March Albert, Aschbacher Richard, Sleghel Ferisa, Soelva Gertrud, Kaczor Malgorzata, Migliavacca Roberta, Piazza Aurora, Mattioni Marchetti Vittoria, Pagani Laura, Scalzo Katia, Pasquetto Valentina, Pagani Elisabetta
Reparto di Geriatria, Comprensorio Sanitario di Bolzano, Italy.
Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Italy.
New Microbiol. 2017 Oct;40(4):258-263. Epub 2017 Oct 10.
In 2016, we undertook a point prevalence screening study for Enterobacteriaceae with extended-spectrum β-lactamases (ESBLs), high-level AmpC cephalosporinases and carbapenemases, and also methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE) in a long-term care facility (LTCF) and the associated acute care hospital geriatric unit in Bolzano, Northern Italy. Urine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on selective agars. Demographic data were collected. ESBL and carbapenemase genes were sought by PCR. We found the following colonization percentages with multidrug-resistant (MDR) bacteria in 2016 in LTCF residents: all MDR organisms, 66.1%; ESBL producers, 53.0%; carbapenemase-producers, 1.7%; MRSA, 14.8%; VRE, 0.8%. Colonization by all MDR bacteria was 19.4% for LTCF staff and 26.0% for geriatric unit patients. PCR showed that 80.3% of Escherichia coli isolates from LTCF residents, all E. coli isolates from LTCF staff, 62.5% and 100% of Klebsiella pneumoniae from LTCF residents and geriatric unit patients, respectively, had a blaCTX-M-type gene. All carbapenemase-producing Enterobacteriaceae harboured a blaVIM-type gene. To conclude, the ongoing widespread diffusion of MDR bacteria in the LTCF suggests that efforts should be strengthened on MDR screening, implementation of infection control strategies and antibiotic stewardship programs targeting the unique aspects of LTCFs.
2016年，我们在意大利北部博尔扎诺的一家长期护理机构（LTCF）及其附属的急性护理医院老年科，针对产超广谱β-内酰胺酶（ESBLs）、高水平AmpC头孢菌素酶和碳青霉烯酶的肠杆菌科细菌，以及耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）开展了一项现患率筛查研究。将尿液样本以及直肠、腹股沟、口咽和鼻拭子接种于选择性琼脂平板上。收集了人口统计学数据。通过聚合酶链反应（PCR）检测ESBL和碳青霉烯酶基因。我们发现，2016年LTCF居民中多重耐药（MDR）菌的定植率如下：所有MDR菌，66.1%；产ESBL菌，53.0%；产碳青霉烯酶菌，1.7%；MRSA，14.8%；VRE，0.8%。LTCF工作人员中所有MDR菌的定植率为19.4%，老年科患者中为26.0%。PCR检测显示，LTCF居民中80.3%的大肠杆菌分离株、LTCF工作人员的所有大肠杆菌分离株、LTCF居民和老年科患者中分别有62.5%和100%的肺炎克雷伯菌携带blaCTX-M型基因。所有产碳青霉烯酶的肠杆菌科细菌均携带blaVIM型基因。总之，MDR菌在LTCF中持续广泛传播，这表明应加强针对LTCF独特情况的MDR筛查、感染控制策略的实施以及抗生素管理计划。
