Pop-Vicas Aurora, Mitchell Susan L, Kandel Ruth, Schreiber Robert, D'Agata Erika M C
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts02215, USA.
J Am Geriatr Soc. 2008 Jul;56(7):1276-80. doi: 10.1111/j.1532-5415.2008.01787.x. Epub 2008 Jun 28.
To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug-resistant gram-negative bacteria (MDRGN) in the long-term care (LTC) setting.
Cross-sectional.
Four nursing units in a 648-bed LTC facility in Boston, Massachusetts.
Eighty-four long-term care residents.
Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization.
A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2-7.35, P=.02) and nonambulatory status (AOR=5.7, 95% CI=1.1-28.9, P=.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person-to-person transmission.
Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.
量化长期护理（LTC）机构中多重耐药革兰氏阴性菌（MDRGN）定植的患病率、危险因素及传播方式。
横断面研究。
马萨诸塞州波士顿一家拥有648张床位的LTC机构中的四个护理单元。
84名长期护理居民。
采集鼻拭子和直肠拭子以确定是否存在MDRGN定植；若存在，则进行分子分型。还测定了耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）的患病率。从病历中获取人口统计学和临床特征。采用多变量分析来确定与MDRGN定植独立相关的因素。
分别有51%、28%和4%的受试者定植有MDRGN、MRSA和VRE。经过多变量调整后，重度痴呆（调整优势比（AOR）=2.9，95%置信区间（CI）=1.2 - 7.35，P = 0.02）和非行走状态（AOR = 5.7，95% CI = 1.1 - 28.9，P = 0.04）是携带MDRGN的仅有的独立危险因素。分子分型表明存在人传人现象。
在LTC机构中，MDRGN定植很常见。重度痴呆诊断是携带MDRGN的主要危险因素。
