How important is patient-to-patient transmission in extended-spectrum β-lactamase Escherichia coli acquisition
How important is patient-to-patient transmission in extended-spectrum β-lactamase Escherichia coli acquisition
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DOI：
10.1016/j.ajic.2006.09.011
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发表时间：
2007-03-01
影响因子：
4.9
通讯作者：
Johnson, J. Kristie
中科院分区：
文献类型：
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作者：
Harris, Anthony D.;Kotetishvili, Mamuka;Johnson, J. Kristie
背景：产超广谱β-内酰胺酶(ESBL)的大肠埃希菌是一种新兴的病原菌。抗生素选择性压力与患者间传播之间的因果关系尚未得到评估。这项研究的目的是量化在重症监护病房(ICU)人群中使用肛周监测培养获得产生ESBL的大肠杆菌感染的患者中人与人之间的传播量。方法：对2001年9月1日至2004年9月1日在三级护理医院内科和外科ICU住院的预期队列患者进行了研究。患者在入院、每周和出院时进行肛周培养。采用脉冲凝胶电泳法(PFGE)进行菌株分型，并采用流行病学标准量化患者间的传播量。结果：ICU共有1806名患者入院。有74名患者在ICU入院时感染了产超广谱β-内酰胺酶的大肠杆菌，23名患者获得了产超广谱β-内酰胺酶的大肠埃希菌。在这23名患者中，有14种PFGE类型，其中3例(13%)患者通过相似的PFGE类型和在医院的重叠时间被定义为人与人之间的传播。结论：我们的数据表明，人与人之间的传播不是ICU环境下获得产生ESBL的大肠埃希菌定植的重要原因。
Background: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an emerging pathogen. The causal role of antibiotic selective pressure versus patient-to-patient transmission has not been assessed. The objective of this study was to quantify the amount of patient-to-patient transmission among patients who acquire an ESBL-producing E coli infection using perianal surveillance cultures in an intensive care unit (ICU) population.Methods: A prospective cohort of patients admitted between September 1, 2001, and September 1, 2004, to the medical and surgical ICUs at a tertiary care hospital was studied. Patients had perianal cultures on admission, weekly, and upon discharge. Strain typing by pulsed-held gel electrophoresis (PFGE) and epidemiologic criteria were used to quantify the amount of patient-to-patient transmission.Results: There were 1806 patients admitted to the ICUs. There were 74 patients who had ESBL-producing E coli on admission to the ICU and 23 patients who acquired ESBL-producing E coli. Among these 23 patients, there were 14 PFGE types, and 3 (13%) patient acquisitions were defined as patient-to-patient transmission by similar PFGE type and overlapping time in the hospital.Conclusion: Our data suggest that patient-to-patient transmission is not an important cause of the acquisition of ESBL-producing E coli colonization in the ICU setting.