Eveillard M, Biendo M, Canarelli B, Daoudi F, Laurans G, Rousseau F, Thomas D
Laboratoire de bactériologie-hygiène, CHU Amiens, hôpital Nord, place Victor Pauchet, 80054 Amiens, France.
Pathol Biol (Paris). 2001 Sep;49(7):515-21. doi: 10.1016/s0369-8114(01)00204-8.
Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLE) constitute with methicillin-resistant Staphylococcus aureus the main multiresistant bacteria recovered in French hospitals. Our objectives were to evaluate these ESBLE diffusion in our teaching hospital and to follow their incidence during a 16-month period, whereas a control programme (barrier precautions) had been implemented in the beginning of 1999. This study was conducted in a teaching hospital containing 1800 beds, from February 1999 to May 2000. All ESBLE isolated in clinical or screening samples were included. Duplicates (same bacteria in the same patient) were excluded. The detection of the ESBL was performed with the double-disk diffusion test. Incidence densities were determined with their 95% confidence interval (CI95%). Their evolution by four-month period was evaluated with the chi-square test for trend. During the 16-month period, 229 ESBLE were isolated. The incidence was 0.35 per 1000 patient-days (PD) (CI95% = [0.30-0.40]) for the whole hospital. It was 0.47/1000 PD (CI95% = [0.38-0.56]) in medical wards, 0.29/1000 PD (CI95% = [0.20-0.38]) in surgical wards and 1.32/1000 PD (CI95% = [0.90-1.74]) in intensive care units. Enterobacter aerogenes strains represented more than 75% of all ESBLE, whereas Klebsiella pneumoniae stains represented only 8.6%. During the study, the incidence of ESBLE and the proportion of strains acquired in our hospital decreased significantly (p < 0.0001 and p < 0.001 respectively). Indeed, between the first eight-month period and the last one, the incidence of ESBLE acquired in our hospital decreased by 55%, whereas the incidence of imported strains increased slightly. This study shows that the diffusion of ESBLE concerns the entire hospital. The implementation of a control programme of the spread of multiresistant bacteria allowed us to reduce significantly the incidence of ESBLE. This incidence seemed to be stable for several months. The implementation of a policy which restricts antimicrobial use would allow us to complete the the efficacy of barrier precautions.
产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌与耐甲氧西林金黄色葡萄球菌一起，是法国医院中分离出的主要多重耐药菌。我们的目标是评估这些产ESBL细菌在我们教学医院中的传播情况，并在16个月期间跟踪其发生率，而在1999年初已实施了一项控制计划（屏障预防措施）。本研究于1999年2月至2000年5月在一家拥有1800张床位的教学医院进行。纳入所有在临床或筛查样本中分离出的产ESBL细菌。排除重复菌株（同一患者体内的相同细菌）。采用双纸片扩散试验检测ESBL。计算发病率密度及其95%置信区间（CI95%）。用趋势卡方检验评估其每四个月期间的变化情况。在16个月期间，共分离出229株产ESBL细菌。全院发病率为每1000患者日（PD）0.35例（CI95% = [0.30 - 0.40]）。内科病房为0.47/1000 PD（CI95% = [0.38 - 0.56]），外科病房为0.29/1000 PD（CI95% = [0.20 - 0.38]），重症监护病房为1.32/1000 PD（CI95% = [0.90 - 1.74]）。产气肠杆菌菌株占所有产ESBL细菌的75%以上，而肺炎克雷伯菌菌株仅占8.6%。在研究期间，产ESBL细菌的发生率以及在我院获得的菌株比例均显著下降（分别为p < 0.0001和p < 0.001）。实际上，在前八个月期间和最后八个月期间，我院获得的产ESBL细菌的发生率下降了55%，而输入菌株的发生率略有上升。本研究表明，产ESBL细菌的传播涉及整个医院。实施多重耐药菌传播控制计划使我们能够显著降低产ESBL细菌的发生率。这种发生率在几个月内似乎保持稳定。实施限制抗菌药物使用的政策将使我们能够完善屏障预防措施的效果。
