Repessé Xavier, Artiguenave Margaux, Paktoris-Papine Sophie, Espinasse Florence, Dinh Aurélien, Charron Cyril, El Sayed Faten, Geri Guillaume, Vieillard-Baron Antoine
Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France.
Infection Control Unit, Section Biology Pathology and Health Products, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
Ann Intensive Care. 2017 Dec;7(1):73. doi: 10.1186/s13613-017-0295-0. Epub 2017 Jul 3.
The transmission of extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBL) is prevented by additional contact precautions, mainly relying on isolation in a single room and hand hygiene. Contact isolation cannot be achieved in our 12-bed ICU, which has only double rooms. We report the epidemiology of ESBL imported, acquired and transmitted in an ICU with no single rooms.
We prospectively conducted an observational and non-interventional study in a French 12-bed ICU. Inclusion criteria were patients >18 years of age treated by at least two successive nursing teams. Patient characteristics at admission and clinical data during hospital stay were collected prospectively. ESBL carriage was monitored using rectal swabs collected at admission and once weekly during the ICU stay. Potential cross-transmission was studied (1) by identifying index patients defined as possible ESBL sources for transmission, (2) by classifying each ESBL strain according to the cefotaximase München (CTX) 1 and 9 groups and (3) by gene sequencing for remaining cases of possible transmission.
From June 2014 to April 2015, of 550 patients admitted to the ICU, 470 met the inclusion criteria and 221 had at least two rectal swabs. The rate of ESBL colonization, mainly by Escherichia coli, at admission was 13.2%. The incidence of ESBL acquisition, mainly with E. coli too, was 4.1%. Mortality did not differ between ESBL carriers and non-carriers. In univariate analysis, ESBL acquisition was associated with male gender, SAPS II, SOFA, chronic kidney disease at admission, duration of mechanical ventilation, need for catecholamine and the ICU LOS. In multivariate analysis, SAPS II at admission was the only risk factor for ESBL acquisition. We confirmed cross-transmission, emanating from the same index patient, in two of the nine patients with ESBL acquisition (0.8%, 2/221). No case of cross-transmission in the same double room was observed.
Prevalence of ESBL colonization in our ICU was 13.2%. Despite the absence single rooms, the incidence of ESBL acquisition was 4.1% and cross-transmission was proven in only two cases, resulting from the same index patient who was not hospitalized in the same double room.
产超广谱β-内酰胺酶肠杆菌科细菌（ESBL）的传播可通过额外的接触预防措施来预防，主要依靠单人房间隔离和手卫生。在我们有12张床位且只有双人房间的重症监护病房（ICU）中无法实现接触隔离。我们报告了在一个没有单人房间的ICU中ESBL的输入、获得和传播的流行病学情况。
我们在法国一家有12张床位的ICU中前瞻性地开展了一项观察性非干预研究。纳入标准为年龄大于18岁且由至少两个连续护理团队治疗的患者。前瞻性收集患者入院时的特征和住院期间的临床数据。使用入院时及ICU住院期间每周一次采集的直肠拭子监测ESBL携带情况。通过以下方式研究潜在的交叉传播：（1）确定被定义为可能的ESBL传播源的索引患者；（2）根据头孢噻肟酶慕尼黑（CTX）1和9组对每个ESBL菌株进行分类；（3）对其余可能传播的病例进行基因测序。
2014年6月至2015年4月，在入住ICU的550例患者中，470例符合纳入标准，221例至少有两次直肠拭子检查。入院时ESBL定植率（主要为大肠杆菌）为13.2%。ESBL获得率（主要也为大肠杆菌）为4.1%。ESBL携带者和非携带者的死亡率无差异。单因素分析中，ESBL获得与男性、简化急性生理学评分系统（SAPS）II、序贯器官衰竭评估（SOFA）、入院时慢性肾脏病、机械通气时间长短、使用儿茶酚胺的需求及ICU住院时间相关。多因素分析中，入院时SAPS II是ESBL获得的唯一危险因素。在9例获得ESBL的患者中有2例（0.8%，2/221）证实存在来自同一索引患者的交叉传播。未观察到在同一双人房间内发生交叉传播的病例。
我们ICU中ESBL定植率为13.2%。尽管没有单人房间，但ESBL获得率为4.1%，且仅在两例中证实存在交叉传播，均源于未在同一双人房间住院的同一索引患者。
