Failure to control an outbreak, of multidrug-resistant Streptococcus pneumoniae in a long-term-care facility:: Emergence and ongoing transmission of a fluoroquinolone-resistant strain
Failure to control an outbreak, of multidrug-resistant Streptococcus pneumoniae in a long-term-care facility:: Emergence and ongoing transmission of a fluoroquinolone-resistant strain
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DOI：
10.1086/502534
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发表时间：
2005-03-01
影响因子：
4.5
通讯作者：
Layton, M
中科院分区：
文献类型：
--
作者：
Carter, RJ;Sorensen, G;Layton, M
目的：在长期护理机构（LTCF）的艾滋病患者中，描述多重耐药肺炎链球菌（MDRSP）爆发期间与肺炎球菌疾病和无症状定植相关的危险因素，评价抗菌预防在消除MDRSP定植方面的有效性，并描述MDRSP爆发菌株中氟喹诺酮耐药的出现。设计：流行病学调查的基础上的图表审查和表征SP菌株的抗菌药物敏感性测试和PFGE和前瞻性MDRSP监测。设置：一个80个床位的艾滋病护理单位在LTCE参与者：工作人员和居民的单位。1995年4月至1996年1月，发生7例MDRSP病例。对所有居民（n = 65）和工作人员（n = 70）进行的鼻咽（NP）拭子调查在6名居民（9%）中检测到无症状定植，但没有工作人员。分离株仅对利福平、氧氟沙星和万古霉素敏感。给予利福平和氧氟沙星7天疗程以消除居民中的定植：预防后1、4和10周的NP拭子调查在每次随访时确定了1个或多个定植居民，分离株对一种或两种治疗药物均显示耐药性。在1996年和1999年之间，另外6例患者被诊断为氟喹诺酮类耐药（RES-R）MDRSP感染，PFGE结果表明，爆发菌株持续3年后，最初的爆发recognized.CONCLUSIONS：化学预防可能有助于发展的RES-R爆发菌株，继续在该设施中传播到1999年。对未来MDRSP疫情的长期控制应主要依靠疫苗接种和严格的感染控制措施。
OBJECTIVES: To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term-care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain.DESIGN: Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance.SETTING: An 80-bed AIDS-care unit in an LTCEPARTICIPANTS: Staff and residents on the unit.RESULTS: From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n = 65) and staff (n = 70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolate's showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized.CONCLUSIONS: Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.