Ramanathan Yamunadevi V, Venkatasubramanian Ramasubramanian, Nambi P Senthur, Ramabathiran Madhumitha, Venkataraman Ramesh, Thirunarayan M A, Samundeeswari P, Ramakrishnan Nagarajan
Institute of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India.
Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India.
Indian J Med Microbiol. 2018 Oct-Dec;36(4):572-576. doi: 10.4103/ijmm.IJMM_18_437.
Infection/colonization due to carbapenem-resistant enterobacteriaceae (CRE) are emerging as an important challenge, particularly in high risk patients due to widespread use of Carbapenems. Therefore, preventing both CRE infections and their transmission has become an important infection control objective.
Determine the proportion of asymptomatic carriers of CRE among patients admitted to our critical care unit (CCU) from the community and other health care facilities. Enumerate risk factors and guide implementation of infection control interventions.
This prospective surveillance study was done in a 24 bed CCU of a tertiary care hospital, at Chennai, India between August2017 through December 2017. Patients were screened based on a composed questionnaire framed from Centers for Diseases Control and Prevention CRE tool-kit. Two rectal swabs were collected from each patient. They were processed in microbiology laboratory.
A total of 102 patients were included. CRE colonization were identified in 8 (7.8%) of the total samples. Among 8 CRE colonized patients 3 (37.5%) patients developed systemic infection. Patients who were exposed to high end antibiotic and past history of surgery had significant association with CRE colonization of (P = 0.0029) and (P = 0.0167) respectively.
Overall CRE colonization rates among our CCU patients were found to be low. Risk factors associated with CRE colonization were high end antibiotic exposure and surgery in past 90 days. Hence rectal screening should be a risk factor-based active surveillance. Association of systemic infection among CRE colonizers was more significant. This study led us to modify our infection control practices in CCU.
耐碳青霉烯类肠杆菌科细菌（CRE）引起的感染/定植正成为一项重大挑战，尤其是在因碳青霉烯类药物广泛使用而处于高风险的患者中。因此，预防CRE感染及其传播已成为重要的感染控制目标。
确定从社区和其他医疗机构转入我们重症监护病房（CCU）的患者中CRE无症状携带者的比例。列举风险因素并指导感染控制干预措施的实施。
这项前瞻性监测研究于2017年8月至2017年12月在印度钦奈一家三级护理医院的24张床位的CCU中进行。根据美国疾病控制与预防中心CRE工具包制定的综合问卷对患者进行筛查。从每位患者采集两份直肠拭子。样本在微生物实验室进行处理。
共纳入102例患者。在全部样本中发现8例（7.8%）存在CRE定植。在8例CRE定植患者中，3例（37.5%）发生了全身感染。使用高档抗生素的患者和有手术史的患者分别与CRE定植有显著相关性（P = 0.0029）和（P = 0.0167）。
我们CCU患者中CRE总体定植率较低。与CRE定植相关的风险因素是使用高档抗生素和过去90天内进行过手术。因此，直肠筛查应基于风险因素进行主动监测。CRE定植者中全身感染的相关性更为显著。这项研究促使我们在CCU修改感染控制措施。
