Staphylococcus aureus rectal carriage and its association with infections in patients in a surgical intensive care unit and a liver transplant unit
Staphylococcus aureus rectal carriage and its association with infections in patients in a surgical intensive care unit and a liver transplant unit
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DOI：
10.1086/502095
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发表时间：
2002-09-01
影响因子：
4.5
通讯作者：
Singh, N
中科院分区：
文献类型：
--
作者：
Squier, C;Rihs, JD;Singh, N
背景：直肠携带金黄色葡萄球菌是危重病患者医院内金黄色葡萄球菌感染的危险因素，目前尚不完全清楚。方法：连续204例外科重症监护病房和移植患者在入院时和此后每周采集鼻拭子和直肠拭子，直到出院或死亡。结果：总体上，49.5%(101/204)的患者从未携带金黄色葡萄球菌，21.6%(44/204)的患者仅为鼻腔金黄色葡萄球菌携带者，3.4%(7/204)的患者仅为直肠携带金黄色葡萄球菌。25.5%(52/204)的携带者同时携带鼻腔和直肠。金黄色葡萄球菌感染发生率为15.7%(32/204)，其中非携带者3%(3/101)，单纯鼻携带者18.2%(8/44)，直肠携带者0%(0/7)，鼻部和直肠同时携带者40.4%(21/52)(P=.001)。同时有直肠和鼻部携带的患者比仅有鼻部携带的患者更容易发生金黄色葡萄球菌感染(优势比为3.9；95%可信区间为1.18至7.85；P=0.025)。通过脉冲场凝胶电泳法，82%(14/17)的金黄色葡萄球菌感染患者的直肠和鼻腔分离株克隆一致。结论：在重症监护病房和肝移植患者中，直肠携带金黄色葡萄球菌是一个被低估的储存库。直肠加鼻腔携带可能预示着这些患者感染金黄色葡萄球菌的风险比目前认识到的更大。
BACKGROUND: The role of rectal carriage of Staphylococcus aureus as a risk factor for nosocomial S. aureus infections in critically ill patients has not been fully discerned,METHODS: Nasal and rectal swabs for S. aureus were obtained on admission and weekly thereafter until discharge or death from 204 consecutive patients admitted to the surgical intensive care unit and Ever transplant unit.RESULTS: Overall, 49.5% (101 of 204) of the patients never harbored S. aureus, 21.6% (44 of 204) were nasal car-tiers only, 3.4% (7 of 204) were rectal carriers only, and 25.5% (52 of 204) were both nasal and rectal carriers. Infections due to S. aureus developed in 15.7% (32 of 204) of the patients; these included 3% (3 of 101) of the non-carriers, 18.2% (8 of 44) of the nasal carriers only, 0% (0 of 7) of the rectal carriers only, and 40.4% (21 of 52) of the patients who were both nasal and rectal carriers (P=.001). Patients with both rectal and nasal carriage were significantly more likely to develop S. aureus infection than were those with nasal carriage only (odds ratio, 3.9; 95% confidence interval, 1.18 to 7.85; P=.025). By pulsed-field gel electrophoresis, the infecting rectal and nasal isolates were clonally identical in 82% (14 of 17) of the patients with S. aureus infections.CONCLUSIONS: Rectal carriage represents an underappreciated reservoir for S. aureus in patients in the intensive care unit and liver transplant recipients. Rectal plus nasal carriage may portend a greater risk for S. aureus infections in these patients than currently realized.