Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak
Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak
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DOI：
10.1016/j.jhin.2009.07.022
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发表时间：
2010-04-01
影响因子：
6.9
通讯作者：
Raveh, D.
中科院分区：
文献类型：
--
作者：
Wiener-Well, Y.;Rudensky, B.;Raveh, D.
在以色列全国爆发耐碳青霉烯类肺炎克雷伯菌 (CRKP) 期间，我们进行了点流行率调查，以确定无症状携带的程度。随后，进行了一项回顾性病例对照研究，将 CRKP 携带者与非携带者进行比较，以检测携带的危险因素。从所有符合条件且同意的住院患者中采集口腔、肛周和直肠拭子。使用针对碳青霉烯类耐药革兰氏阴性菌的选择性培养基，脉冲场凝胶电泳 (PFGE) 有助于确定克隆来源。从 298 名患者身上获得培养物。 16例（5.4%）为CRKP携带者，在内外科病房携带率较高。在调查之前，只有 18% 的携带者接受过碳青霉烯类药物治疗。 16 名携带者中，有 5 人的 CRKP 临床标本呈阳性，因此临床感染与无症状携带者的比例为 1:3。直肠是最敏感的采样部位，检测出 15/16 的携带者，该方法的总体灵敏度为 94%，阴性预测值为 99.6%。在对 CRKP 携带危险因素的多变量分析中，三个变量与携带状态显着相关：尿布使用、住院时间较长和万古霉素使用。 PFGE 证明所有 16 个分离株都是相同的，证实了克隆起源。 CRKP 爆发期间在单个医疗中心进行的点流行率调查显示，携带率为 5.4%。这些分离株的克隆起源表明，严格遵守隔离程序可能会遏制此次疫情的爆发。 (C) 2009 年医院感染协会。由爱思唯尔有限公司出版。保留所有权利。
During a national outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) in Israel, we conducted a point prevalence survey to determine the extent of asymptomatic carriage. Subsequently, a retrospective case control study was done, comparing carriers of CRKP with non-carriers, in order to detect risk factors for carriage. Oral, perianal and rectal swabs were obtained from all hospitalised eligible and consenting patients. Selective media for carbapenem-resistant Gram-negative bacteria were used and pulsed-field gel electrophoresis (PFGE) helped to determine clonal source. Culture was obtained from 298 patients. Sixteen (5.4%) were carriers of CRKP, with a higher carriage rate in medical and surgical wards. Only 18% of carriers were treated with any carbapenem prior to the survey. Five of the 16 carriers had a positive clinical specimen for CRKP, hence a clinical infection versus asymptomatic carriage ratio of 1:3. The rectum was the most sensitive site sampled, detecting 15/16 carriers, and the overall sensitivity of the method was 94% with a negative predictive value of 99.6%. In a multivariate analysis of risk factors for CRKP carriage, three variables were significantly related to carriage state: diaper use, longer duration of hospital stay and vancomycin use. PFGE demonstrated that all 16 isolates were identical, confirming clonal origin. A point prevalence survey performed at a single medical centre during an outbreak of CRKP demonstrated a carriage rate of 5.4%. The clonal origin of these isolates suggests that strict adherence to isolation procedure may contain this outbreak. (C) 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.