老年护理院和一般社区患者的细菌分离株和抗生素耐药模式比较。

Comparison of the bacterial isolates and antibiotic resistance patterns of elderly nursing home and general community patients.

机构信息

Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

出版信息

Intern Med J. 2012 Jul;42(7):e157-64. doi: 10.1111/j.1445-5994.2011.02436.x.

DOI:10.1111/j.1445-5994.2011.02436.x

PMID:21241444

Abstract

BACKGROUND

Nursing home-acquired infections may differ from general community-acquired infections in bacteriology and antibiotic resistance. However, there are currently limited data on this topic in the Australian setting.

AIMS

To compare bacterial isolates and antibiotic resistance patterns, from pathology specimens of nursing home and community patients, and to comment on the suitability of empiric antibiotic guidelines for nursing home-acquired infection.

METHODS

This was a retrospective cohort study of patients, aged ≥ 65 years, who resided in either nursing homes or the general community. Patients with a hospital admission in the previous 28 days were excluded. Positive specimen cultures, collected between July 2003 and June 2008 in the Emergency Department and Outpatient Clinics of the Austin Hospital (Melbourne), were examined. The main outcome measures were the bacterial isolates, and their antibiotic resistance patterns, of patients from nursing homes and the general community.

RESULTS

Specimens of blood (638), sputum (425), urine (4044) and wound cultures (785) were examined. The bacteriology of blood culture isolates did not differ between the two groups (P= 0.3). However, the bacteriology of sputum, urine and wound cultures differed significantly between the groups (P= 0.025, P < 0.001, P= 0.004 respectively). There were also higher proportions of antibiotic resistance among some bacteria in nursing home patients, especially methicillin resistance among Staphylococcus aureus isolates across all specimen types, and resistance to several empiric antibiotics among Enterobacteriaceae isolates in urine cultures.

CONCLUSION

Empiric antibiotic guidelines appear adequate to treat nursing home-acquired septicaemia and pneumonia. However, guidelines for urinary tract infections and wound infections may need to be refined.

摘要

背景

养老院获得性感染在细菌学和抗生素耐药性方面可能与一般社区获得性感染不同。然而，目前在澳大利亚，关于这个主题的数据有限。

目的

比较养老院和社区患者的病理标本中分离的细菌和抗生素耐药模式，并评论针对养老院获得性感染的经验性抗生素指南的适用性。

方法

这是一项对年龄≥65 岁的患者的回顾性队列研究，他们居住在养老院或社区中。排除在过去 28 天内有住院史的患者。检查 2003 年 7 月至 2008 年 6 月期间在奥克斯汀医院（墨尔本）急诊室和门诊诊所采集的阳性标本培养物。主要观察指标是养老院和社区患者的细菌分离株及其抗生素耐药模式。

结果

共检查了血液（638 例）、痰（425 例）、尿（4044 例）和伤口培养物（785 例）标本。两组患者的血培养分离株的细菌学特征没有差异（P=0.3）。然而，痰、尿和伤口培养物的细菌学特征在两组之间存在显著差异（P=0.025、P<0.001、P=0.004）。在养老院患者中，某些细菌的抗生素耐药率也较高，尤其是所有标本类型中金黄色葡萄球菌分离株的耐甲氧西林率，以及尿培养中肠杆菌科分离株对几种经验性抗生素的耐药率。