隔离和环境清洁，以控制鲍曼不动杆菌和铜绿假单胞菌的传播。
Carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa are endemic in many medical centres. Because therapeutic options are limited, understanding the epidemiology and controlling the spread of these pathogens are of paramount importance.Isolates of K. pneumoniae, A. baumannii and P. aeruginosa were collected from 14 hospitals in New York City over a 3 month period in 2009, and analysed for the presence of genes encoding important carbapenemases. Comparisons were made with a similar study conducted in 2006. Demographic and infection control-related information from hospitals was collected.Overall, 29 of K. pneumoniae possessed the carbapenemase KPC, significantly improved from the 38 observed in 2006 (P0.001). However, carbapenem resistance worsened in A. baumannii (mostly due to the emergence of strains with OXA-type carbapenemases) and P. aeruginosa. The decline in KPC-possessing K. pneumoniae was not uniformly observed in all of the hospitals. In a subset analysis of nine hospitals, those with a decreasing prevalence of bla(KPC) had shorter average lengths of stay.Measurable improvement has occurred in reducing the spread of KPC-possessing K. pneumoniae, and reducing the average length of stay may augment infection control efforts. However, the problem of carbapenem-resistant A. baumannii and P. aeruginosa lingers. New approaches, including respiratory isolation and environmental cleaning, need to be examined to control the spread of A. baumannii and P. aeruginosa.