Cohen Regev, Babushkin Frida, Cohen Shoshana, Afraimov Marina, Shapiro Maurice, Uda Martina, Khabra Efrat, Adler Amos, Ben Ami Ronen, Paikin Svetlana
Head of Infectious diseases unit, Sanz Medical Center, Laniado hospital, Neytanya, Israel ; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Infectious diseases unit, Sanz Medical Center, Laniado hospital, Netanya, Israel.
Antimicrob Resist Infect Control. 2017 Jan 11;6:7. doi: 10.1186/s13756-016-0167-7. eCollection 2017.
(PA) surveillance may improve empiric antimicrobial therapy, since colonizing strains frequently cause infections. This colonization may be 'endogenous' or 'exogenous', and the source determines infection control measures. We prospectively investigated the sources of PA, the clinical impact of PA colonization upon admission and the dynamics of colonization at different body sites throughout the intensive care unit stay.
Intensive care patients were screened on admission and weekly from the pharynx, endotracheal aspirate, rectum and urine. Molecular typing was performed using Enterobacterial Repetitive Intergenic Consensus Polymerase Chain reaction (ERIC-PCR).
Between November 2014 and January 2015, 34 patients were included. Thirteen (38%) were colonized on admission, and were at a higher risk for PA-related clinical infection (Hazard Ratio = 14.6, = 0.0002). Strains were often patient-specific, site-specific and site-persistent. Sixteen out of 17 (94%) clinical isolates were identical to strains found concurrently or previously on screening cultures from the same patient, and none were unique. Ventilator associated pneumonia-related strains were identical to endotracheal aspirates and pharynx screening (87-75% of cases). No clinical case was found among patients with repeated negative screening.
PA origin in this non-outbreak setting was mainly 'endogenous' and PA-strains were generally patient- and site-specific, especially in the gastrointestinal tract. While prediction of ventilator associated pneumonia-related PA-strain by screening was fair, the negative predictive value of screening was very high.
由于定植菌株常引发感染，（铜绿假单胞菌）PA监测可能会改善经验性抗菌治疗。这种定植可能是“内源性”或“外源性”的，其来源决定感染控制措施。我们前瞻性地调查了PA的来源、入院时PA定植的临床影响以及在重症监护病房住院期间不同身体部位定植的动态变化。
对重症监护患者在入院时以及每周从咽部、气管内吸出物、直肠和尿液进行筛查。使用肠杆菌重复基因间共识聚合酶链反应（ERIC-PCR）进行分子分型。
在2014年11月至2015年1月期间，纳入了34例患者。13例（38%）在入院时即被定植，且发生PA相关临床感染的风险更高（风险比=14.6，P=0.0002）。菌株通常具有患者特异性、部位特异性和部位持续性。17株临床分离株中有16株（94%）与同一患者筛查培养物中同时或先前发现的菌株相同，无一株是独特的。呼吸机相关性肺炎相关菌株与气管内吸出物和咽部筛查结果相同（87%-75%的病例）。在筛查反复阴性的患者中未发现临床病例。
在这种非暴发情况下PA的来源主要是“内源性”的，PA菌株通常具有患者和部位特异性，尤其是在胃肠道。虽然通过筛查预测呼吸机相关性肺炎相关PA菌株的效果尚可，但筛查的阴性预测值非常高。
