Robert Koch Institute, Department of Infectious Diseases, Division for Applied Infection Control and Hospital Hygiene, Berlin, Germany.
Robert Koch Institute, Department of Infectious Diseases, Division for Applied Infection Control and Hospital Hygiene, Berlin, Germany.
J Hosp Infect. 2018 Jan;98(1):14-20. doi: 10.1016/j.jhin.2017.07.004. Epub 2017 Jul 10.
Rehabilitation clinics may vary widely in terms of type of care provided, duration of hospital stay, and case severity. Few data are available on prevalence of Clostridium difficile or extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) colonization in rehabilitation clinics in Germany.
This study investigated the frequency of intestinal colonization by these pathogens among patients in rehabilitation clinics of different specialization.
In the scope of a point prevalence study, faecal samples and demographic and clinical data were collected in five rehabilitation clinics. Samples were screened for C. difficile and ESBL-E by culture. Isolates were characterized by polymerase chain reaction for C. difficile toxins A and B, for β-lactamase genes, and by molecular typing including pulsed-field gel electrophoresis and PCR-based ribotyping.
Of 305 patients screened, 11.1% were colonized by toxigenic C. difficile and 7.5% by ESBL-E. Colonization rates differed markedly between facilities, ranging from 1.6% to 26.3% for C. difficile and from zero to 23.7% for ESBL-E. Prevalence of colonization by C. difficile and ESBL-E was higher in neurological rehabilitation clinics than in clinics with other specialties (P<0.001). Molecular typing revealed six patients from one neurological rehabilitation clinic harbouring a unique C. difficile strain (ribotype 017). CTX-M-15 was the most prevalent ESBL type. We detected several indistinguishable pairs of ESBL-E isolates within some facilities.
Significant differences were found in the prevalence of C. difficile and ESBL-E between rehabilitation clinics. Facilities providing specialized medical care for critically ill patients had higher prevalence rates. These results may help to delineate the requirements for infection prevention and control in rehabilitation clinics.
康复诊所提供的护理类型、住院时间长短和病例严重程度可能存在很大差异。德国康复诊所中艰难梭菌或产超广谱β-内酰胺酶肠杆菌科（ESBL-E）定植的流行情况数据很少。
本研究调查了不同专业康复诊所患者中这些病原体肠道定植的频率。
在一项时点患病率研究中，在五家康复诊所收集粪便样本和人口统计学及临床数据。通过培养法筛查粪便样本中的艰难梭菌和 ESBL-E。通过聚合酶链反应对艰难梭菌毒素 A 和 B、β-内酰胺酶基因进行鉴定，并通过脉冲场凝胶电泳和基于 PCR 的核糖体分型进行分子分型。
在筛查的 305 名患者中，11.1%的患者定植了产毒艰难梭菌，7.5%的患者定植了 ESBL-E。不同医疗机构之间的定植率差异显著，艰难梭菌的定植率范围为 1.6%至 26.3%，ESBL-E 的定植率范围为零至 23.7%。神经康复诊所的艰难梭菌和 ESBL-E 定植率明显高于其他专业的诊所（P<0.001）。分子分型显示，来自一家神经康复诊所的六名患者携带独特的艰难梭菌菌株（核糖体型 017）。CTX-M-15 是最常见的 ESBL 型。我们在一些医疗机构内发现了几对难以区分的 ESBL-E 分离株。
康复诊所中艰难梭菌和 ESBL-E 的流行率存在显著差异。为危重症患者提供专业医疗服务的医疗机构具有更高的流行率。这些结果可能有助于明确康复诊所感染预防和控制的要求。
