Intensive Care Unit, CHU Félix Guyon, Saint-Denis, France.
Bacteriology Laboratory, CHU Félix Guyon, Saint-Denis, France.
J Travel Med. 2015 Sep-Oct;22(5):300-5. doi: 10.1111/jtm.12220. Epub 2015 Jun 17.
Few national recommendations exist on management of patients returning from abroad and all focus on hospitalized patients. Our purpose was to compare, in an intensive care unit (ICU), the admission prevalence and acquisition of multidrug-resistant (MDR) bacteria carriage in patients with ("Abroad") or without ("Local") a recent stay abroad, and then identify the risk factors in "Abroad" patients.
In this retrospective study, we reviewed charts of all the patients hospitalized in the ICU unit from January 2011 through July 2013 with hygiene samplings performed. We identified all patients who had stayed abroad ("Abroad") within 6 months prior to ICU admission.
Of 1,842 ICU patients, 129 (7%) "Abroad" patients were reported. In the "Abroad" group, the rate of MDR strain carriage was higher at admission (33% vs 6.7%, p < 0.001) and also more often diagnosed during the ICU stay (acquisition rate: 17% vs 5.2%, p < 0.001) than in "Local" patients. Risk factors associated with MDR bacteria carriage at admission in "Abroad" patients were diabetes mellitus [odds ratio (OR) 5.1 (1.7-14.8), p = 0.003] and "hospitalization abroad with antibiotic treatment" [OR 10.7 (4.2-27.3), p < 0.001]. Hospitalization abroad without antibiotic treatment was not identified as a risk factor.
The main factor associated with MDR bacteria carriage after a stay abroad seems to be a hospitalization abroad only in case of antibiotic treatment abroad. Screening and isolation of "Abroad" patients should be recommended, even in case of a first negative screening.
关于从国外返回的患者的管理，目前仅有少数国家建议，且这些建议均聚焦于住院患者。我们的目的是比较在重症监护病房（ICU）中，近期有国外旅行史（“国外”）和无国外旅行史（“本地”）的患者的住院率和多重耐药菌（MDR）携带率，并确定“国外”患者的危险因素。
本回顾性研究纳入了 2011 年 1 月至 2013 年 7 月期间入住 ICU 并进行了卫生采样的所有患者的病历。我们识别出所有在 ICU 入院前 6 个月内有国外旅行史的患者。
在 1842 例 ICU 患者中，有 129 例（7%）“国外”患者。在“国外”组中，入院时 MDR 菌株携带率更高（33% vs 6.7%，p < 0.001），且在 ICU 住院期间也更常被诊断（获得率：17% vs 5.2%，p < 0.001）。与“国外”患者入院时 MDR 细菌携带相关的危险因素是糖尿病（比值比 [OR] 5.1（1.7-14.8），p = 0.003）和“国外住院且接受抗生素治疗”（OR 10.7（4.2-27.3），p < 0.001）。国外住院但未接受抗生素治疗未被确定为危险因素。
在国外停留后与 MDR 细菌携带相关的主要因素似乎是国外住院且仅在国外接受抗生素治疗的情况下。即使首次筛查结果为阴性，也应建议对“国外”患者进行筛查和隔离。
