Loeb Mark B, Craven Sharon, McGeer Allison J, Simor Andrew E, Bradley Suzanne F, Low Donald E, Armstrong-Evans Maxine, Moss Lorraine A, Walter Stephen D
Department of Pathology and Molecular Medicine, McMaster University and Hamilton Regional Laboratory Program, Hamilton, Ontario, Canada.
Am J Epidemiol. 2003 Jan 1;157(1):40-7. doi: 10.1093/aje/kwf173.
The authors prospectively collected data on exposure to antimicrobial agents and susceptibility patterns among all clinical isolates of bacteria taken from 9,156 residents of 50 nursing homes in Canada and the United States in 1998-1999. Exposure to antimicrobial agents was measured during the 10 weeks prior to detection of targeted resistant bacteria in residents and compared with antibiotic exposure during a 10-week interval in individuals with sensitive organisms. These main effects were adjusted for infection-control and staffing covariates using multiple logistic regression modeling. Increased staffing of nursing homes with registered nurses (adjusted odds ratio (OR) = 0.79 (95% confidence interval (CI): 0.72, 0.87) per registered nurse per 100 resident-days) and use of antibacterial soap (adjusted OR = 0.40, 95% CI: 0.18, 0.90) were associated with reduced risk of methicillin-resistant Staphylococcus aureus in nursing home residents. An increase in the number of hand-washing sinks per 100 residents was shown to reduce the risk of trimethoprim-sulfamethoxazole (TMP/SMX)-resistant Enterobacteriaceae (adjusted OR = 0.94, 95% CI: 0.90, 0.98). Exposure to TMP-SMX and exposure to fluoroquinolones were significant risk factors for isolation of TMP-SMX-resistant Enterobacteriaciae (adjusted OR = 1.14, 95% CI: 1.06, 1.22) and fluoroquinolone-resistant Enterobacteriaciae (adjusted OR = 1.08, 95% CI: 1.04, 1.11), respectively. These findings suggest that increased staffing, more hand-washing sinks, and use of antimicrobial soap may reduce resistance to antimicrobial agents in long-term care facilities.
作者前瞻性地收集了1998 - 1999年从加拿大和美国50家养老院的9156名居民身上采集的所有临床分离细菌的抗菌药物暴露情况和药敏模式数据。在居民中检测到目标耐药细菌前的10周内测量抗菌药物暴露情况，并与敏感菌个体在10周期间的抗生素暴露情况进行比较。使用多元逻辑回归模型对感染控制和人员配备协变量进行这些主要效应的调整。养老院注册护士人员增加（每100居民日每增加一名注册护士，调整后的比值比（OR）= 0.79（95%置信区间（CI）：0.72，0.87））以及使用抗菌肥皂（调整后的OR = 0.40，95% CI：0.18，0.90）与养老院居民耐甲氧西林金黄色葡萄球菌风险降低相关。每100名居民的洗手池数量增加可降低耐甲氧苄啶 - 磺胺甲恶唑（TMP/SMX）肠杆菌科细菌的风险（调整后的OR = 0.94，95% CI：0.90，0.98）。暴露于TMP - SMX和氟喹诺酮类药物分别是分离出耐TMP - SMX肠杆菌科细菌（调整后的OR = 1.14，95% CI：1.06，1.22）和耐氟喹诺酮肠杆菌科细菌（调整后的OR = 1.08，95% CI：1.04，1.11）的显著危险因素。这些发现表明，人员增加、更多的洗手池和使用抗菌肥皂可能会降低长期护理机构中对抗菌药物的耐药性。
