Skally M, Duffy F, Burns K, Doyle D, Foley S, Thomas T, Collins C, Smyth E, Turton J, Humphreys H
Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland.
J Hosp Infect. 2014 Nov;88(3):156-61. doi: 10.1016/j.jhin.2014.07.011. Epub 2014 Aug 27.
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae pose an increasing challenge in hospitals.
To describe the benefits of using molecular techniques to investigate the spread of ESBL-producing Klebsiella pneumoniae (ESBL-KP) within a tertiary referral centre.
Following the identification of a cluster of five ESBL-KP on one ward, a hospital-wide retrospective epidemiological investigation was undertaken into the incidence and spread of these organisms. Variable number tandem repeat (VNTR) profiles were used to assign patients to possible clusters. Patient outcome and length of hospital stay were reviewed. Locations of patients assigned to each cluster were investigated as possible sources of spread. Antimicrobial prescribing practices and hand hygiene compliance on affected wards were also reviewed.
Twenty-four ESBL-KP isolates were characterized by VNTR. The mean length of stay was 102.5 days for patients with ESBL-KP, which was significantly longer compared with the mean length of stay for all patients (10.1 days, P < 0.01). Nineteen patients were assigned to clusters with shared VNTR profiles. Review of patient transfer histories identified two instances where cross-transmission may have occurred. In both cases, compliance with good hand hygiene practice and antimicrobial prescribing was suboptimal.
Molecular typing provided a valuable insight into the clones of ESBL-KP circulating within the study institution. Increased surveillance to identify colonization among patients and routine typing of isolates should be considered, but the resource implications for patient isolation are considerable.
产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌在医院中构成的挑战日益增加。
描述使用分子技术调查产ESBL肺炎克雷伯菌（ESBL-KP）在三级转诊中心内传播情况的益处。
在一个病房发现5株产ESBL-KP的聚集性病例后，对这些细菌在全院范围内进行了回顾性流行病学调查，以了解其发病率和传播情况。使用可变数目串联重复序列（VNTR）图谱将患者分配到可能的聚集性病例组。回顾患者的预后和住院时间。调查分配到每个聚集性病例组的患者所在位置，以寻找可能的传播源。还回顾了受影响病房的抗菌药物处方习惯和手卫生依从性情况。
通过VNTR对24株产ESBL-KP分离株进行了特征分析。产ESBL-KP患者的平均住院时间为102.5天，与所有患者的平均住院时间（10.1天）相比显著更长（P<0.01）。19名患者被分配到具有共享VNTR图谱的聚集性病例组。回顾患者的转运历史发现了两起可能发生交叉传播的情况。在这两起病例中，手卫生良好做法和抗菌药物处方的依从性均欠佳。
分子分型为了解研究机构内传播的ESBL-KP克隆提供了有价值的见解。应考虑加强监测以识别患者中的定植情况并对分离株进行常规分型，但对患者隔离的资源需求相当大。
