Kurz Mathis S E, Bayingana Claude, Ndoli Jules M, Sendegeya Augustin, Durst Anita, Pfüller Roland, Gahutu Jean Bosco, Mockenhaupt Frank P
Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda.
Trop Med Int Health. 2017 Feb;22(2):210-220. doi: 10.1111/tmi.12824. Epub 2017 Jan 13.
To assess the presence and risk factors of intestinal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among patients admitted to the University Teaching Hospital of Butare and among their attending caregivers, and to analyse the acquisition of ESBL-PE carriage during hospital stay and associated factors.
We screened 392 patients and their attending caregivers at admission and discharge for ESBL-PE carriage. Bacterial species were determined using the API-20E system, and antimicrobial susceptibility testing was performed by agar disc diffusion. Data on socio-economic status, diet, behaviour, household assets, livestock and hospital procedures were collected.
At admission, 50% of the patients showed intestinal ESBL-PE carriage (Escherichia coli, 51%; Klebsiella pneumoniae, 39%; Enterobacter cloacae, 19%) as did 37% of their caregivers. Co-resistance was common but no carbapenem resistance was detected. At discharge, the proportion of ESBL-PE-colonised patients increased to 65% (caregivers, 47%) with almost complete carriage in paediatric patients (93%). The acquisition rate among initially non-colonised patients was 55% (or, 71/1000 patient days). Independent predictors of admission carriage included a colonised caregiver, prior antibiotic intake, egg consumption and neglecting to boil drinking water, whereas being a paediatric patient, undergoing surgery and male gender predicted acquisition during hospitalisation.
Abundant admission carriage of ESBL-PE and a high acquisition rate in a Rwandan university hospital point to potential intrahospital transmission and community dissemination. Caregivers are an additional source of possible spread. Risk factors of colonisation such as diet and water source need to be tackled to prevent the further emergence and spread of ESBL-PE.
评估布塔雷大学教学医院收治的患者及其陪护人员中产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）肠道携带情况及危险因素，并分析住院期间ESBL-PE携带的获得情况及相关因素。
我们在入院和出院时对392例患者及其陪护人员进行ESBL-PE携带情况筛查。使用API-20E系统确定细菌种类，并通过琼脂纸片扩散法进行药敏试验。收集社会经济状况、饮食、行为、家庭资产、家畜及医院诊疗程序等数据。
入院时，50%的患者肠道存在ESBL-PE携带（大肠埃希菌，51%；肺炎克雷伯菌，39%；阴沟肠杆菌，19%），其陪护人员的携带率为37%。多重耐药常见，但未检测到碳青霉烯类耐药。出院时，ESBL-PE定植患者比例增至65%（陪护人员为47%），儿科患者几乎全部携带（93%）。初始未定植患者的获得率为55%（即71/1000患者日）。入院时携带的独立预测因素包括陪护人员定植、既往抗生素使用、食用鸡蛋及未煮沸饮用水，而儿科患者、接受手术及男性性别则预测住院期间会获得感染。
卢旺达一家大学医院中ESBL-PE入院时携带率高且获得率高，表明存在医院内传播及社区传播的可能性。陪护人员是可能传播的额外来源。需要解决饮食和水源等定植危险因素，以预防ESBL-PE的进一步出现和传播。
