Reinheimer Claudia, Kempf Volkhard A J, Jozsa Katalin, Wichelhaus Thomas A, Hogardt Michael, O'Rourke Fiona, Brandt Christian
Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
BMC Infect Dis. 2017 Jan 5;17(1):17. doi: 10.1186/s12879-016-2105-y.
Patients with contact to healthcare-system in high-prevalence countries (HPC) and refugee patients in hospital settings (REF) have previously been identified to be at risk of carrying multidrug-resistant organisms (MDRO). Comparative studies addressing the epidemiology of MDRO in patients transferred from hospitals abroad (ABROAD) and REF are lacking but are necessary to introduce refined infection control measures.
From December 2015 to June 2016, 117 REF, 84 ABROAD and 495 patients admitted to intensive care unit, with no refugee history or pre-treatment abroad (ICU), at University Hospital Frankfurt, Germany (UHF) were screened for MDRO on day of admittance. Data within these groups were compared and set in an epidemiological context.
52.1% (95% confidence interval = 42.7-61.5) of REF and 41.6% (31.0-52.9) of ABROAD, were positive for at least one MDRGN, respectively. In contrast, 7.9% (5.6-10.6) of ICU were positive for MDRGN. Thereof, 0.9% (0.0-4.7) of REF, 15.5% (8.5-25.0) of ABROAD and 0% (0.0-0.7) of ICU were positive for at least one MDRGN with carbapenem resistance (CR). In total, 19 MDRGN with CR were detected in ABROAD, with the most frequent species with CR being A. baumannii with 42.1% (20.3-66.5). Regarding MRSA, 10.3% (5.4-17.2) of REF, 5.9% (1.9-13.3) of ABROAD and a significantly lower proportion 1.4% (0.6-2.9) of ICU, respectively, were tested positive.
Both REF and ABROAD pose a relevant hospital hygiene risk. High prevalence of MDRGN with CR in ABROAD was observed. Concise screening and infection control guidelines are needed in patient cohorts with increased risk for MDRO carriage.
在高流行率国家（HPC）接触医疗系统的患者以及医院环境中的难民患者（REF）此前已被确定有携带多重耐药菌（MDRO）的风险。针对从国外医院转诊的患者（ABROAD）和难民患者中MDRO流行病学的比较研究尚缺，但对于引入完善的感染控制措施而言是必要的。
2015年12月至2016年6月，德国法兰克福大学医院（UHF）对117名难民患者、84名从国外转诊的患者以及495名入住重症监护病房且无难民病史或国外治疗史的患者（ICU）在入院当天进行了MDRO筛查。对这些组的数据进行比较并置于流行病学背景中。
分别有52.1%（95%置信区间=42.7-61.5）的难民患者和41.6%（31.0-52.9）的从国外转诊的患者至少对一种多重耐药菌呈阳性。相比之下，7.9%（5.6-10.6）的重症监护病房患者对多重耐药菌呈阳性。其中，0.9%（0.0-4.7）的难民患者、15.5%（8.5-25.0）的从国外转诊的患者和0%（0.0-0.7）的重症监护病房患者至少对一种耐碳青霉烯类多重耐药菌（CR）呈阳性。总共在从国外转诊的患者中检测到19株耐碳青霉烯类多重耐药菌，耐碳青霉烯类最常见的菌种是鲍曼不动杆菌，占42.1%（范围20.3-66.5）。关于耐甲氧西林金黄色葡萄球菌（MRSA），分别有10.3%（5.4-17.2）的难民患者、5.9%（1.9-13.3）的从国外转诊的患者以及显著更低比例的1.4%（0.6-2.9）的重症监护病房患者检测呈阳性。
难民患者和从国外转诊的患者均构成相关的医院卫生风险。观察到从国外转诊的患者中耐碳青霉烯类多重耐药菌的高流行率。对于有携带MDRO风险增加的患者群体，需要简洁的筛查和感染控制指南。
