MacArthur R D, Lehman M H, Currie-McCumber C A, Shlaes D M
Department of Infectious Diseases, Johns Hopkins Hospital, Baltimore, MD 21205.
Am J Epidemiol. 1988 Oct;128(4):821-7. doi: 10.1093/oxfordjournals.aje.a115035.
The authors conducted a prospective six-month study of colonization by gentamicin-resistant Pseudomonas aeruginosa on an intermediate care unit at a Cleveland, Ohio hospital with the use of selective culture techniques, serotyping, and plasmid analysis. Thirty-five of 163 patients (21%) were culture positive at least once for gentamicin-resistant Pseudomonas aeruginosa. Patient samples, environmental cultures, and personnel hand cultures revealed no common source for the organisms. Plasmid profiling added little to the serotyping data. Only nonambulation and length of stay on the unit were significant independent risk factors for colonization with gentamicin-resistant Pseudomonas aeruginosa by multiple logistic regression analysis. Age, use of urinary catheters, exposure to antibiotics, and duration of antibiotic use were correlated with one or both of the independent risk factors, but were not themselves independently associated with colonization by these resistant organisms. Cross-colonization apparently was not an important mode of dissemination of gentamicin-resistant Pseudomonas aeruginosa on this intermediate care unit. The identified risk factors appear to be more important than cross-colonization, and control strategies should address these issues.
作者在俄亥俄州克利夫兰市一家医院的中级护理病房，采用选择性培养技术、血清分型和质粒分析，对耐庆大霉素铜绿假单胞菌的定植进行了为期6个月的前瞻性研究。163例患者中有35例（21%）至少有一次耐庆大霉素铜绿假单胞菌培养呈阳性。患者样本、环境培养物和医护人员手部培养物均未发现该菌的共同来源。质粒图谱分析对血清分型数据的补充作用不大。通过多因素逻辑回归分析，只有不能行走和在该病房的住院时间是耐庆大霉素铜绿假单胞菌定植的显著独立危险因素。年龄、使用导尿管、接触抗生素以及抗生素使用时间与一个或两个独立危险因素相关，但它们本身与这些耐药菌的定植并无独立关联。在这个中级护理病房，交叉定植显然不是耐庆大霉素铜绿假单胞菌传播的重要方式。已确定的危险因素似乎比交叉定植更为重要，控制策略应针对这些问题。
