护理机构中耐万古霉素情况及定植的流行病学
Epidemiology of Vancomycin-Resistant and Colonization in Nursing Facilities.
作者信息
Davis Elyse, Hicks Liam, Ali Ihsan, Salzman Elizabeth, Wang Joyce, Snitkin Evan, Gibson Kristen, Cassone Marco, Mody Lona, Foxman Betsy
机构信息
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Faculty of Basic and Applied Sciences, Department of Medical Laboratory Technology, The University of Haripur, Haripur, Khyber Pakhtunkhwa, Pakistan.
出版信息
Open Forum Infect Dis. 2020 Jan 6;7(1):ofz553. doi: 10.1093/ofid/ofz553. eCollection 2020 Jan.
BACKGROUND
Vancomycin-resistant and frequently colonize nursing facility (NF) residents, creating opportunities for vancomycin-resistant (VRE) transmission and dissemination of mobile genetic elements conferring antimicrobial resistance. Most VRE studies do not speciate; our study addresses this lack and compares the epidemiology of and .
METHODS
We enrolled 651 newly admitted patients from 6 different NFs and collected swabs from several body sites at enrollment, 14 days, 30 days, and monthly thereafter for up to 6 months. The VRE were speciated using a duplex polymerase chain reaction. We used multinomial logistic regression models to compare risk factors associated with colonization of and
RESULTS
Overall, 40.7% were colonized with , , or both. At enrollment, more participants were colonized with (17.8%) than (8.4%); 3.2% carried both species. was carried twice as long as (69 days and 32 days, respectively), but incidence rates were similar (, 3.9/1000 person-days vs , 4.1/1000 person-days). Length of stay did not differ by species among incident cases. Residents who used antibiotics within the past 30 days had a greater incidence of both (odds ratio [OR] = 2.89; 95% confidence interval [CI], 1.82-4.60) and (OR = 1.80; 95% CI, 1.16-2.80); device use was most strongly associated with the incidence of colonization (OR = 2.01; 95% CI, 1.15-3.50).
CONCLUSIONS
Recent increases in vancomycin-resistant prevalence may reflect increased device use and longer duration of carriage.
背景
耐万古霉素肠球菌经常定植于护理机构（NF）的居民中，为耐万古霉素肠球菌（VRE）的传播以及赋予抗菌药物耐药性的移动遗传元件的传播创造了机会。大多数VRE研究未进行菌种鉴定；我们的研究解决了这一不足，并比较了[具体菌种1]和[具体菌种2]的流行病学情况。
方法
我们纳入了来自6个不同护理机构的651名新入院患者，并在入院时、14天、30天以及此后每月（最长6个月）从多个身体部位采集拭子。使用双重聚合酶链反应对VRE进行菌种鉴定。我们使用多项逻辑回归模型比较与[具体菌种1]和[具体菌种2]定植相关的危险因素。
结果
总体而言，40.7%的患者被[具体菌种1]、[具体菌种2]或两者定植。入院时，被[具体菌种1]定植的参与者（17.8%）多于被[具体菌种2]定植的参与者（8.4%）；3.2%的患者同时携带这两种菌种。[具体菌种1]的携带时间是[具体菌种2]的两倍（分别为69天和32天），但发病率相似（[具体菌种1]，3.9/1000人日；[具体菌种2]，4. /1000人日）。在发病病例中，住院时间因菌种不同而无差异。在过去30天内使用过抗生素的居民，[具体菌种1]（优势比[OR]=2.89；95%置信区间[CI]，1.82 - 4.60）和[具体菌种2]（OR = 1.80；95% CI，1.16 - 2.80）的发病率均更高；器械使用与[具体菌种1]定植的发病率关联最为密切（OR = 2.01；95% CI，1.15 - 3.50）。
结论
近期耐万古霉素[具体菌种1]患病率的增加可能反映了器械使用的增加和携带时间的延长。
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