Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients.
Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients.
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DOI：
10.1093/cid/cix270
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发表时间：
2017-07-15
期刊：
影响因子：
--
通讯作者：
Holt KE
中科院分区：
文献类型：
--
作者：
Gorrie CL;Mirceta M;Wick RR;Edwards DJ;Thomson NR;Strugnell RA;Pratt NF;Garlick JS;Watson KM;Pilcher DV;McGloughlin SA;Spelman DW;Jenney AWJ;Holt KE
肺炎克雷伯菌定植是ICU感染的一个重要危险因素，约有一半的克雷伯菌定植于ICU。肺炎感染由患者自身的微生物群引起。入院时进行定植筛查可以限制定植患者和其他人的感染风险。 肺炎克雷伯菌是一种机会致病菌，是医院相关感染的主要原因。重症监护室（ICU）的病人尤其危险。肺炎克雷伯氏菌是健康人体微生物组的一部分，为感染提供了潜在的宿主。然而，肠道定植的频率及其对感染的贡献还没有得到很好的表征。我们进行了一项为期1年的前瞻性队列研究，对498名ICU患者进行了直肠和咽喉携带K。肺炎入院后不久。使用全基因组测序并结合流行病学数据对从筛查拭子和临床诊断样本中分离的肺炎克雷伯菌进行表征，以确定可能的传播事件。 在直接从社区入院的ICU患者中，肺炎克雷伯菌携带频率估计为6%（95%置信区间[CI]，3%-8%），在最近与医疗保健接触的患者中，肺炎克雷伯菌携带频率估计为19%（95% CI，14%-51%）。入院时肠道定植与随后的感染显著相关（感染风险16% vs 3%，比值比[OR] = 6.9，P <0.001），基因组数据表明80%的分离株对中携带和感染分离株匹配。确定了5条可能的传播链，占K的12%。重症监护室的肺炎感染总的来说，K.肺炎感染是由患者自身的独特菌株引起的，并且48%的筛选的感染患者对先前的定殖是阳性的。这些数据证实了K。肺炎克雷伯氏菌定植是ICU感染的重要危险因素，约50%的肺炎克雷伯氏菌定植是ICU感染的重要危险因素。肺炎感染由患者自身的微生物群引起。入院时进行定植筛查可以限制定植患者和其他人的感染风险。
Klebsiella pneumoniae colonization is a significant risk factor for infection in ICU, with approximately half of K. pneumoniae infections resulting from patients’ own microbiota. Screening for colonization on admission could limit risk of infection in the colonized patient and others. Klebsiella pneumoniae is an opportunistic pathogen and leading cause of hospital-associated infections. Intensive care unit (ICU) patients are particularly at risk. Klebsiella pneumoniae is part of the healthy human microbiome, providing a potential reservoir for infection. However, the frequency of gut colonization and its contribution to infections are not well characterized. We conducted a 1-year prospective cohort study in which 498 ICU patients were screened for rectal and throat carriage of K. pneumoniae shortly after admission. Klebsiella pneumoniae isolated from screening swabs and clinical diagnostic samples were characterized using whole genome sequencing and combined with epidemiological data to identify likely transmission events. Klebsiella pneumoniae carriage frequencies were estimated at 6% (95% confidence interval [CI], 3%–8%) among ICU patients admitted direct from the community, and 19% (95% CI, 14%–51%) among those with recent healthcare contact. Gut colonization on admission was significantly associated with subsequent infection (infection risk 16% vs 3%, odds ratio [OR] = 6.9, P < .001), and genome data indicated matching carriage and infection isolates in 80% of isolate pairs. Five likely transmission chains were identified, responsible for 12% of K. pneumoniae infections in ICU. In sum, 49% of K. pneumoniae infections were caused by the patients’ own unique strain, and 48% of screened patients with infections were positive for prior colonization. These data confirm K. pneumoniae colonization is a significant risk factor for infection in ICU, and indicate ~50% of K. pneumoniae infections result from patients’ own microbiota. Screening for colonization on admission could limit risk of infection in the colonized patient and others.
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