The Importance of Long-term Acute Care Hospitals in the Regional Epidemiology of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae
The Importance of Long-term Acute Care Hospitals in the Regional Epidemiology of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae
复制标题
DOI：
10.1093/cid/cit500
复制
发表时间：
2013-11-01
影响因子：
11.8
通讯作者：
Hayden, Mary K.
中科院分区：
文献类型：
--
作者：
Lin, Michael Y.;Lyles-Banks, Rosie D.;Hayden, Mary K.
背景资料。在美国，产肺炎克雷伯菌碳青霉烯酶(KPC)的肠杆菌科细菌在临床感染中的检测越来越多，但这些细菌在短期和长期急性护理医院的定植负担尚不清楚。芝加哥有成人重症监护病房(ICU)的短期急性护理医院被招募进行两项横断面单日点患病率调查(调查1,2010年7月-2011年1月；调查2,2011年1-7月)。此外，芝加哥地区(库克县)的所有长期急性护理医院(LTACH)在2011年1-5月期间被招募进行单日点患病率调查。从直肠、腹股沟或尿液部位采集拭子标本，进行携带BLA的肠杆菌科细菌(KPC)检测。我们调查了25家符合条件的短期急性护理医院中的24家和7家符合条件的LTACH。在LTACH中，30.4%(119/391)的患者带有产KPC的肠杆菌科细菌，而在短期住院的ICU患者中，这一比例为3.3%(30/910)(患病率为9.2；95%可信区间为6.3-13.5)。所有接受调查的LTACH都有患者患有KPC(患病率范围为10%-54%)，而24家短期医院中有15家患者患有KPC(患病率范围为0%-29%)。调查时存在的几个患者水平的协变量-LTACH设施类型、机械通风和住院时间-是产生KPC的肠杆菌科细菌定植的独立危险因素。我们发现在LTACH患者中产生KPC的肠杆菌科细菌具有很高的定植流行率。长期护理机构中需要慢性医疗护理的患者可能在这些极具抗药性的病原体的传播中发挥重要作用。
Background. In the United States, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short-stay and long-term acute care hospitals is unknown.Methods. Short-stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for 2 cross-sectional single-day point prevalence surveys (survey 1, July 2010-January 2011; survey 2, January-July 2011). In addition, all long-term acute care hospitals (LTACHs) in the Chicago region (Cook County) were recruited for a single-day point prevalence survey during January-May 2011. Swab specimens were collected from rectal, inguinal, or urine sites and tested for Enterobacteriaceae carrying bla(KPC).Results. We surveyed 24 of 25 eligible short-stay acute care hospitals and 7 of 7 eligible LTACHs. Among LTACHs, 30.4% (119 of 391) of patients were colonized with KPC-producing Enterobacteriaceae, compared to 3.3% (30 of 910) of short-stay hospital ICU patients (prevalence ratio, 9.2; 95% confidence interval, 6.3-13.5). All surveyed LTACHs had patients harboring KPC (prevalence range, 10%-54%), versus 15 of 24 short-stay hospitals (prevalence range, 0%-29%). Several patient-level covariates present at the time of survey-LTACH facility type, mechanical ventilation, and length of stay-were independent risk factors for KPC-producing Enterobacteriaceae colonization.Conclusions. We identified high colonization prevalence of KPC-producing Enterobacteriaceae among patients in LTACHs. Patients with chronic medical care needs in long-term care facilities may play an important role in the spread of these extremely drug-resistant pathogens.