Hagiya Hideharu, Yamamoto Norihisa, Kawahara Ryuji, Akeda Yukihiro, Shanmugakani Rathina Kumar, Ueda Akiko, Nishi Isao, Asada Rumiko, Yoshida Hisao, Tomono Kazunori
Department of Infection Control and Prevention, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Bacteriology, Osaka Institute of Public Health, Osaka, Japan.
J Infect Chemother. 2018 Sep;24(9):769-772. doi: 10.1016/j.jiac.2018.03.009. Epub 2018 Apr 12.
The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing at medical institutions in Japan without even noticing. Recently, we performed a point prevalence survey for CRE carriage at a medical facility in northern Osaka that demonstrated an unexpectedly high prevalence of bla-positive CRE, particularly at long-term care hospitals (LTCH). To identify the risk factors for CRE carriage, we collected clinical data of patients at a representative LTCH. Of 140 patients who were included in this study, 27 (19.3%) were colonized with metallo-beta-lactamase (IMP-6) producers. Pulsed-field gel electrophoresis of the IMP-6 producing Enterobacteriaceae suggested a non-clonal transmission of Escherichia coli, while a clonal spread was shown for Klebsiella pneumoniae. Risk factors for CRE colonization were a longer stay at the hospital stay and a lower independence state, as measured by Norton scales. We propose that a paradigm shift in infection control, inciting a coordinated regional effort to involve LTCHs, should be discussed in the aging society of Japan.
日本医疗机构中耐碳青霉烯类肠杆菌科细菌（CRE）的流行率一直在不知不觉中上升。最近，我们在大阪北部的一家医疗机构进行了一项CRE携带情况的现患率调查，结果显示bla阳性CRE的流行率出乎意料地高，尤其是在长期护理医院（LTCH）。为了确定CRE携带的危险因素，我们收集了一家代表性LTCH患者的临床数据。在本研究纳入的140例患者中，27例（19.3%）被产金属β-内酰胺酶（IMP-6）的细菌定植。对产IMP-6的肠杆菌科细菌进行脉冲场凝胶电泳分析表明，大肠杆菌存在非克隆传播，而肺炎克雷伯菌则呈现克隆传播。根据诺顿量表测量，CRE定植的危险因素是住院时间较长和独立性较低。我们建议，在日本老龄化社会中，应讨论感染控制的范式转变，促使区域协调努力将LTCH纳入其中。
