Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany; Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania.
Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany.
J Hosp Infect. 2018 Sep;100(1):47-53. doi: 10.1016/j.jhin.2018.05.017. Epub 2018 May 28.
Despite the high reported rates of surgical site infections (SSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (EPE) in low-income countries, including Tanzania, the role of EPE carriage in subsequent occurrence of SSIs is not known. This study investigated the rates of EPE carriage among surgical patients at the time of admission and discharge, and linked EPE genotype with SSIs.
EPE were confirmed among isolates from rectal and wound/pus swabs using VITEK-2. Polymerase chain reaction and sequencing were performed to detect beta-lactamase genes. Multi-locus sequence typing was used to determine the genotypes of EPE isolates.
Among 930 patients enrolled, EPE carriage was significantly higher on discharge than admission (36.4% vs 23.7%, P<0.001). Of 272 patients who tested negative on admission, 78 (28.7%) acquired EPE during hospitalization. History of hospital stay within the previous three months was an independent predictor of EPE acquisition [hazard ratio 2, 95% confidence interval (CI) 1.04-3.98, P=0.038]. Of the 536 patients who were successfully followed-up after surgery, 78 (14.6%, 95% CI 11.6-17.5) developed SSIs. Of 57 SSIs investigated, 33 (58%) were caused by enteric Gram-negative bacteria, of which 63.6% (21/33) were EPE. Escherichia coli sequence type (ST)131 pandemic clone and Klebsiella pneumoniae ST391 predominated among wound isolates. The bla gene was detected in 37 (97.3%) of 38 ESBL isolates. Male sex was an independent predictor of SSI (odds ratio 2.92, 95% CI 1.73-4.91, P<0.001).
These findings warrant implementation of strict infection control measures, antimicrobial stewardship and exploration of the transmission dynamics of EPE in surgical wards.
尽管在包括坦桑尼亚在内的低收入国家，报告的由产超广谱β-内酰胺酶（ESBL）的肠杆菌科（EPE）引起的手术部位感染（SSI）发生率很高，但 EPE 定植在随后发生 SSI 中的作用尚不清楚。本研究调查了住院和出院时手术患者的 EPE 携带率，并将 EPE 基因型与 SSI 相关联。
使用 VITEK-2 从直肠和伤口/脓液拭子中分离的菌株中确认 EPE。进行聚合酶链反应和测序以检测β-内酰胺酶基因。多位点序列分型用于确定 EPE 分离株的基因型。
在纳入的 930 名患者中，EPE 携带率在出院时明显高于入院时（36.4% vs 23.7%，P<0.001）。在 272 名入院时检测为阴性的患者中，有 78 名（28.7%）在住院期间获得了 EPE。过去三个月内有住院史是获得 EPE 的独立预测因素[风险比 2，95%置信区间（CI）1.04-3.98，P=0.038]。在手术后成功随访的 536 名患者中，有 78 名（14.6%，95%CI 11.6-17.5）发生 SSI。在 57 例调查的 SSI 中，有 33 例（58%）由肠内革兰氏阴性菌引起，其中 63.6%（21/33）为 EPE。大肠杆菌 ST131 流行克隆和肺炎克雷伯菌 ST391 是伤口分离株中的主要类型。在 38 株 ESBL 分离株中检测到 bla 基因。男性是 SSI 的独立预测因素（比值比 2.92，95%CI 1.73-4.91，P<0.001）。
这些发现需要实施严格的感染控制措施、抗菌药物管理和探索手术病房中 EPE 的传播动态。
