Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting.
Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting.
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DOI：
10.1093/cid/cis581
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发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
Mühlemann K
中科院分区：
文献类型：
--
作者：
Hilty M;Betsch BY;Bögli-Stuber K;Heiniger N;Stadler M;Küffer M;Kronenberg A;Rohrer C;Aebi S;Endimiani A;Droz S;Mühlemann K
产生超广谱 β-内酰胺酶 (ESBL) 的肠杆菌科细菌在家庭中的传播超过了非疫情环境中的医院传播。 ESBL 生产者输入医院的频率与住院期间的传播频率一样。 ESBL-肺炎克雷伯菌在医院内的传播可能比 ESBL-大肠杆菌更有效。背景。 关于产超广谱 β-内酰胺酶 (ESBL) 肠杆菌科细菌在医院和家庭中传播率的研究很少。方法。 从 2008 年 5 月到 2010 年 9 月，对 82 名新携带产 ESBL 大肠杆菌 (ESBL-Ec；n = 72) 或产 ESBL 肺炎克雷伯菌 (ESBL-Kp；n = 10) 的患者及其医院 (n = 112) 和家庭 (n = 96) 接触者进行了前瞻性研究。对分离株进行了表型和分子特征分析（bla 基因测序、重复外源回文聚合酶链式反应、脉冲场凝胶电泳和多位点序列分型）。传播被定义为在指示患者及其接触者中携带具有相同 blaESBL 基因的克隆相关 ESBL 产生者。结果。 在指标患者中，CTX-M-15 是 ESBL-Ec (58%) 和 ESBL-Kp (70%) 中最常见的 ESBL。二十 (28%) ESBL-Ec 分离株属于高流行性克隆 ST131。在医院内，传播率为 4.5% (ESBL-Ec) 和 8.3% (ESBL-Kp)，传播发生率分别为每 1000 个暴露日 5.6 (Ec) 和 13.9 (Kp)。尽管 75% 的 ESBL-Kp 指数患者实施了感染控制措施，但只有 22% 的 ESBL-Ec 指数患者实施了感染控制措施，但 ESBL-Kp 医院传播的发生率显着高于 ESBL-Ec (P < .0001)。与指标患者无关的 ESBL 产生者的检测与院内传播事件一样频繁（ESBL-Ec，5.7%；ESBL-Kp，16.7%）。在家庭中，ESBL-Ec 的传播率为 23%，ESBL-Kp 的传播率为 25%。结论。 ESBL 产生者的家庭传播超过了医院传播。医院感染控制措施的效果可能因 ESBL 产生者的不同物种和克隆而异。
Transmission of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae in households outweighs nosocomial dissemination in the non-outbreak setting. Importation of ESBL producers into the hospitals is as frequent as transmission during hospital stay. ESBL–Klebsiella pneumoniae might be more efficiently transmitted within the hospital than ESBL–Escherichia coli. Background. Studies about transmission rates of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae in hospitals and households are scarce. Methods. Eighty-two index patients with new carriage of ESBL-producing Escherichia coli (ESBL-Ec; n = 72) or ESBL-producing Klebsiella pneumoniae (ESBL-Kp; n = 10) and their hospital (n = 112) and household (n = 96) contacts were studied prospectively from May 2008 through September 2010. Isolates were phenotypically and molecularly characterized (sequencing of bla genes, repetitive extragenic palindromic polymerase chain reaction, pulse-field gel electrophoresis, and multilocus sequence typing). Transmission was defined as carriage of a clonally-related ESBL producer with identical blaESBL gene(s) in the index patient and his or her contact(s). Results. CTX-M-15 was the most prevalent ESBL in ESBL-Ec (58%) and ESBL-Kp (70%) in the index patients. Twenty (28%) ESBL-Ec isolates were of the hyperepidemic clone ST131. In the hospital, transmission rates were 4.5% (ESBL-Ec) and 8.3% (ESBL-Kp) and the incidences of transmissions were 5.6 (Ec) and 13.9 (Kp) per 1000 exposure days, respectively. Incidence of ESBL-Kp hospital transmission was significantly higher than that of ESBL-Ec (P < .0001), despite implementation of infection control measures in 75% of ESBL-Kp index patients but only 22% of ESBL-Ec index patients. Detection of ESBL producers not linked to an index patient was as frequent (ESBL-Ec, 5.7%; ESBL-Kp, 16.7%) as nosocomial transmission events. In households, transmission rates were 23% for ESBL-Ec and 25% for ESBL-Kp. Conclusions. Household outweighs nosocomial transmission of ESBL producers. The effect of hospital infection control measures may differ between different species and clones of ESBL producers.
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影响因子：
5.2
作者：
Karisik, E.;Ellington, M. J.;Woodford, N.
通讯作者：
Woodford, N.
影响因子：
11.8
作者：
Lucet, JC;Decré, D;Régnier, B
通讯作者：
Régnier, B
影响因子：
4.9
作者：
Lartigue, Marie-Frederique;Zinsius, Catherine;Nordmann, Patrice
通讯作者：
Nordmann, Patrice
影响因子：
5.2
作者：
Endimiani, Andrea;Hujer, Kristine M.;Perreten, Vincent
通讯作者：
Perreten, Vincent
影响因子：
11.8
作者：
Calbo, Esther;Freixas, Nuria;Garau, Javier
通讯作者：
Garau, Javier