Division of Healthcare Quality Promotion, National Center for Zoonotic and Emerging Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2021 Dec 6;73(11):e4552-e4559. doi: 10.1093/cid/ciaa1031.
Escherichia coli is one of the most common causes of healthcare-associated infections (HAIs); multidrug resistance reduces available options for antibiotic treatment. We examined factors associated with the spread of multidrug-resistant E. coli phenotypes responsible for device- and procedure-related HAIs from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities, using isolate and antimicrobial susceptibility data reported to the National Healthcare Safety Network during 2013-2017.
We used multivariable logistic regression to examine associations between co-resistant phenotypes, patient and healthcare facility characteristics, and time. We also examined the geographic distribution of co-resistant phenotypes each year by state and by hospital referral region to identify hot spots.
A total of 96 672 E. coli isolates were included. Patient median age was 62 years, and 60% were female; more than half (54%) were reported from catheter-associated urinary tract infections. From 2013 to 2017, 35% of the isolates were nonsusceptible to fluoroquinolones (FQs), 17% to extended-spectrum cephalosporins (ESCs), and 13% to both ESCs and FQs. The proportion of isolates co-resistant to ESCs and FQs was higher in 2017 (14%) than in 2013 (11%) (P < .0001); overall prevalence and increases were heterogeneously distributed across healthcare referral regions. Co-resistance to FQs and ESCs was independently associated with male sex, central line-associated bloodstream infections, long-term acute care hospitals, and the 2016-2017 (vs 2013-2014) reporting period.
Multidrug resistance among E. coli causing device- and procedure-related HAIs has increased in the United States. FQ and ESC co-resistant strains appear to be spreading heterogeneously across hospital referral regions.
大肠杆菌是引起医疗保健相关感染（HAIs）的最常见原因之一；多药耐药性降低了抗生素治疗的选择。我们使用 2013-2017 年向国家医疗保健安全网络报告的分离株和抗菌药物敏感性数据，研究了与急性护理医院、长期急性护理医院和住院康复设施中与器械和程序相关的 HAI 相关的多药耐药大肠杆菌表型传播相关的因素。
我们使用多变量逻辑回归来研究共同耐药表型、患者和医疗机构特征以及时间之间的关联。我们还每年按州和医院转诊区域检查共同耐药表型的地理分布，以确定热点地区。
共纳入 96672 株大肠杆菌分离株。患者中位年龄为 62 岁，60%为女性；超过一半（54%）的患者来自导管相关尿路感染。2013 年至 2017 年，35%的分离株对氟喹诺酮类药物（FQs）耐药，17%对扩展谱头孢菌素（ESCs）耐药，13%对 FQs 和 ESCs 均耐药。2017 年（14%）与 2013 年（11%）相比，对 ESCs 和 FQs 共同耐药的分离株比例更高（P <.0001）；整体流行率和增长在医疗保健转诊区域内呈异质性分布。对 FQs 和 ESCs 的共同耐药与男性、中心静脉相关血流感染、长期急性护理医院以及 2016-2017 年（与 2013-2014 年相比）报告期独立相关。
引起与器械和程序相关的 HAI 的大肠杆菌的多药耐药性在美国有所增加。FQ 和 ESC 共同耐药菌株似乎在医院转诊区域内呈异质传播。
