Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Am J Infect Control. 2013 Mar;41(3):190-4. doi: 10.1016/j.ajic.2012.09.020.
Hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) are cohorted under contact precautions, including in the days between rehospitalization and surveillance culture results. This study investigates duration of CRE carriage to define populations requiring precautions upon readmission.
Patients with CRE-positive culture during 2009-2010 were followed up by rectal swab cultures taken retrospectively and prospectively for the study or as part of clinical follow-up.
One hundred thirty-seven patients met the inclusion criteria, with follow-up cultures obtained from 97. Mean time to CRE negativity was 387 days (95% confidence interval: 312-463). Seventy-eight percent of patients (64/82) had positive culture at 3 months, 65% (38/58) at 6 months, and 39% (12/30) at 1 year. Duration of carriage was affected by repeat hospitalization (P = .001) and clinical, as opposed to surveillance, culture (P = .002).
CRE carriers from a previous hospitalization have a lower probability of CRE carriage upon readmission if the index specimen was a surveillance culture and 1 year passed without further hospitalization. Multiple hospitalizations and CRE disease extend duration of carriage. This study better defines patients requiring cohorting and isolation, thus limiting spread of CRE and allowing for improved allocation of infection control measures.
耐碳青霉烯肠杆菌科（CRE）定植的住院患者需接受接触预防措施，包括在再次住院和进行监测培养结果之间的日子里。本研究旨在通过对 CRE 定植时间的调查，确定需要在再次入院时采取预防措施的人群。
对 2009 年至 2010 年间 CRE 阳性培养的患者进行回顾性和前瞻性直肠拭子培养随访，以便研究或作为临床随访的一部分。
137 名患者符合纳入标准，其中 97 名患者获得了随访培养。获得 CRE 阴性结果的平均时间为 387 天（95%置信区间：312-463）。78%（64/82）的患者在 3 个月时培养阳性，65%（38/58）在 6 个月时阳性，39%（12/30）在 1 年时阳性。定植持续时间受重复住院（P=0.001）和临床而非监测培养（P=0.002）的影响。
如果指数样本为监测培养且无进一步住院，上一次住院时携带 CRE 的患者在下一次住院时携带 CRE 的可能性较低。多次住院和 CRE 疾病会延长定植时间。本研究更好地定义了需要进行群体隔离的患者，从而限制了 CRE 的传播，并允许更好地分配感染控制措施。
