Service de Microbiologie, AP-HP Hôpital Européen Georges Pompidou, Paris Cedex 15, France.
Clin Microbiol Infect. 2014 Nov;20(11):O879-86. doi: 10.1111/1469-0691.12663. Epub 2014 Jul 25.
There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended-spectrum beta-lactamase (ESBL) and high-level expressed AmpC cephalosporinase (HL-CASE) producers. During a 3-month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE-selective media. Bacteria were identified using MALDI-TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL-CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of MDRE detection among the 93 patients (62% vs. 70%). In contrast, screening at admission and discharge, screening at admission and weekly thereafter, and screening at admission and weekly thereafter and at discharge significantly increased MDRE detection (77%, p 0.02; 76%, p 0.01; 86%, p<0.001, respectively). The difference in MDRE detection between these strategies relies essentially on the levels of detection of patients with HL-CASE producers. The most reasonable strategy would be to collect two samples, one at admission and one at discharge, which would detect 87.5% of the ESBL strains, 67.3% of the HL-CASE strains and 77.4% of all MDRE strains. This study should facilitate decision-making concerning the most suitable screening policy for MDRE detection in a given ICU setting.
目前，对于重症监护病房（ICU）中多重耐药肠杆菌科（MDRE）的最佳筛选程序尚未达成共识。因此，我们评估了五种用于检测产超广谱β-内酰胺酶（ESBL）和高水平表达的头孢菌素酶（HL-CASE）的策略。在三个月的时间里，我们每天从每个 ICU 患者的前 24 小时到 ICU 住院的最后一天采集直肠筛查拭子样本。将样本接种在 MDRE 选择性培养基上。使用 MALDI-TOF 质谱法鉴定细菌，并使用纸片扩散法进行药敏试验。从 269 名患者中的 93 名（34.6%）采集的 2348 份筛查样本中分离出 682 株 MDRE。ESBL 和 HL-CASE 产菌株的发生率分别为每 100 例入院患者 17.8 例和 19.3 例。在 48 名患者中，MDRE 携带呈间歇性。与入院时系统筛查相比，在 93 名患者中，出院时系统筛查并未显著增加 MDRE 的检出率（62%比 70%）。相比之下，入院和出院时筛查、入院和每周后筛查、以及入院和每周后及出院时筛查显著增加了 MDRE 的检出率（77%，p=0.02；76%，p=0.01；86%，p<0.001）。这些策略中 MDRE 检出率的差异主要取决于 HL-CASE 产菌株的检出水平。最合理的策略是采集两个样本，一个在入院时，一个在出院时，这将可以检测到 87.5%的 ESBL 株、67.3%的 HL-CASE 株和 77.4%的所有 MDRE 株。本研究将有助于为特定 ICU 环境中 MDRE 检测制定最合适的筛选策略提供决策依据。
