Department of Medical Microbiology and Infection Control, VU university medical center, PK 1 X 124, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
Antimicrob Resist Infect Control. 2018 Apr 12;7:52. doi: 10.1186/s13756-018-0344-y. eCollection 2018.
The distribution of Extended-Spectrum Beta-Lactamase-producing Gram-negative bacteria (ESBL-GNB) colonization sites is relevant for infection control guidelines on detection and follow-up of colonization. We questioned whether it is possible to rely solely on rectal swab culture for follow-up of ESBL-GNB colonization.
We retrospectively assessed ESBL-GNB colonization sites in patients in a tertiary hospital in the Netherlands. The Laboratory Information Management System was queried for all bacterial cultures obtained between January 2012 and August 2016. All patients with one or more cultures positive for ESBL-GNB were identified and the distribution of ESBL-GNB positive sample sites was assessed. A subgroup analysis was performed on patients for whom at least one rectal swab specimen was available.
We identified 1011 ESBL-GNB carriers with 16,578 specimens for analysis. ESBL-GNB were most frequently isolated from the rectum (506/1011), followed by the urogenital (414/1011) and respiratory tract (142/1011), and pus (136/1011). For 588 patients at least one rectal swab specimen was available. In this subgroup, ESBL-GNB colonization was detected only in the rectum in 55.4% (326/588) of patients, in 30.6% (180/588) in the rectum and a different culture site, and in 13.9% (82/588) no rectal colonization was detected.
Rectal colonization with ESBL-GNB was detected in 86% of ESBL-GNB carriers. However, in 14% of ESBL-GNB carriers we did not detect rectal colonization. Therefore, samples taken for follow-up of colonization with multi-drug resistant Gram-negative bacteria (MDR-GNB) should ideally also include samples from the site where the MDR-GNB was initially found.
产超广谱β-内酰胺酶革兰氏阴性菌（ESBL-GNB）定植部位的分布与感染控制指南中关于定植检测和随访的相关。我们质疑是否可以仅依靠直肠拭子培养来随访 ESBL-GNB 定植。
我们回顾性评估了荷兰一家三级医院患者的 ESBL-GNB 定植部位。通过实验室信息管理系统对 2012 年 1 月至 2016 年 8 月间获得的所有细菌培养物进行了查询。所有培养物中 ESBL-GNB 阳性的患者均被识别，并评估了 ESBL-GNB 阳性样本部位的分布。对至少有一份直肠拭子标本的患者进行了亚组分析。
我们共确定了 1011 例 ESBL-GNB 携带者，共分析了 16578 份标本。ESBL-GNB 最常从直肠分离（506/1011），其次是泌尿生殖道（414/1011）和呼吸道（142/1011），以及脓液（136/1011）。在 588 名至少有一份直肠拭子标本的患者中，在该亚组中，55.4%（326/588）的患者仅在直肠中检测到 ESBL-GNB 定植，30.6%（180/588）的患者在直肠和其他培养部位中检测到 ESBL-GNB 定植，13.9%（82/588）的患者未检测到直肠定植。
86%的 ESBL-GNB 携带者中检测到 ESBL-GNB 直肠定植。然而，在 14%的 ESBL-GNB 携带者中，我们未检测到直肠定植。因此，为了随访耐多药革兰氏阴性菌（MDR-GNB）定植而采集的样本，理想情况下也应包括最初发现 MDR-GNB 的部位的样本。
