March Albert, Aschbacher Richard, Pagani Elisabetta, Sleghel Ferisa, Soelva Gertrud, Hopkins Katie L, Doumith Michel, Innocenti Patrizia, Burth Johanna, Piazzani Fabrizio, Woodford Neil
From the Reparto di Geriatria , Comprensorio Sanitario di Bolzano , Italy.
Scand J Infect Dis. 2014 Feb;46(2):114-22. doi: 10.3109/00365548.2013.859392. Epub 2013 Dec 17.
In 2012 we undertook a screening study for Enterobacteriaceae with extended-spectrum β-lactamases (ESBLs), derepressed or acquired high-level AmpC cephalosporinases, and metallo-β-lactamases (MBLs), and also methicillin-resistant Staphylococcus aureus (MRSA), in a long-term care facility (LTCF1) and the associated acute care hospital geriatric ward in Bolzano, northern Italy. The study followed up an initial survey carried out in LTCF1 in 2008. For comparison, screening in 2012 was extended to a second LTCF.
Urine samples and rectal, inguinal, oropharyngeal, and nasal swabs were plated on selective agars. Isolates were typed by pulsed-field gel electrophoresis. Resistance genes and Escherichia coli belonging to ST131 were sought by PCR. Demographic data were collected.
Fewer residents of LTCF1 were colonized with multidrug-resistant (MDR) bacteria in 2012: all MDR organisms, 53.8% vs 74.8% in 2008; ESBL producers, 49.0% vs 64.0% in 2008; MRSA, 13.2% vs 38.7% in 2008; only 2 MBL-producers were isolated in 2012 vs 8 in 2008. Colonization of staff in LTCF1 by MDR bacteria had also decreased (overall 10.5% in 2012 vs 27.5% in 2008). Changed case mixes and risk factors, together with strengthened hygiene measures probably underlie the changes. Colonization proportions in 2012 in LTCF2 were similar to those in LTCF1. By contrast there was no significant change in the proportion of patients colonized by MDR bacteria in the geriatric ward (22.2% in 2008 vs 22.7% in 2012).
A significant decrease in the proportions of staff and residents of an LTCF colonized by MDR bacteria was observed over a 4-y interval.
2012年，我们在意大利北部博尔扎诺的一家长期护理机构（LTCF1）及其附属的急性护理医院老年病房，针对产超广谱β-内酰胺酶（ESBLs）、去阻遏或获得性高水平AmpC头孢菌素酶以及金属β-内酰胺酶（MBLs）的肠杆菌科细菌，以及耐甲氧西林金黄色葡萄球菌（MRSA）开展了一项筛查研究。该研究对2008年在LTCF1进行的初步调查进行了随访。为作比较，2012年的筛查范围扩大至第二家长期护理机构。
将尿液样本以及直肠、腹股沟、口咽和鼻拭子接种于选择性琼脂平板上。通过脉冲场凝胶电泳对分离株进行分型。采用聚合酶链反应寻找耐药基因以及属于ST131的大肠杆菌。收集人口统计学数据。
2012年，LTCF1中携带多重耐药（MDR）菌的居民减少：所有MDR菌，2012年为53.8%，2008年为74.8%；产ESBL菌，2012年为49.0%，2008年为64.0%；MRSA，2012年为13.2%，2008年为38.7%；2012年仅分离出2株产MBL菌，2008年为8株。LTCF1工作人员中MDR菌的定植情况也有所下降（2012年总体为10.5%，2008年为27.5%）。病例组合和风险因素的变化，以及强化的卫生措施可能是这些变化的原因。2012年LTCF2的定植比例与LTCF1相似。相比之下，老年病房中MDR菌定植患者的比例没有显著变化（2008年为22.2%，2012年为22.7%）。
在4年的时间间隔内，观察到长期护理机构工作人员和居民中MDR菌定植比例显著下降。
