印度尼西亚雅加达国家转诊医院重症监护病房中地方性耐碳青霉烯不敏感复杂体。
Endemic carbapenem-nonsusceptible complex in intensive care units of the national referral hospital in Jakarta, Indonesia.
机构信息
1Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/ Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
2Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
出版信息
Antimicrob Resist Infect Control. 2018 Jan 12;7:5. doi: 10.1186/s13756-017-0296-7. eCollection 2018.
BACKGROUND
Carbapenem-nonsusceptible complex have emerged worldwide, but the epidemiology in Indonesian hospitals has not been studied.
METHODS
A prospective observational study was performed on the intensive care units (ICUs) of the national referral hospital in Jakarta-Indonesia, in 2013 and 2014. All consecutive adult patients admitted and hospitalized for >48 h in ICUs were included. Basic and clinical data at admission were recorded. Carbapenem-nonsusceptible complex from clinical cultures and standardized screening were included. Environmental niches and healthcare workers (HCWs) were also screened. PCR was used to detect carbapenemase genes, and Raman spectroscopy as well as multilocus sequence typing (MLST) for typing.
RESULTS
Of 412 included patients, 69 (16.7%) carried carbapenem-nonsusceptible complex on admission, and 89 (25.9%) became positive during ICU stay. The acquisition rate was 43 per 1000 patient-days at risk. Six isolates were cultured from environment and one from a HCW. Acquisition of carbapenem-nonsusceptible complex was associated with longer ICU stay (median interquartile range [IQR]: 11 days [5-18], adjusted hazard ratio [aHR]: 2.56 [99% confidence interval (CI):1.76-3.70]), but not with mortality (adjusted odds ratio: 1.59 [99%CI: 0.74-3.40] at the chosen level of significance). The -like gene was detected in 292/318 (91.8%) isolates, including isolates from the environment and HCW. Typing revealed five major clusters. Sequence types (ST)195, ST208, ST218, ST642 as well as new STs were found. The dominant clone consisted of isolates from patients and environment throughout the study period.
CONCLUSIONS
Carbapenem-nonsusceptible complex are endemic in this setting. Prevention requires source control and limiting transmission of strains.
TRIAL REGISTRATION
The study was retrospectively registered at www.trialregister.nl (No:5541). Candidate number: 23,527, NTR number: NTR5541, Date registered NTR: 22nd December 2015.
背景
耐碳青霉烯肠杆菌科在全球范围内出现，但印度尼西亚医院的流行病学情况尚未得到研究。
方法
在 2013 年和 2014 年，对印度尼西亚雅加达国家转诊医院的重症监护病房（ICU）进行了一项前瞻性观察性研究。所有连续的成年患者均被纳入，这些患者在 ICU 住院超过 48 小时。记录入院时的基本和临床数据。从临床培养物和标准化筛查中纳入耐碳青霉烯肠杆菌科。还对环境和医护人员（HCW）进行筛查。PCR 用于检测碳青霉烯酶基因，拉曼光谱和多位点序列分型（MLST）用于分型。
结果
在 412 例纳入的患者中，有 69 例（16.7%）在入院时携带耐碳青霉烯肠杆菌科，89 例（25.9%）在 ICU 住院期间呈阳性。感染率为每 1000 个风险患者日 43 例。从环境中培养出 6 株分离株，从 1 名 HCW 中培养出 1 株。耐碳青霉烯肠杆菌科的获得与 ICU 住院时间延长有关（中位数四分位距 [IQR]：11 天[5-18]，调整后的危险比 [aHR]：2.56 [99%置信区间（CI）：1.76-3.70]），但与死亡率无关（调整后的优势比：在选定的显著性水平为 0.74-3.40]）。在 318 株（91.8%）分离株中检测到 -样基因，包括环境和 HCW 分离株。分型显示了五个主要的聚类。发现 ST195、ST208、ST218、ST642 以及新的 ST。优势克隆由整个研究期间患者和环境中的分离株组成。
结论
耐碳青霉烯肠杆菌科在该环境中普遍存在。预防需要控制传染源并限制菌株的传播。
试验注册
该研究在 www.trialregister.nl 进行了回顾性注册（编号：5541）。候选号码：23,527，NTR 号：NTR5541，注册日期 NTR：2015 年 12 月 22 日。
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