Galoisy-Guibal L, Soubirou J L, Desjeux G, Dusseau J Y, Eve O, Escarment J, Ecochard R
Service d'Information Medicale, Hopital d'Instruction des Armees Desgenettes, Lyon, France.
Infect Control Hosp Epidemiol. 2006 Nov;27(11):1233-41. doi: 10.1086/507277. Epub 2006 Oct 4.
To investigate whether carriage of multidrug-resistant bacteria is a risk factor for nosocomial infection and whether detection of carriage is predictive of subsequent onset of nosocomial infection.
In this observational cohort (study period, June 1998 through October 2002), nasal and rectal swab specimens from 412 consecutive patients admitted to the intensive care unit were tested for carriage of multidrug-resistant bacteria. Concomitantly, the bacteria responsible for any subsequent nosocomial infection, the date of infection, and some of the known clinical risk factors for nosocomial infection were noted. These factors were adjusted for potential confounders, using a Cox model stratified on the propensity score of multidrug-resistant bacteria carriage. The diagnostic characteristics of a carriage test, including the positive and negative diagnostic likelihood ratios, were calculated for all strata of the propensity score.
Forty-two patients were carrying multidrug-resistant bacteria. Nosocomial infection occurred in 95 patients, of whom 16 (38%) were carriers, and 79 (83%) were noncarriers (P=.01). After adjustment for potential confounders, statistical analysis revealed that carriage remained a risk factor for nosocomial infection (relative risk, 2.08 [95% confidence interval {CI}, 1.13-3.81]). Receipt of antibiotic treatment at the time of intensive care unit admission was found to be protective against nosocomial infection. A positive result of test for detection of carriage seemed to be an efficient predictor of subsequent nosocomial infection (positive diagnostic likelihood ratio, 2.05 [95% CI, 1.15-3.66]), although a negative test result was not a predictor of subsequent nosocomial infection (negative likelihood ratio, 0.91 [95% CI, 0.73-1.11]).
Carriage proved to be a risk factor for subsequent nosocomial infection. However, the carriage test was useful as a predictive tool only for patients with a positive test result.
调查多重耐药菌的携带是否为医院感染的危险因素，以及携带检测能否预测随后医院感染的发生。
在这个观察性队列研究（研究期为1998年6月至2002年10月）中，对412例连续入住重症监护病房的患者的鼻拭子和直肠拭子标本进行多重耐药菌携带检测。同时，记录导致任何随后医院感染的细菌、感染日期以及一些已知的医院感染临床危险因素。使用基于多重耐药菌携带倾向评分分层的Cox模型对这些因素进行潜在混杂因素调整。针对倾向评分的所有分层计算携带检测的诊断特征，包括阳性和阴性诊断似然比。
42例患者携带多重耐药菌。95例患者发生医院感染，其中16例（38%）为携带者，79例（83%）为非携带者（P = 0.01）。在对潜在混杂因素进行调整后，统计分析显示携带仍然是医院感染的危险因素（相对危险度，2.08 [95%置信区间{CI}，1.13 - 3.81]）。在重症监护病房入院时接受抗生素治疗被发现对医院感染有保护作用。携带检测的阳性结果似乎是随后医院感染的有效预测指标（阳性诊断似然比，2.05 [95% CI，1.15 - 3.66]），尽管阴性检测结果不是随后医院感染的预测指标（阴性似然比，0.91 [95% CI，0.73 - 1.11]）。
携带被证明是随后医院感染的危险因素。然而，携带检测仅对检测结果为阳性的患者作为预测工具有用。
