Intensive Care Unit, Calmette Hospital, University Hospital of Lille, Lille, France.
Clin Microbiol Infect. 2011 Aug;17(8):1201-8. doi: 10.1111/j.1469-0691.2010.03420.x. Epub 2010 Dec 13.
The objective of this prospective cohort study was to determine whether admission to an intensive care unit (ICU) room previously occupied by a patient with multidrug-resistant (MDR) Gram-negative bacilli (GNB) increases the risk of acquiring these bacteria by subsequent patients. All patients hospitalized for >48 h were eligible. Patients with MDR GNB at ICU admission were excluded. The MDR GNB were defined as MDR Pseudomonas aeruginosa, Acinetobacter baumannii and extended spectrum β-lactamase (ESBL) -producing GNB. All patients were hospitalized in single rooms. Cleaning of ICU rooms between two patients was performed using quaternary ammonium disinfectant. Risk factors for MDR P. aeruginosa, A. baumannii and ESBL-producing GNB were determined using univariate and multivariate analysis. Five hundred and eleven consecutive patients were included; ICU-acquired MDR P. aeruginosa was diagnosed in 82 (16%) patients, A. baumannii in 57 (11%) patients, and ESBL-producing GNB in 50 (9%) patients. Independent risk factors for ICU-acquired MDR P. aeruginosa were prior occupant with MDR P. aeruginosa (OR 2.3, 95% CI 1.2-4.3, p 0.012), surgery (OR 1.9, 95% CI 1.1-3.6, p 0.024), and prior piperacillin/tazobactam use (OR 1.2, 95% CI 1.1-1.3, p 0.040). Independent risk factors for ICU-acquired A. baumannii were prior occupant with A. baumannii (OR 4.2, 95% CI 2-8.8, p <0.001), and mechanical ventilation (OR 9.3, 95% CI 1.1-83, p 0.045). Independent risk factors for ICU-acquired ESBL-producing GNB were tracheostomy (OR 2.6, 95% CI 1.1-6.5, p 0.049), and sedation (OR 6.6, 95% CI 1.1-40, p 0.041). We conclude that admission to an ICU room previously occupied by a patient with MDR P. aeruginosa or A. baumannii is an independent risk factor for acquisition of these bacteria by subsequent room occupants. This relationship was not identified for ESBL-producing GNB.
这项前瞻性队列研究的目的是确定入住先前被耐多药（MDR）革兰氏阴性菌（GNB）患者占用的重症监护病房（ICU）病房是否会增加随后患者感染这些细菌的风险。所有住院时间超过 48 小时的患者均符合条件。入住 ICU 时患有 MDR GNB 的患者被排除在外。MDR GNB 定义为 MDR 铜绿假单胞菌、鲍曼不动杆菌和产超广谱β-内酰胺酶（ESBL）的 GNB。所有患者均住院于单人间。使用季铵盐消毒剂对 ICU 病房进行两次患者之间的清洁。使用单变量和多变量分析确定 MDR 铜绿假单胞菌、鲍曼不动杆菌和产 ESBL 的 GNB 的危险因素。共纳入 511 例连续患者；82 例（16%）患者诊断为 ICU 获得性 MDR 铜绿假单胞菌，57 例（11%）患者诊断为鲍曼不动杆菌，50 例（9%）患者诊断为产 ESBL 的 GNB。ICU 获得性 MDR 铜绿假单胞菌的独立危险因素包括先前有 MDR 铜绿假单胞菌的患者入住（比值比 2.3，95%置信区间 1.2-4.3，p=0.012）、手术（比值比 1.9，95%置信区间 1.1-3.6，p=0.024）和先前使用哌拉西林/他唑巴坦（比值比 1.2，95%置信区间 1.1-1.3，p=0.040）。ICU 获得性鲍曼不动杆菌的独立危险因素包括先前有鲍曼不动杆菌的患者入住（比值比 4.2，95%置信区间 2-8.8，p<0.001）和机械通气（比值比 9.3，95%置信区间 1.1-83，p=0.045）。ICU 获得性产 ESBL 的 GNB 的独立危险因素包括气管切开术（比值比 2.6，95%置信区间 1.1-6.5，p=0.049）和镇静（比值比 6.6，95%置信区间 1.1-40，p=0.041）。我们得出结论，入住先前被 MDR 铜绿假单胞菌或鲍曼不动杆菌患者占用的 ICU 病房是随后入住该病房的患者感染这些细菌的独立危险因素。这种关系在产 ESBL 的 GNB 中并未发现。
