Center for Interdisciplinary Research to Prevent Infections, School of Nursing, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Int J Antimicrob Agents. 2017 Aug;50(2):127-134. doi: 10.1016/j.ijantimicag.2017.03.012. Epub 2017 Jun 21.
Carbapenem antibiotics are used as a last resort to treat serious Gram-negative bacteria (GNB) infections; however, carbapenemase-producing strains of GNB have emerged as a major source of resistance. Owing to the highly transmissible nature of plasmid-borne carbapenemases, numerous reports have warned about the likely spread into the community from healthcare settings. Since the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the community is largely unknown, we conducted a scoping review of the literature to assess the percentage of CRE isolates that could be associated with the community. Initially, 361 studies were assessed and 15 met the inclusion criteria. Although 5 studies (33.3%) found no community-associated CRE, the remaining 10 studies identified percentages ranging from 0.04% to 29.5% of either community-associated or community-onset CRE among their samples, with US-based studies alone ranging from 5.6 to 10.8%. The presence of CRE in the community poses an urgent public health threat.
碳青霉烯类抗生素被用作治疗严重革兰氏阴性菌 (GNB) 感染的最后手段；然而，产生碳青霉烯酶的 GNB 菌株已成为耐药的主要来源。由于质粒携带的碳青霉烯酶具有高度传染性，许多报告都警告说，这些酶可能会从医疗机构传播到社区。由于社区中碳青霉烯类耐药肠杆菌科 (CRE) 的流行情况在很大程度上尚不清楚，我们对文献进行了范围性综述，以评估可能与社区相关的 CRE 分离株的百分比。最初评估了 361 项研究，其中 15 项符合纳入标准。尽管有 5 项研究（33.3%）未发现社区相关性 CRE，但其余 10 项研究在其样本中发现了社区相关性或社区发病 CRE 的比例在 0.04%至 29.5%之间，仅基于美国的研究发现比例在 5.6%至 10.8%之间。CRE 在社区中的存在构成了紧迫的公共卫生威胁。
