Risk factors for Burkholderia cepacia complex Bacteremia among intensive care unit patients without cystic fibrosis:: A case-control study
Risk factors for Burkholderia cepacia complex Bacteremia among intensive care unit patients without cystic fibrosis:: A case-control study
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DOI：
10.1086/519177
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发表时间：
2007-08-01
影响因子：
4.5
通讯作者：
Woods, Christopher W.
中科院分区：
文献类型：
--
作者：
Bressler, Adam M.;Kaye, Keith S.;Woods, Christopher W.
背景洋葱伯克霍尔德菌复合体与囊性纤维化（CF）患者的定植或疾病相关。对于没有CF的患者，除了偶尔在点源爆发中出现外，对这种复合物的了解很少。研究B的危险因素。头孢菌血症住院，重症监护病房患者无CF。我们确定了一个或多个血培养B阳性的患者。1996年5月1日至2002年3月31日期间，不包括CF患者。对照组患者与病例组患者按病房、住院时间和菌血症发作日期进行匹配。匹配分析用于识别B的风险因素。洋葱菌我们招募了40名B患者。洋葱菌血症纳入研究。无B的环境或其他点源。虽然怀疑存在水平传播，但确定了洋葱病复合体。实施接触预防措施可有效降低B的发病率。洋葱菌血症我们选择了119个匹配的对照。病例组和对照组的年龄、性别和种族相似。在多变量分析中，检测到B前需要透析的肾衰竭、近期腹部手术、2次或2次以上支气管镜检查。洋葱菌血症、气管造口术和在检测到B之前存在中心线。洋葱菌血症与B的发生独立相关。洋葱菌血症，而经皮饲管的存在与较低的疾病风险相关。B。洋葱头菌复合体是CF患者和非CF患者中重要的新出现的医院病原体组。交叉传播、频繁的肺部操作和中心静脉通路可能促进医院内传播。感染控制措施似乎有助于限制B的毒性、可传播克隆的传播。洋葱复合体。
BACKGROUND. The Burkholderia cepacia complex is associated with colonization or disease in patients with cystic fibrosis (CF). For patients without CF, this complex is poorly understood apart from its presence in occasional point source outbreaks.OBJECTIVE. To investigate risk factors for B. cepacia bacteremia in hospitalized, intensive care unit patients without CF.METHODS. We identified patients with 1 or more blood cultures positive for B. cepacia between May 1, 1996, and March 31, 2002, excluding those with CF. Control patients were matched to case patients by ward, duration of hospitalization, and onset date of bacteremia. Matched analyses were used to identify risk factors for B. cepacia bacteremia.RESULTS. We enrolled 40 patients with B. cepacia bacteremia into the study. No environmental or other point source for B. cepacia complex was identified, although horizontal spread was suspected. Implementation of contact precautions was effective in decreasing the incidence of B. cepacia bacteremia. We selected 119 matched controls. Age, sex, and race were similar between cases and controls. In multivariable analysis, renal failure that required dialysis, recent abdominal surgery, 2 or more bronchoscopic procedures before detection of B. cepacia bacteremia, tracheostomy, and presence of a central line before detection of B. cepacia bacteremia were independently associated with development of B. cepacia bacteremia, whereas presence of a percutaneous feeding tube was associated with a lower risk of disease.CONCLUSIONS. B. cepacia complex is an important emerging group of nosocomial pathogens in patients with and patients without CF. Nosocomial spread is likely facilitated by cross-transmission, frequent pulmonary procedures, and central venous access. Infection control measures appear useful for limiting the spread of virulent, transmissible clones of B. cepacia complex.