Vasilakopoulou Alexandra, Karakosta Polyxeni, Vourli Sophia, Tarpatzi Aikaterini, Varda Paraskevi, Kostoula Maria, Antoniadou Anastasia, Pournaras Spyros
Clinical Microbiology Laboratory, Medical School, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Infection Control Committee, Attikon University General Hospital, Athens, Greece.
Front Public Health. 2020 Mar 18;8:55. doi: 10.3389/fpubh.2020.00055. eCollection 2020.
Gastrointestinal carriage of vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative bacteria (CRGN) constitutes a major public health concern as it may be followed by clinical infection development or lead to intra-hospital dissemination. Detection of carriers and implementation of infection control measures are essential in every hospital. In this study we determined the point prevalence of VRE and CRGN in the fecal flora of the inpatients of a tertiary university hospital in Greece. We determined risk factors for carriage and examined the impact of carriage on hospital outcomes. A point prevalence study of VRE/CRGN rectal carriage of inpatients was conducted on March 2018. Specimens were selectively cultured for VRE/CRGN, microorganisms were biochemically identified, submitted to antibiotic susceptibility testing, and tested for carbapenemase production. Data on potential risk factors and hospital outcomes were collected at the time of culture and until hospital discharge. Multivariable logistic and linear regression models were used, adjusting for confounders. Four hundred ninety-one patients were enrolled in the study. Of them, 64 (13.0%) were positive for VRE carriage, 40 (8.2%) for CRGN, and 10 patients (2.1%) for both VRE and CRGN. VRE carriage was independently associated with age over 65 years (adjusted OR: 2.4 [95%CI: 1.3, 4.5]) and length of stay (LOS) before rectal sampling (OR: 1.1 [95%CI: 1.0, 1.1]). Carriage of CRGN was associated with 11 days increase of LOS after rectal sampling (β-coef: 11.4 [95%CI: 1.6, 21.2]), with a 3.5-fold increased risk of acquiring a resistant pathogen after rectal swabbing (RR: 3.5 [95%CI 1.2, 9.9]) and with a 6-fold increased risk of mortality (RR: 6.1 [95%CI: 2.1, 17.9]), after adjusting for sex, age, and comorbidity index. High prevalence rates were found for VRE and CRGN carriage among the inpatients of our hospital. Prolonged hospitalization and age were independent risk factors for VRE carriage, while CRGN carriage was associated with increased risk of acquiring a resistant pathogen, prolonged hospital stay, and increased mortality.
耐万古霉素肠球菌（VRE）和耐碳青霉烯革兰氏阴性菌（CRGN）在胃肠道的携带是一个重大的公共卫生问题，因为随后可能会发展为临床感染或导致医院内传播。在每家医院，检测携带者并实施感染控制措施至关重要。在本研究中，我们测定了希腊一家三级大学医院住院患者粪便菌群中VRE和CRGN的现患率。我们确定了携带的危险因素，并研究了携带对医院结局的影响。2018年3月对住院患者的VRE/CRGN直肠携带情况进行了现患率研究。标本针对VRE/CRGN进行选择性培养，对微生物进行生化鉴定，进行抗生素敏感性测试，并检测碳青霉烯酶的产生。在培养时以及直至患者出院时收集有关潜在危险因素和医院结局的数据。使用多变量逻辑回归和线性回归模型，并对混杂因素进行了校正。491名患者纳入本研究。其中，64名（13.0%）VRE携带呈阳性，40名（8.2%）CRGN携带呈阳性，10名患者（2.1%）VRE和CRGN携带均呈阳性。VRE携带与65岁以上年龄（校正比值比：2.4 [95%置信区间：1.3, 4.5]）以及直肠采样前的住院时间（LOS）（比值比：1.1 [95%置信区间：1.0, 1.1]）独立相关。CRGN携带与直肠采样后住院时间增加11天（β系数：11.4 [95%置信区间：1.6, 21.2]）、直肠拭子采样后获得耐药病原体的风险增加3.5倍（相对风险：3.5 [95%置信区间1.2, 9.9]）以及死亡风险增加6倍（相对风险：6.1 [95%置信区间：2.1, 17.9]）相关，校正了性别、年龄和合并症指数后得出上述结果。在我们医院的住院患者中发现VRE和CRGN携带的患病率很高。住院时间延长和年龄是VRE携带的独立危险因素，而CRGN携带与获得耐药病原体的风险增加、住院时间延长和死亡率增加相关。
