Infection Control Unit, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; IAME, UMR 1137, INSERM, Université de Paris, Paris, France.
Infection Control Unit, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
J Hosp Infect. 2020 May;105(1):10-16. doi: 10.1016/j.jhin.2020.02.012. Epub 2020 Feb 22.
Colonization pressure is a risk factor for intensive care unit (ICU)-acquired multi-drug-resistant organisms (MDROs).
To measure the long-term respective impact of colonization pressure on ICU-acquired extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and meticillin-resistant Staphylococcus aureus (MRSA).
All patients admitted to two ICUs (medical and surgical) between January 1997 and December 2015 were included in this retrospective observational study. Rectal and nasal surveillance cultures were obtained at admission and weekly thereafter. Contact precautions were applied for colonized or infected patients. Colonization pressure was defined as the ratio of the number of MDRO-positive patient-days (PDs) of each MDRO to the total number of PDs. Single-level negative binomial regression models were used to evaluate the incidence of weekly MDRO acquisition.
Among the 23,423 patients included, 2327 (10.0%) and 1422 (6.1%) were colonized with ESBL-PE and MRSA, respectively, including 660 (2.8%) and 351 (1.5%) acquisitions. ESBL-PE acquisition increased from 0.51/1000 patient-exposed days (PEDs) in 1997 to 6.06/1000 PEDs in 2015 (P<0.001). In contrast, MRSA acquisition decreased steadily from 3.75 to 0.08/1000 PEDs (P<0.001). Controlling for period-level covariates, colonization pressure in the previous week was associated with MDRO acquisition for ESBL-PE (P<0.001 and P=0.04 for medical and surgical ICU, respectively), but not for MRSA (P=0.34 and P=0.37 for medical and surgical ICU, respectively). The increase in colonization pressure was significant above 100/1000 PDs for ESBL-PE.
Colonization pressure contributed to the increasing incidence of ESBL-PE but not MRSA. This study suggests that preventive control measures should be customized to MDROs.
定植压力是重症监护病房（ICU）获得多重耐药菌（MDRO）的一个风险因素。
测量定植压力对 ICU 获得的产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）和耐甲氧西林金黄色葡萄球菌（MRSA）的长期各自影响。
本回顾性观察研究纳入了 1997 年 1 月至 2015 年 12 月期间入住两个 ICU（内科和外科）的所有患者。在入院时和此后每周采集直肠和鼻腔监测培养物。对定植或感染患者采用接触预防措施。定植压力定义为每株 MDRO 阳性患者日（PD）数与总 PD 数的比值。采用单水平负二项回归模型评估每周 MDRO 获得的发生率。
在纳入的 23423 例患者中，分别有 2327 例（10.0%）和 1422 例（6.1%）定植 ESBL-PE 和 MRSA，包括 660 例（2.8%）和 351 例（1.5%）获得。ESBL-PE 的获得率从 1997 年的 0.51/1000 患者暴露日（PED）增加到 2015 年的 6.06/1000 PED（P<0.001）。相比之下，MRSA 的获得率从 3.75 稳步下降至 0.08/1000 PED（P<0.001）。控制时期水平协变量后，前一周的定植压力与 ESBL-PE 的 MDRO 获得相关（内科和外科 ICU 分别为 P<0.001 和 P=0.04），但与 MRSA 无关（内科和外科 ICU 分别为 P=0.34 和 P=0.37）。对于 ESBL-PE，定植压力超过 100/1000 PD 时增加具有显著意义。
定植压力导致 ESBL-PE 的发病率增加，但不导致 MRSA。本研究表明，预防控制措施应针对 MDRO 进行定制。
