Faecal carriage rate of extended-spectrum β-lactamase-producing Enterobacteriaceae in hospitalised patients and healthy asymptomatic individuals coming for health check-up
Faecal carriage rate of extended-spectrum β-lactamase-producing Enterobacteriaceae in hospitalised patients and healthy asymptomatic individuals coming for health check-up
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DOI：
10.1016/j.jgar.2016.05.007
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发表时间：
2016-09-01
影响因子：
4.6
通讯作者：
Biswas, Raja
中科院分区：
文献类型：
--
作者：
Babu, Rachana;Kumar, Anil;Biswas, Raja
产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）在住院患者和社区患者中的流行是一个重大的公共卫生问题。本研究的目的是评估ESBL-PE在住院患者和健康无症状健康体检者中的粪便携带率。使用添加头孢他啶的麦康凯琼脂对2011年11月至2013年7月期间480名年龄≥ 18岁的成人（260名健康个体和220名住院患者）的非重复性连续粪便样本进行筛选。对所有筛选阳性分离株进行种属水平鉴定，并检测产ESBL。对代表性ESBL-PE分离株进行药敏试验和多重ESBL PCR。ESBL-PE的粪便携带率在住院患者中为62.7%，在健康无症状个体中为33.8%。最常见的ESBL-PE是大肠埃希菌（住院患者和健康个体分别为70.3%和78.4%），其次是肺炎克雷伯菌（26.8%和17.0%）。ESBL-PE对碳青霉烯类抗生素的敏感性最高（分别为85%和100%），其次为阿米卡星（67.2%和98%）、头孢哌酮/舒巴坦（27.8%和88.2%）和哌拉西林/他唑巴坦（18%和74.5%）。环丙沙星在两组中均表现出高水平的耐药性。ESBL基因分析显示CTX-M基因占优势。总之，ESBL-PE在住院患者中的粪便携带率几乎是健康个体的两倍。住院患者中出现碳青霉烯类耐药分离株的携带。这些生物在社区中的传播需要采取根本措施来改善卫生条件和实施抗生素管理。(C)2016年国际感染和癌症化疗学会。由爱思唯尔有限公司出版。保留所有权利。
The prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in hospitalised and community patients is of significant public health concern. The aim of this study was to estimate the faecal carriage rate of ESBL-PE in hospitalised patients and healthy asymptomatic individuals coming for health check-up. Non-repetitive, consecutive stool samples from 480 adults (260 healthy individuals and 220 hospitalised patients) aged >= 18 years from November 2011 to July 2013 were screened using MacConkey agar supplemented with ceftazidime. All screen-positive isolates were identified to species level and were tested for ESBL production. Representative ESBL-PE isolates were subjected to susceptibility testing and multiplex ESBL PCR. The faecal carriage rate of ESBL-PE was found to be 62.7% among hospitalised patients and 33.8% among healthy asymptomatic individuals. The most common ESBL-PE was Escherichia coli (70.3% and 78.4% in hospitalised patients and healthy individuals, respectively), followed by Klebsiella pneumoniae (26.8% and 17.0%). ESBL-PE showed the highest sensitivity to carbapenems (85% and 100%, respectively), followed by amikacin (67.2% and 98%), cefoperazone/sulbactam (27.8% and 88.2%) and piperacillin/tazobactam (18% and 74.5%). Ciprofloxacin exhibited a high level of resistance among both groups. Molecular analysis for ESBL genes showed a predominance of the CTX-M gene. In conclusion, the faecal carriage rate of ESBL-PE among hospitalised patients was almost double that of healthy individuals. Carriage of carbapenem-resistant isolates is emerging among hospitalised patients. The spread of these organisms in the community merits radical measures to improve sanitation and implement antibiotic stewardship. (C) 2016 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.