Inverarity Donald, Kilgour Elizabeth, Dunn Caroline, Thomas Linda, Fox Richard, Mitchell Lindsay, Paterson Pamela
Department of Microbiology, Monklands Hospital, Airdrie, UK.
Infection Control Team, Monklands Hospital, NHS Lanarkshire, UK.
J Infect Prev. 2014 Mar;15(2):50-56. doi: 10.1177/1757177413507120. Epub 2013 Oct 14.
Following a cluster of haematology patients with carbapenem-resistant (CRKP) septicaemia, we initiated screening for rectal carriage of CRKP and multidrug-resistant (MDRKP) in this patient group. Haematology inpatients submit a rectal swab once weekly. When plated onto chromogenic Brilliance™ UTI Agar (Oxoid), and incubated overnight with a 10 µg ertapenem disc (Oxoid), is identified and semi-automated antibiotic susceptibility testing is performed using the Vitek 2 analyser (Biomerieux). When no zone of inhibition occurs, immediate intervention through patient isolation and enhanced environmental cleaning can be instigated to control further spread while empirical antibiotic prescribing is adapted to take account of identified resistances. Over 2 years, six patients with CRKP and 20 patients with MDRKP were identified. These isolates were resistant to first-line empirical treatment choices for neutropenic sepsis and presented a clinical risk of treatment failure for sepsis post cytotoxic chemotherapy. We describe how this rectal screening methodology was developed and how the results influenced appropriate antibiotic prescribing, patient placement in single rooms and the cleaning of the ward environment to prevent person-to-person transmission of MDRKP and CRKP.
在一组患有耐碳青霉烯类肺炎克雷伯菌（CRKP）败血症的血液科患者之后，我们开始对该患者群体进行CRKP和多重耐药肺炎克雷伯菌（MDRKP）的直肠携带情况筛查。血液科住院患者每周提交一次直肠拭子。将其接种在显色的Brilliance™ UTI琼脂（Oxoid）上，并用10 μg厄他培南纸片（Oxoid）过夜培养，进行鉴定，并使用Vitek 2分析仪（生物梅里埃公司）进行半自动抗生素敏感性测试。当没有抑菌圈出现时，可通过患者隔离和加强环境清洁立即进行干预，以控制进一步传播，同时调整经验性抗生素处方以考虑已确定的耐药性。在两年多的时间里，共发现6例CRKP患者和20例MDRKP患者。这些分离株对中性粒细胞减少败血症的一线经验性治疗选择耐药，并对细胞毒性化疗后败血症的治疗失败存在临床风险。我们描述了这种直肠筛查方法是如何开发的，以及结果如何影响适当的抗生素处方、患者安置在单人病房以及病房环境的清洁，以防止MDRKP和CRKP的人际传播。
