Division of Geriatric Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
Eur J Clin Microbiol Infect Dis. 2012 Aug;31(8):1797-804. doi: 10.1007/s10096-011-1504-7. Epub 2012 Jan 25.
The objective of this prospective surveillance study was to quantify colonization with antimicrobial-resistant organisms (AROs) and infections attributable to indwelling devices in skilled nursing facility (SNF) residents. The study was conducted in 15 SNFs in Southeast Michigan. Residents with (n=90) and without (n=88) an indwelling device were enrolled and followed for 907 resident-months. Residents were cultured monthly from multiple anatomic sites and data on infections were obtained. The device-attributable rate was calculated by subtracting the infection rate in the device group from the infection rate in the non-device group. A total of 197 new infections occurred during the study period; 87 in the device group (incidence rate [IR] =331/1,000 resident-months) and 110 infections in the non-device group (IR=171/1,000 resident-months), with a relative risk of 1.9 (95% confidence interval [CI]: 1.4-2.6). The attributable rate of excess infections among residents in the device group was 160/1,000 resident-months, with an attributable fraction of 48% (95% CI: 31-61%). Prevalence rates for all AROs were higher in the device group compared with the no-device group. The prevalence of the number of AROs per 1,000 residents cultured increased from no-device to those with only feeding tubes, followed by those with only urinary catheters and both these devices. In conclusion, the presence of indwelling devices is associated with higher incidence rates for infections and prevalence rates for AROs. Our study quantifies this risk and shows that approximately half of all infections in SNF residents with indwelling devices can be eliminated with device removal. Effective strategies to reduce infections and AROs in these residents are warranted.
本前瞻性监测研究的目的是量化长期护理机构（SNF）居民定植的抗菌药物耐药菌（ARO）和与留置装置相关的感染。该研究在密歇根州东南部的 15 家 SNF 中进行。入组了有（n=90）和无（n=88）留置装置的居民，并随访了 907 个居民月。每月从多个解剖部位对居民进行培养，并获得感染数据。通过从装置组的感染率中减去非装置组的感染率，计算装置归因率。在研究期间共发生 197 例新感染；装置组 87 例（发病率[IR] =331/1000 居民月），非装置组 110 例（IR=171/1000 居民月），相对风险为 1.9（95%置信区间[CI]：1.4-2.6）。装置组居民过度感染的归因率为 160/1000 居民月，归因分数为 48%（95% CI：31-61%）。与无装置组相比，装置组所有 ARO 的流行率更高。每 1000 名培养居民中 ARO 数量的流行率从无装置组增加到只有喂养管组，然后是只有导尿管组和同时有这两种装置的组。总之，留置装置的存在与感染的发生率较高和 ARO 的流行率较高有关。我们的研究量化了这种风险，并表明，大约一半的有留置装置的 SNF 居民的感染可以通过去除装置来消除。需要采取有效的策略来减少这些居民的感染和 ARO。
