Risk factors for resistance to antimicrobial agents among nursing home residents
Risk factors for resistance to antimicrobial agents among nursing home residents
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DOI：
10.1093/aje/kwf173
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发表时间：
2003-01-01
影响因子：
5
通讯作者：
Walter, SD
中科院分区：
文献类型：
--
作者：
Loeb, MB;Craven, S;Walter, SD
作者前瞻性地收集了1998-1999年加拿大和美国50家养老院9,156名居民的所有临床细菌分离株的抗菌药物暴露和敏感性模式的数据。在居民中检测到目标耐药菌之前的10周内测量了抗菌药物的暴露，并与敏感微生物个体在10周间隔内的抗生素暴露进行了比较。使用多元逻辑回归模型对感染控制和人员配置协变量调整这些主要影响。增加护理院的注册护士（调整后的比值比（OR）=0.79（95%置信区间（CI）：0.72，0.87）每100住院日注册护士）和使用抗菌肥皂（调整后的OR=0.40，95% CI：0.18，0.90）与护理院居民耐甲氧西林金黄色葡萄球菌的风险降低。每100名居民洗手池数量的增加可降低耐甲氧苄氨嘧啶-磺胺甲恶唑（TMP/SMX）肠杆菌科的风险（调整后OR=0.94，95% CI：0.90，0.98）。TMP SMX暴露和氟喹诺酮类暴露分别是分离出TMP SMX耐药肠杆菌（校正OR=1.14，95%CI：1.06，1.22）和氟喹诺酮耐药肠杆菌（校正OR=1.08，95%CI：1.04，1.11）的显著风险因素。这些研究结果表明，增加人员配备，更多的洗手池和使用抗菌肥皂可能会减少长期护理机构对抗菌剂的耐药性。
The authors prospectively collected data on exposure to antimicrobial agents and susceptibility patterns among all clinical isolates of bacteria taken from 9,156 residents of 50 nursing homes in Canada and the United States in 1998-1999. Exposure to antimicrobial agents was measured during the 10 weeks prior to detection of targeted resistant bacteria in residents and compared with antibiotic exposure during a 10-week interval in individuals with sensitive organisms. These main effects were adjusted for infection-control and staffing covariates using multiple logistic regression modeling. Increased staffing of nursing homes with registered nurses (adjusted odds ratio (OR)=0.79 (95% confidence interval (CI): 0.72, 0.87) per registered nurse per 100 resident-days) and use of antibacterial soap (adjusted OR=0.40, 95% CI: 0.18, 0.90) were associated with reduced risk of methicillin-resistant Staphylococcus aureus in nursing home residents. An increase in the number of hand-washing sinks per 100 residents was shown to reduce the risk of trimethoprim-sulfamethoxazole (TMP/SMX)-resistant Enterobacteriaceae (adjusted OR=0.94, 95% CI: 0.90, 0.98). Exposure to TMP-SMX and exposure to fluoroquinolones were significant risk factors for isolation of TMP-SMX-resistant Enterobacteriaciae (adjusted OR=1.14, 95% CI: 1.06, 1.22) and fluoroquinolone-resistant Enterobacteriaciae (adjusted OR=1.08, 95% CI: 1.04, 1.11), respectively. These findings suggest that increased staffing, more hand-washing sinks, and use of antimicrobial soap may reduce resistance to antimicrobial agents in long-term care facilities.