在重症监护病房进行选择性消化道去污染时对抗头孢菌素的肠杆菌科的去污染。

Decontamination of cephalosporin-resistant Enterobacteriaceae during selective digestive tract decontamination in intensive care units.

机构信息

Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.

出版信息

J Antimicrob Chemother. 2012 Sep;67(9):2250-3. doi: 10.1093/jac/dks187. Epub 2012 May 29.

DOI:10.1093/jac/dks187

PMID:22643189

Abstract

OBJECTIVES

Prevalences of cephalosporin-resistant Enterobacteriaceae are increasing globally, especially in intensive care units (ICUs). The effect of selective digestive tract decontamination (SDD) on the eradication of cephalosporin-resistant Enterobacteriaceae from the intestinal tract is unknown. We quantified eradication rates of cephalosporin-resistant and cephalosporin-susceptible Enterobacteriaceae during SDD in patients participating in a 13 centre cluster-randomized study and from a single-centre cohort.

METHODS

All SDD patients colonized with Enterobacteriaceae in the intestinal tract at ICU admission were included. Cephalosporin resistance was defined as resistance to ceftazidime, cefotaxime or ceftriaxone and aminoglycoside resistance as resistance to tobramycin or gentamicin. Duration of rectal colonization was determined by screening twice weekly during ICU stay. Swabs were inoculated on selective medium supplemented with tobramycin or cefotaxime.

RESULTS

Five hundred and seven (17%) of 2959 SDD patients with at least one rectal sample were colonized with Enterobacteriaceae at ICU admission: 77 (15%) with cephalosporin-resistant Enterobacteriaceae and 50 (10%) with aminoglycoside-resistant Enterobacteriaceae. Fifty-six (73%) patients colonized with cephalosporin-resistant Enterobacteriaceae were successfully decontaminated before ICU discharge, as were 343 (80%) patients colonized with cephalosporin-susceptible Enterobacteriaceae (P = 0.17). For aminoglycoside resistance, 31 (62%) patients were decontaminated, as were 368 patients (81%) colonized with aminoglycoside-susceptible Enterobacteriaceae (P < 0.01). On average, decolonization was demonstrated after 4 days if colonized with cephalosporin-susceptible Enterobacteriaceae and aminoglycoside-susceptible Enterobacteriaceae, and after 5 and 5.5 days if colonized with cephalosporin-resistant Enterobacteriaceae and aminoglycoside-resistant Enterobacteriaceae, respectively (log-rank test P = 0.053 for cephalosporin resistance and P = 0.03 for aminoglycoside resistance). If eradication failed, no associations were found with increased resistance in time (P > 0.05 for all comparisons).

CONCLUSIONS

SDD can successfully eradicate cephalosporin-resistant Enterobacteriaceae from the intestinal tract.

摘要

目的

全球范围内，肠杆菌科中头孢菌素耐药菌的流行率正在上升，尤其是在重症监护病房（ICU）中。选择性消化道去污染（SDD）对肠道中头孢菌素耐药肠杆菌科的清除效果尚不清楚。我们量化了在参与 13 个中心集群随机研究的患者和单个中心队列中，SDD 期间头孢菌素耐药和头孢菌素敏感肠杆菌科的清除率。

方法

所有在 ICU 入院时肠道定植肠杆菌科的 SDD 患者均被纳入研究。头孢菌素耐药被定义为对头孢他啶、头孢噻肟或头孢曲松的耐药，氨基糖苷类耐药被定义为对妥布霉素或庆大霉素的耐药。通过在 ICU 住院期间每周两次筛查来确定直肠定植的持续时间。拭子接种于添加妥布霉素或头孢噻肟的选择性培养基上。

结果

在 2959 例接受至少一次直肠样本检测的 SDD 患者中，有 507 例（17%）在 ICU 入院时定植了肠杆菌科：77 例（15%）为头孢菌素耐药肠杆菌科，50 例（10%）为氨基糖苷类耐药肠杆菌科。在 ICU 出院前，56 例（73%）定植头孢菌素耐药肠杆菌科的患者成功被清除，343 例（80%）定植头孢菌素敏感肠杆菌科的患者也成功被清除（P=0.17）。对于氨基糖苷类耐药，31 例（62%）患者被清除，368 例（81%）定植氨基糖苷类敏感肠杆菌科的患者也被清除（P<0.01）。如果定植的是头孢菌素敏感肠杆菌科和氨基糖苷类敏感肠杆菌科，平均在 4 天后显示出去定植，而如果定植的是头孢菌素耐药肠杆菌科和氨基糖苷类耐药肠杆菌科，则分别在 5 天和 5.5 天后显示出去定植（对数秩检验，头孢菌素耐药的 P=0.053，氨基糖苷类耐药的 P=0.03）。如果清除失败，与时间推移相关的耐药性增加没有关联（所有比较的 P>0.05）。