长期护理机构的耐多药革兰氏阴性菌：对居民、医护人员和无生命表面的评估。
Multidrug-resistant gram-negative bacteria at a long-term care facility: assessment of residents, healthcare workers, and inanimate surfaces.
机构信息
Department of Medicine, Hebrew Senior Life, Boston, Massachusetts 02131, USA.
出版信息
Infect Control Hosp Epidemiol. 2009 Dec;30(12):1172-9. doi: 10.1086/648453.
OBJECTIVE
To characterize the clinical and molecular epidemiology of multidrug-resistant (MDR) organisms in residents, in healthcare workers (HCWs), and on inanimate surfaces at a long-term care facility (LTCF).
DESIGN
Point-prevalence study in 4 separate wards at a 600-bed urban LTCF that was conducted from October 31, 2006 through February 5, 2007.
PARTICIPANTS
One hundred sixty-one LTCF residents and 13 HCWs.
METHODS
Nasal and rectal samples were obtained for culture from each resident, selected environmental surfaces in private and common rooms, and the hands and clothing of HCWs in each ward. All cultures were evaluated for the presence of MDR gram-negative bacteria, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. Clinical and demographic information were collected for each enrolled resident. Molecular typing was performed to identify epidemiologically related strains.
RESULTS
A total of 37 (22.8%), 1 (0.6%), and 18 (11.1%) residents were colonized with MDR gram-negative bacteria, vancomycin-resistant enterococci, and methicillin-resistant S. aureus, respectively. MDR gram-negative bacteria were recovered from 3 (1.8%) of the 175 environmental samples cultured, all of which were obtained from common areas in LTCF wards. One (7.7%) of the 13 HCWs harbored MDR gram-negative bacteria. Molecular typing identified clonally related MDR gram-negative strains in LTCF residents. After multivariable analysis, length of hospital stay of at least 4 years, fecal incontinence, and antibiotic exposure for at least 8 days were independent risk factors associated with harboring MDR gram-negative bacteria among LTCF residents.
CONCLUSIONS
The prevalence of MDR gram-negative bacteria is high among LTCF residents and exceeds that of vancomycin-resistant enterococci and methicillin-resistant S. aureus. Common areas in LTCFs may provide a unique opportunity for person-to-person transmission of MDR gram-negative bacteria.
目的
描述长期护理机构（LTCF）居民、医护人员（HCWs）和无生命表面上的耐多药（MDR）生物体的临床和分子流行病学特征。
设计
2006 年 10 月 31 日至 2007 年 2 月 5 日，在一家拥有 600 张床位的城市 LTCF 的 4 个独立病房进行的点患病率研究。
参与者
161 名 LTCF 居民和 13 名 HCWs。
方法
从每位居民的鼻腔和直肠采集样本进行培养，从私人和公共房间选择环境表面，并对每个病房的 HCWs 的手和衣物进行培养。所有培养物均评估是否存在耐多药革兰氏阴性菌、耐甲氧西林金黄色葡萄球菌和万古霉素耐药肠球菌。为每位入组的居民收集临床和人口统计学信息。进行分子分型以鉴定具有流行病学相关性的菌株。
结果
共有 37 名（22.8%）、1 名（0.6%）和 18 名（11.1%）居民分别定植了耐多药革兰氏阴性菌、万古霉素耐药肠球菌和耐甲氧西林金黄色葡萄球菌。从培养的 175 个环境样本中，共从 3 个（1.8%）样本中回收了耐多药革兰氏阴性菌，均来自 LTCF 病房的公共区域。13 名 HCWs 中的 1 名（7.7%）携带耐多药革兰氏阴性菌。分子分型鉴定出具有克隆相关性的耐多药革兰氏阴性菌株存在于 LTCF 居民中。多变量分析后，至少 4 年的住院时间、大便失禁和至少 8 天的抗生素暴露是 LTCF 居民携带耐多药革兰氏阴性菌的独立危险因素。
结论
LTCF 居民中耐多药革兰氏阴性菌的流行率较高，超过万古霉素耐药肠球菌和耐甲氧西林金黄色葡萄球菌。LTCF 的公共区域可能为耐多药革兰氏阴性菌的人际传播提供独特机会。
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