Hamprecht A, Rohde A M, Behnke M, Feihl S, Gastmeier P, Gebhardt F, Kern W V, Knobloch J K, Mischnik A, Obermann B, Querbach C, Peter S, Schneider C, Schröder W, Schwab F, Tacconelli E, Wiese-Posselt M, Wille T, Willmann M, Seifert H, Zweigner J
German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany.
German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany.
J Antimicrob Chemother. 2016 Oct;71(10):2957-63. doi: 10.1093/jac/dkw216. Epub 2016 Jun 17.
The objectives of this study were to prospectively assess the rectal carriage rate of third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB) in non-ICU patients on hospital admission and to investigate resistance mechanisms and risk factors for carriage.
Adult patients were screened for 3GCREB carriage at six German tertiary care hospitals in 2014 using rectal swabs or stool samples. 3GCREB isolates were characterized by phenotypic and molecular methods. Each patient answered a questionnaire about potential risk factors for colonization with MDR organisms (MDROs). Univariable and multivariable risk factor analyses were performed to identify factors associated with 3GCREB carriage.
Of 4376 patients, 416 (9.5%) were 3GCREB carriers. Escherichia coli was the predominant species (79.1%). ESBLs of the CTX-M-1 group (67.3%) and the CTX-M-9 group (16.8%) were the most frequent β-lactamases. Five patients (0.11%) were colonized with carbapenemase-producing Enterobacteriaceae. The following risk factors were significantly associated with 3GCREB colonization in the multivariable analysis (P < 0.05): centre; previous MDRO colonization (OR = 2.12); antibiotic use within the previous 6 months (OR = 2.09); travel outside Europe (OR = 2.24); stay in a long-term care facility (OR = 1.33); and treatment of gastroesophageal reflux disease (GERD) (OR = 1.22).
To our knowledge, this is the largest admission prevalence study of 3GCREB in Europe. The observed prevalence of 9.5% 3GCREB carriage was higher than previously reported and differed significantly among centres. In addition to previously identified risk factors, the treatment of GERD proved to be an independent risk factor for 3GCREB colonization.
本研究的目的是前瞻性评估非重症监护病房（ICU）患者入院时耐第三代头孢菌素肠杆菌科细菌（3GCREB）的直肠携带率，并调查其耐药机制及携带的危险因素。
2014年，在德国六家三级护理医院，采用直肠拭子或粪便样本对成年患者进行3GCREB携带情况筛查。通过表型和分子方法对3GCREB分离株进行鉴定。每位患者回答一份关于多重耐药菌（MDROs）定植潜在危险因素的问卷。进行单变量和多变量危险因素分析，以确定与3GCREB携带相关的因素。
4376例患者中，416例（9.5%）为3GCREB携带者。大肠埃希菌是主要菌种（79.1%）。CTX-M-1组（67.3%）和CTX-M-9组（16.8%）的超广谱β-内酰胺酶（ESBLs）是最常见的β-内酰胺酶。5例患者（0.11%）被产碳青霉烯酶肠杆菌科细菌定植。多变量分析中，以下危险因素与3GCREB定植显著相关（P<0.05）：中心；既往MDRO定植（比值比[OR]=2.12）；既往6个月内使用抗生素（OR=2.09）；欧洲以外旅行（OR=2.24）；长期护理机构入住史（OR=1.33）；胃食管反流病（GERD）治疗史（OR=1.22）。
据我们所知，这是欧洲最大规模的3GCREB入院患病率研究。观察到的3GCREB携带率为9.5%，高于先前报道，且各中心之间存在显著差异。除先前确定的危险因素外，GERD治疗被证明是3GCREB定植的独立危险因素。
