Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
J Clin Microbiol. 2012 May;50(5):1698-703. doi: 10.1128/JCM.06469-11. Epub 2012 Feb 29.
The epidemiology of new acquisition of antibiotic-resistant organisms (AROs) in community-based skilled nursing facilities (SNFs) is not well studied. To define the incidence, persistence of, and time to new colonization with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and ceftazidime-resistant (CAZ(r)) and ciprofloxacin-resistant (CIP(r)) Gram-negative bacteria (GNB) in SNFs, SNF residents were enrolled and specimens from the nares, oropharynx, groin, perianal area, and wounds were prospectively cultured monthly. Standard microbiological tests were used to identify MRSA, VRE, and CAZ(r) and CIP(r) GNB. Residents with at least 3 months of follow-up were included in the analysis. Colonized residents were categorized as having either preexisting or new acquisition. The time to colonization for new acquisition of AROs was calculated. Eighty-two residents met the eligibility criteria. New acquisition of AROs was common. For example, of the 59 residents colonized with CIP(r) GNB, 28 (47%) were colonized with CIP(r) GNB at the start of the study (96% persistent and 4% intermittent), and 31 (53%) acquired CIP(r) GNB at the facility (61% persistent). The time to new acquisition was shortest for CIP(r) GNB, at a mean of 75.5 days; the time to new acquisition for MRSA was 126.6 days (P = 0.007 versus CIP(r) GNB), that for CAZ(r) was 176.0 days (P = 0.0001 versus CIP(r) GNB), and that for VRE was 186.0 days (P = 0.0004 versus CIP(r) GNB). Functional status was significantly associated with new acquisition of AROs (odds ratio [OR], 1.24; P = 0.01). New acquisition of AROs, in particular CIP(r) GNB and MRSA, is common in SNFs. CIP(r) GNB are acquired rapidly. Additional longitudinal studies to investigate risk factors for ARO acquisition are required.
社区型长期护理机构（SNF）中新获得的抗生素耐药菌（ARO）的流行病学情况尚未得到充分研究。为了确定社区型 SNF 中新获得耐甲氧西林金黄色葡萄球菌（MRSA）、万古霉素耐药肠球菌（VRE）、头孢他啶耐药（CAZ(r)）和环丙沙星耐药（CIP(r)）革兰氏阴性菌（GNB）的发生率、持续性和定植时间，对 SNF 居民进行了前瞻性研究，每月采集鼻腔、口咽、腹股沟、肛周和伤口的标本进行培养。使用标准微生物学检测方法鉴定 MRSA、VRE 和 CAZ(r) 和 CIP(r) GNB。对至少随访 3 个月的居民进行了分析。定植居民分为原有定植和新获得定植。计算新获得 ARO 的定植时间。82 名居民符合入选标准。新获得 ARO 很常见。例如，在 59 名 CIP(r) GNB 定植的居民中，28 名（47%）在研究开始时就定植了 CIP(r) GNB（96%为持续性，4%为间歇性），31 名（53%）在机构内获得了 CIP(r) GNB（61%为持续性）。新获得 CIP(r) GNB 的时间最短，平均为 75.5 天；新获得 MRSA 的时间为 126.6 天（与 CIP(r) GNB 相比，P=0.007），新获得 CAZ(r) 的时间为 176.0 天（与 CIP(r) GNB 相比，P=0.0001），新获得 VRE 的时间为 186.0 天（与 CIP(r) GNB 相比，P=0.0004）。功能状态与新获得 ARO 显著相关（优势比[OR]，1.24；P=0.01）。SNF 中普遍存在新获得的 ARO，特别是 CIP(r) GNB 和 MRSA。CIP(r) GNB 定植迅速。需要进行更多的纵向研究来调查 ARO 获得的危险因素。
