Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, USA.
Infect Control Hosp Epidemiol. 2010 Apr;31(4):330-7. doi: 10.1086/651304.
To determine the anatomic sites and natural history of colonization with gram-negative multidrug-resistant organisms (MDROs).
Prospective, longitudinal cohort study.
Walter Reed Army Medical Center, a 236-bed tertiary care center in Washington, DC.
Deployed subjects (ie, inpatients medically evacuated from Iraq or Afghanistan) or nondeployed subjects admitted to the same hospital.
Consenting patients had 6 anatomic sites cultured every 3 days for 2 weeks and then weekly. Gram-negative organisms resistant to 3 or more classes of antibiotics were considered MDROs. Isolates were genotyped using pulsed-field gel electrophoresis. Clinical data, data on antibiotic use, and clinical culture results were collected.
Of 60 deployed subjects, 14 (23%) were colonized with an MDRO at admission, and 13 (22%) had incident colonization during hospitalization. The groin was the most sensitive anatomic site for detecting MDRO colonization, and all but one subject remained colonized for the duration of their hospitalization. Sixty percent of subjects with incident Acinetobacter colonization and 25% of subjects with incident Klebsiella colonization had strains that were related to those isolated from other subjects. Of 60 nondeployed subjects, 5 (8%) were colonized with an MDRO at admission; all had recent healthcare contact, and 1 nondeployed subject had an isolate related to a strain recovered from a deployed subject.
Colonization with gram-negative MDROs is common among patients with war-related trauma admitted to a military hospital and also occurs among nondeployed patients with recent healthcare contact. The groin is the most sensitive anatomic site for active surveillance, and spontaneous decolonization is rare.
确定革兰氏阴性多重耐药菌（MDRO）定植的解剖部位和自然史。
前瞻性、纵向队列研究。
华盛顿特区 236 张床位的三级保健中心沃尔特·里德陆军医疗中心。
部署人员（即从伊拉克或阿富汗医疗后送的住院患者）或入住同一医院的非部署人员。
同意的患者每隔 3 天对 6 个解剖部位进行培养，持续 2 周，然后每周进行一次。对 3 种或 3 种以上抗生素耐药的革兰氏阴性菌被认为是 MDRO。使用脉冲场凝胶电泳对分离株进行基因分型。收集临床数据、抗生素使用数据和临床培养结果。
在 60 名部署人员中，14 名（23%）在入院时定植 MDRO，13 名（22%）在住院期间发生定植。腹股沟是检测 MDRO 定植最敏感的解剖部位，除 1 名患者外，所有患者在整个住院期间均定植。60%发生定植不动杆菌和 25%发生定植肺炎克雷伯菌的患者的菌株与从其他患者分离出的菌株有关。在 60 名非部署人员中，5 名（8%）在入院时定植 MDRO；他们都有近期的医疗接触，1 名非部署人员的分离株与从部署人员中回收的菌株有关。
与战争相关创伤住院患者中革兰氏阴性 MDRO 定植很常见，也发生在近期有医疗接触的非部署患者中。腹股沟是主动监测最敏感的解剖部位，自发去定植很少见。
