Microbiotas, Host, Antibiotics, Bacterial Resistance (MiHAR Lab), University of Nantes, Nantes, France.
Microbiotas, Host, Antibiotics, Bacterial Resistance (MiHAR Lab), University of Nantes, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France.
J Hosp Infect. 2019 May;102(1):25-30. doi: 10.1016/j.jhin.2019.02.002. Epub 2019 Feb 12.
Colonization by carbapenemase-producing Enterobacteriaceae (CPE) may persist for several months after hospital discharge, especially in patients with altered microbiota.
To identify how many previously OXA-48 CPE-positive patients identified during an outbreak period were readmitted; to evaluate their CPE-positive or -negative digestive tract colonization at hospital readmission and during readmission stay; and to assess the role of antibiotic exposure on their CPE colonization status during readmission.
All CPE cohort patients from June 2013 to May 2016 (N = 189) were registered in a survey database and were systematically identified at readmission by a daily informatics and alert program using specific hospital population number. Each cohort patient was systematically screened for CPE colonization on the day of readmission and then weekly if the length of stay was more than six days.
In all, 114 (60.3%) patients previously CPE-colonized were readmitted to our hospital. Excluding the 12 patients who were not screened because their period of readmission was <24 h, 88 patients were negative (86.3%) and 14 were positive (13.7%) for CPE colonization at first hospital readmission. The 14 CPE-positive patients did not change their infectious status and remained CPE-positive during the study period. Of the 88 negative patients, 65 remained negative during the study period, and 23 subsequently became CPE-positive after the negative readmission screening. CPE-positive colonization was significantly associated with antibiotic exposure during readmission periods (P < 0.001).
Negative screens at hospital readmission did not necessarily predict resolution of CPE carriage. Antibiotic exposure appears to influence the risk of remaining CPE positive.
产碳青霉烯酶肠杆菌科（CPE）定植在出院后可持续数月，尤其是在改变了微生物群的患者中。
确定在暴发期间确定为 OXA-48 型 CPE 阳性的患者中有多少人再次入院；评估他们在医院再次入院和再次入院期间的 CPE 阳性或阴性消化道定植情况；并评估抗生素暴露对其再次入院期间 CPE 定植状态的影响。
从 2013 年 6 月至 2016 年 5 月登记了所有 CPE 队列患者（N=189），并通过每日信息学和警报程序使用特定的医院人群编号在再次入院时系统地识别。在再次入院当天，如果住院时间超过 6 天，则每周对每个队列患者进行 CPE 定植筛查。
共有 114 例（60.3%）先前 CPE 定植的患者再次入住我院。排除 12 名因再次入院时间<24 h 而未进行筛查的患者，88 名患者在首次医院再次入院时 CPE 定植阴性（86.3%），14 名患者 CPE 定植阳性（13.7%）。14 名 CPE 阳性患者的感染状态未改变，在研究期间仍为 CPE 阳性。在 88 名阴性患者中，65 名在研究期间保持阴性，23 名在阴性再次入院筛查后转为 CPE 阳性。CPE 阳性定植与再次入院期间的抗生素暴露显著相关（P<0.001）。
在医院再次入院时进行阴性筛查并不一定能预测 CPE 携带的消除。抗生素暴露似乎会影响持续 CPE 阳性的风险。
