盾牌橙县项目：南加州21家疗养院和长期急性护理机构中多重耐药菌的流行情况
The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California.
作者信息
McKinnell James A, Singh Raveena D, Miller Loren G, Kleinman Ken, Gussin Gabrielle, He Jiayi, Saavedra Raheeb, Dutciuc Tabitha D, Estevez Marlene, Chang Justin, Heim Lauren, Yamaguchi Stacey, Custodio Harold, Gohil Shruti K, Park Steven, Tam Steven, Robinson Philip A, Tjoa Thomas, Nguyen Jenny, Evans Kaye D, Bittencourt Cassiana E, Lee Bruce Y, Mueller Leslie E, Bartsch Sarah M, Jernigan John A, Slayton Rachel B, Stone Nimalie D, Zahn Matthew, Mor Vincent, McConeghy Kevin, Baier Rosa R, Janssen Lynn, O'Donnell Kathleen, Weinstein Robert A, Hayden Mary K, Coady Micaela H, Bhattarai Megha, Peterson Ellena M, Huang Susan S
机构信息
Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-University of California Los Angeles Medical Center, Torrance.
Division of Infectious Diseases, University of California Irvine School of Medicine, Orange.
出版信息
Clin Infect Dis. 2019 Oct 15;69(9):1566-1573. doi: 10.1093/cid/ciz119.
BACKGROUND
Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs.
METHODS
A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase-producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility.
RESULTS
Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage.
CONCLUSIONS
The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.
背景
耐多药微生物（MDROs）通过患者转移在医院、疗养院（NHs）和长期急性护理机构（LTACs）之间传播。消除橙县MDROs危及生命传播的共享医疗干预措施是一项区域公共卫生合作项目，涉及对38家根据患者共享程度高而选定的医疗机构进行去定植。我们报告了21家NHs/LTACs的MDRO基线患病率。
方法
对21家NHs/LTACs（18家NHs，3家LTACs）的50名成年人进行随机抽样，使用鼻腔、皮肤（腋窝/腹股沟）和直肠周围拭子筛查耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌属（VRE）、产超广谱β-内酰胺酶的微生物（ESBL）和耐碳青霉烯类肠杆菌科细菌（CRE）。使用按人和机构聚类的多变量模型评估与MDRO携带相关的机构和居民特征。
结果
NHs中MDROs的患病率为65%，LTACs中为80%。NHs中最常见的MDROs是MRSA（42%）和ESBL（34%）；LTACs中是VRE（55%）和ESBL（38%）。在管理通气的LTAC患者和NH居民的机构中，CRE患病率更高（8%对<1%，P<.001）。18%的NH居民和49%的LTAC患者的MDRO状态已知。携带MDRO的成年人通常还携带其他MDROs（54%的MDRO+NH居民和62%的MDRO+LTAC患者）。MRSA病史（优势比[OR]=1.7；置信区间[CI]：1.2，2.4；P=.004）、VRE（OR=2.1；CI：1.2，3.8；P=.01）、ESBL（OR=1.6；CI：1.1，2.3；P=.03）和糖尿病（OR=1.3；CI：1.0，1.7；P=.03）与任何MDRO携带相关。
结论
大多数NH居民和LTAC患者携带MDROs。机构通常不知道患者的MDRO状态。MDRO的高患病率凸显了在NHs/LTACs中开展预防工作的必要性，作为控制MDRO传播的区域努力的一部分。
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