Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea.
Department of Infection Control, Seoul St. Mary's Hospital, Seoul, Korea.
Ann Lab Med. 2014 Jan;34(1):20-5. doi: 10.3343/alm.2014.34.1.20. Epub 2013 Dec 6.
We investigated the rates of fecal transmission of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) among patients admitted to intensive care units (ICUs).
From June to August 2012, rectal cultures were acquired from all patients at ICU admission. For patients not carrying ESBL-E or CRE at admission, follow-up cultures were performed to detect acquisition. A chromogenic assay was used to screen for ESBL-E and CRE. Bacterial species identification and antibiotic susceptibility tests were performed using the Vitek 2 system (bioMérieux, France). ESBL genotypes were determined by PCR, and clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis.
Out of 347 ICU admissions, 98 patients were found to be carriers of ESBL-E (28.2%, 98/347). Follow-up cultures were acquired from 91 of the patients who tested negative for ESBL-E at admission; the acquisition rate in this group was 12.1% (11/91), although none was a nosocomial transmission. For CRE, the prevalence of fecal carriage was 0.3% (1/347), and the acquisition rate was 2.9% (4/140). None of the CRE isolates were carbapenemase-producers.
The high prevalence of ESBL-E carriage on admission (28.2%), coupled with rare nosocomial transmission and the very low carriage rate of CRE (0.3%), challenge the routine use of active surveillance in non-epidemic settings. Nevertheless, passive surveillance measures, such as rapid and accurate screening of clinical specimens, will be critical for controlling the spread of CRE.
我们调查了入住重症监护病房（ICU）的患者中产超广谱β-内酰胺酶（ESBL）肠杆菌科（ESBL-E）和耐碳青霉烯肠杆菌科（CRE）的粪便传播率。
2012 年 6 月至 8 月，对 ICU 入院的所有患者采集直肠培养物。对于入院时未携带 ESBL-E 或 CRE 的患者，进行随访培养以检测获得情况。采用显色法筛选 ESBL-E 和 CRE。使用 Vitek 2 系统（法国生物梅里埃）进行细菌种属鉴定和抗生素敏感性试验。通过 PCR 确定 ESBL 基因型，脉冲场凝胶电泳评估分离株的克隆相关性。
在 347 例 ICU 入院患者中，发现 98 例（28.2%，98/347）为 ESBL-E 携带者。对入院时 ESBL-E 检测为阴性的 91 例患者进行了随访培养；该组的获得率为 12.1%（11/91），但均非医院获得性传播。对于 CRE，粪便携带率为 0.3%（1/347），获得率为 2.9%（4/140）。CRE 分离株均非碳青霉烯酶产生菌。
入院时 ESBL-E 携带率高（28.2%），罕见医院获得性传播，CRE 携带率极低（0.3%），这对非流行地区常规使用主动监测提出了挑战。然而，快速、准确筛查临床标本等被动监测措施对控制 CRE 的传播至关重要。
