与养老院尿路感染相关的抗生素耐药病原体：2013-2017 年向国家医疗保健安全网络长期护理机构部分报告的数据摘要。
Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013-2017.
机构信息
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA.
出版信息
Infect Control Hosp Epidemiol. 2021 Jan;42(1):31-36. doi: 10.1017/ice.2020.348. Epub 2020 Aug 12.
OBJECTIVE
Antibiotic resistance (AR) is a growing and highly prevalent problem in nursing homes. We describe selected AR phenotypes from pathogens causing urinary tract infections (UTIs) reported by nursing homes to the National Healthcare Safety Network (NHSN).
DESIGN
Pathogens and antibiotic susceptibility testing results for UTI events in nursing homes between January 2013 and December 2017 were analyzed. The pathogen distribution and pooled mean proportion of isolates that tested resistant to select antibiotic agents are reported.
SETTING AND PARTICIPANTS
US nursing homes voluntarily participating in the Long-Term Care Facility component of the NHSN.
RESULTS
Overall, 243 nursing homes reported 1 or more UTIs: 121 (50%) were nonprofit facilities, median bed size was 91 (range: 9-801), and average occupancy was 87%. In total, 6,157 pathogens were reported for 5,485 UTI events. Moreover, 9 pathogens accounted for 90% of all reported UTIs; the 3 most frequently identified were Escherichia coli (41%), Proteus species (14%), and Klebsiella pneumoniae/oxytoca (13%). Among E. coli, fluoroquinolone, and extended-spectrum cephalosporin resistance were most prevalent (50% and 20%, respectively). Although Staphylococcus aureus and Enterococcus faecium represented <5% of pathogens reported, they had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Multidrug resistance was most common in Pseudomonas aeruginosa (11%). For the resistant phenotypes we assessed, 36% of all UTIs reported were associated with a resistant pathogen.
CONCLUSIONS
This is the first summary of AR among common pathogens causing UTIs reported to NHSN by nursing homes. Improved understanding of the resistance burden among common infections helps inform facility infection prevention and antibiotic stewardship efforts.
目的
抗生素耐药性（AR）是疗养院中日益严重且普遍存在的问题。我们描述了疗养院向国家医疗保健安全网络（NHSN）报告的尿路感染（UTI）病原体的选定 AR 表型。
设计
分析了 2013 年 1 月至 2017 年 12 月疗养院 UTI 事件的病原体和抗生素敏感性测试结果。报告了病原体分布和经测试对选定抗生素药物具有耐药性的分离株的汇总平均比例。
设置和参与者
美国自愿参加 NHSN 长期护理设施部分的疗养院。
结果
总体而言，有 243 家疗养院报告了 1 例或多例 UTI：121 家（50%）为非营利性设施，中位床位数为 91 张（范围：9-801），平均入住率为 87%。共有 6157 种病原体报告了 5485 例 UTI 事件。此外，9 种病原体占所有报告的 UTI 的 90%；最常鉴定的 3 种病原体是大肠埃希菌（41%）、变形杆菌属（14%）和肺炎克雷伯菌/产酸克雷伯菌（13%）。在大肠埃希菌中，氟喹诺酮类和广谱头孢菌素的耐药性最为普遍（分别为 50%和 20%）。尽管金黄色葡萄球菌和粪肠球菌分别占报告病原体的<5%，但它们的耐药率最高（分别为 67%耐甲氧西林和 60%耐万古霉素）。铜绿假单胞菌的多药耐药性最为常见（11%）。在所评估的耐药表型中，报告的所有 UTI 中有 36%与耐药病原体有关。
结论
这是 NHSN 首次总结疗养院报告的引起 UTI 的常见病原体的 AR 情况。更好地了解常见感染中的耐药负担有助于为设施感染预防和抗生素管理工作提供信息。
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