Heudorf U, Gustav C, Mischler D, Schulze J
Amt für Gesundheit, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland,
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2014 Apr;57(4):414-22. doi: 10.1007/s00103-013-1927-7.
Residents of long-term care facilities (LTCF) are at risk of healthcare associated infections (HAI) and are often treated with antibiotics. In Germany a current HAI prevalence of 1.6 % and antibiotic use in 1.15% have been reported. However, data published on the current prevalence of multidrug-resistant organisms (MRDO) in LTCFs in Germany are scarce. Therefore, the prevalence of HAI, antibiotic use and presence of MDROs were investigated in LTCF residents in Frankfurt am Main, Germany.
A point prevalence study of HAI and antibiotic use according to the European HALT protocol (health care associated infections in long-term care facilities) was carried out; swabs from the nose, throat and perineum were analyzed for methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE).
A total of 880 residents in 8 LTCFs were enrolled in the study in 2012. The study participants were 30% male, 46.7% were more than 85 years old, 70% exhibitied urinary or fecal incontinence, 11.4% had an indwelling urinary catheter and 0.1% a vascular catheter. Prevalence rates of HAI and of antibiotic use were 2.5 % and 1.5%, respectively. The prevalence of MDROs in 184 residents who agreed to being tested for MDROs was 9.2% MRSA, 26.7% ESBL and 2.7% VRE.
The HAIs and antibiotic use were comparable to the German HALT data from 2010. Compared to other German studies there is a steadily increasing MRSA problem in German LTCFs. High and increasing ESBL rates have been detected in German LTCFs. Further studies are needed to confirm this trend, preferably encompassing molecular methods to study epidemiology.
长期护理机构（LTCF）的居民有发生医疗保健相关感染（HAI）的风险，并且经常接受抗生素治疗。在德国，目前报告的HAI患病率为1.6%，抗生素使用率为1.15%。然而，关于德国LTCF中多重耐药菌（MRDO）当前患病率的公开数据很少。因此，对德国美因河畔法兰克福LTCF居民中的HAI患病率、抗生素使用情况和MDRO的存在情况进行了调查。
根据欧洲HALT方案（长期护理机构中的医疗保健相关感染）对HAI和抗生素使用情况进行了现患率研究；对来自鼻子、喉咙和会阴部的拭子进行分析，以检测耐甲氧西林金黄色葡萄球菌（MRSA）、产超广谱β-内酰胺酶肠杆菌（ESBL）和耐万古霉素肠球菌（VRE）。
2012年，8个LTCF中的880名居民参与了该研究。研究参与者中男性占30%，46.7%的人年龄超过85岁，70%的人有尿失禁或大便失禁，11.4%的人有留置尿管，0.1%的人有血管导管。HAI患病率和抗生素使用率分别为2.5%和1.5%。在184名同意接受MDRO检测的居民中，MDRO的患病率为：MRSA 9.2%，ESBL 26.7%，VRE 2.7%。
HAI和抗生素使用情况与2010年德国HALT数据相当。与德国其他研究相比，德国LTCF中MRSA问题呈稳步上升趋势。在德国LTCF中检测到ESBL率很高且呈上升趋势。需要进一步研究以证实这一趋势，最好采用分子方法来研究流行病学。
