Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt am Main, Germany.
Int J Med Microbiol. 2013 Dec;303(8):405-9. doi: 10.1016/j.ijmm.2013.05.002. Epub 2013 May 10.
Colonization/infection with multidrug-resistant bacteria (MDRB) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, is an increasing problem not only in hospitals but also in long-term care facilities. The aim of this study was to determine the prevalence as well as the risk factors of colonization/infection with MRSA, VRE, and ESBL producing Enterobacteriaceae in geriatric clinics, nursing homes, and ambulant care in Frankfurt am Main, Germany. 288 patients from 2 geriatric clinics (n=46), 8 nursing homes (n=178), and 2 ambulant care facilities (n=64) as well as 64 staff members were screened for MDRB in the time period from October 2006 to May 2007. 58 patients (20.1%) and 4 staff members (6.2%) were colonized with MDRB. Among patients, 27 (9.4%) were colonized with MRSA, 11 (3.8%) were screened positive for VRE, and 25 (8.7%) were found to be colonized with ESBL producing Enterobacteriaceae. Prevalence of MDRB in geriatric clinics, nursing homes, and ambulant care facilities were 32.6%, 18.5%, and 15.6%, respectively. Significant risk factors for MDRB were immobility (OR: 2.7, 95% CI: 1.5-4.9; p=0.002), urinary catheter (OR: 3.1, 95% CI: 1.7-5.9; p<0.001), former hospitalization (OR: 2.1, 95% CI: 1.1-4.0; p=0.033), and wounds/decubiti (OR: 2.3, 95% CI: 1.5-4.9; p=0.03). Finally, the high level of MDRB in geriatric clinics, nursing homes, and ambulant care points to the importance of these institutions as a reservoir for dissemination.
耐多药细菌（MDRB）的定植/感染，如耐甲氧西林金黄色葡萄球菌（MRSA）、万古霉素耐药肠球菌（VRE）和产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌，不仅在医院，而且在长期护理机构也是一个日益严重的问题。本研究的目的是确定德国美因河畔法兰克福老年诊所、养老院和流动护理中 MRSA、VRE 和产 ESBL 肠杆菌科细菌定植/感染的流行率以及危险因素。在 2006 年 10 月至 2007 年 5 月期间，对 2 家老年诊所（n=46）、8 家养老院（n=178）和 2 家流动护理机构（n=64）的 288 名患者和 64 名工作人员进行了 MDRB 筛查。58 名患者（20.1%）和 4 名工作人员（6.2%）定植了 MDRB。在患者中，27 名（9.4%）定植了 MRSA，11 名（3.8%）筛查出 VRE 阳性，25 名（8.7%）定植了产 ESBL 的肠杆菌科细菌。老年诊所、养老院和流动护理机构的 MDRB 流行率分别为 32.6%、18.5%和 15.6%。MDRB 的显著危险因素为：不能活动（OR：2.7，95%CI：1.5-4.9；p=0.002）、导尿管（OR：3.1，95%CI：1.7-5.9；p<0.001）、既往住院（OR：2.1，95%CI：1.1-4.0；p=0.033）和伤口/褥疮（OR：2.3，95%CI：1.5-4.9；p=0.03）。最后，老年诊所、养老院和流动护理机构中 MDRB 的高发生率表明这些机构作为传播的蓄水池的重要性。
