Línea de Epidemiología Molecular Bacteriana, Grupo de Investigación en Microbiología Básica y Aplicada, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia.
Departamento de Nefrología, Hospital San Vicente Fundación, Medellín, Colombia.
J Med Microbiol. 2020 Sep;69(9):1132-1144. doi: 10.1099/jmm.0.001244. Epub 2020 Aug 18.
While colonization by in haemodialysis patients has been assessed, knowledge about colonization by beta-lactam-resistant Gram-negative bacilli is still limited. To describe clinical and molecular characteristics in haemodialysis patients colonized by (MSSA-MRSA) and beta-lactam-resistant Gram-negative bacilli in an ambulatory renal unit. The study included patients with central venous catheters in an outpatient haemodialysis facility in Medellín, Colombia (October 2017-October 2018). Swab specimens were collected from the nostrils and skin around vascular access to assess colonization by (MSSA-MRSA). Stool samples were collected from each patient to evaluate beta-lactam-resistant Gram-negative bacilli colonization. Molecular typing included PFGE, multilocus sequence typing (MLST), typing and enterobacterial repetitive intergenic consensus-PCR (ERIC). Clinical information was obtained from medical records and personal interview. A total of 210 patients were included in the study. colonization was observed in 33.8 % (=71) of the patients, 4.8 % (=10) of which were colonized by methicillin-resistant . Stool samples were collected from 165 patients and of these 41.2 % (=68) and 11.5 % (=19) were colonized by extended-spectrum-beta-lactamase-producing (ESBL) and carbapenem-resistant bacilli, respectively. Typing methods revealed high genetic diversity among and ESBL-producing Gram-negative bacilli (ESBL-GNB). Antibiotic use and hospitalization in the previous 6 months were observed in more than half of the studied population. The high colonization by ESBL-GNB in haemodialysis patients shows evidence for the need for stronger surveillance, not only for but also for multidrug-resistant bacilli in order to avoid their spread. Additionally, the high genetic diversity suggests other sources of transmission outside the renal unit instead of horizontal transmission between patients.
在血液透析患者中， 定植已得到评估，但对β-内酰胺耐药革兰氏阴性杆菌定植的了解仍然有限。描述在哥伦比亚麦德林一家门诊肾脏单位中血液透析患者中定植的 （MSSA-MRSA）和β-内酰胺耐药革兰氏阴性杆菌的临床和分子特征。该研究纳入了哥伦比亚麦德林门诊血液透析中心的中心静脉导管患者（2017 年 10 月至 2018 年 10 月）。从鼻和血管通路周围皮肤采集拭子标本，以评估 （MSSA-MRSA）定植情况。从每位患者采集粪便标本，以评估β-内酰胺耐药革兰氏阴性杆菌定植情况。分子分型包括 PFGE、多位点序列分型（MLST）、 分型和肠杆菌重复基因间一致性聚合酶链反应（ERIC）。临床信息来自病历和个人访谈。共有 210 例患者纳入研究。33.8%（71 例）的患者存在 定植，其中 4.8%（10 例）定植的是耐甲氧西林的 。采集了 165 例患者的粪便标本，其中 41.2%（68 例）和 11.5%（19 例）分别定植了产超广谱β-内酰胺酶（ESBL）和碳青霉烯耐药杆菌。分型方法显示 与产 ESBL 的革兰氏阴性杆菌（ESBL-GNB）之间存在较高的遗传多样性。在研究人群中，超过一半的患者使用了抗生素和在过去 6 个月内住院。血液透析患者中 ESBL-GNB 的高定植表明需要加强监测，不仅要监测 ，还要监测多药耐药菌，以避免其传播。此外，较高的遗传多样性表明除了患者之间的水平传播之外，还有其他传播途径来自肾脏单位之外。
