Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany.
Kuratorium for Dialysis and Transplantation (KfH) Renal Unit, Hospital St. Georg, Leipzig, Germany.
PLoS One. 2020 Oct 15;15(10):e0240314. doi: 10.1371/journal.pone.0240314. eCollection 2020.
Multidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. At the same time, colonization and consecutive infections with such pathogens may increase mortality and morbidity of affected individuals. We aimed to monitor intestinal MDRGN colonization in a yet not investigated German HD population.
We performed cross-sectional point-prevalence testing with 12 months follow-up and selected testing of relatives in an out-patient HD cohort of n = 77 patients by using microbiological cultures from fresh stool samples, combined with Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF-MS) and antimicrobial susceptibility testing.
We detected MDRGN in 8 out of 77 patients (10.4%) and 1 out of 22 relatives (4.5%), indicating only colonization and no infections. At follow-up, 2 patients showed phenotypic persistence of MDRGN colonization, and in 6 other patients de-novo MDRGN colonization could be demonstrated. Pathogens included Escherichia coli and Klebsiella pneumoniae (with extended-spectrum beta-lactamase [ESBL]-production as well as fluoroquinolone resistance), Stenotrophomonas maltophilia and Enterobacter cloacae.
In a single-center study, MDRGN colonization rates were below those found in non-HD high-risk populations and HD units in the US, respectively. Reasons for this could be high hygiene standards and a strict antibiotic stewardship policy with evidence of low consumption of fluoroquinolones and carbapenems in our HD unit and the affiliated hospital.
在亚洲、欧洲和北美的非血液透析风险人群以及血液透析（HD）队列中，越来越多地发现多药耐药革兰氏阴性菌（MDRGN）。与此同时，此类病原体的定植和随后的感染可能会增加受影响个体的死亡率和发病率。我们旨在监测一个尚未研究的德国 HD 人群中的肠道 MDRGN 定植情况。
我们通过对 n = 77 例门诊 HD 队列患者的新鲜粪便样本进行微生物培养，结合基质辅助激光解吸电离飞行时间质谱（MALDI-TOF-MS）和抗菌药物敏感性测试，进行了横断面定群检测和为期 12 个月的随访，并选择了亲属进行检测。
我们在 77 例患者中的 8 例（10.4%）和 22 名亲属中的 1 例（4.5%）中检测到 MDRGN，表明仅存在定植而无感染。在随访中，2 例患者表现出 MDRGN 定植的表型持续存在，而在 6 例其他患者中可证明存在 MDRGN 定植。病原体包括大肠埃希菌和肺炎克雷伯菌（具有超广谱β-内酰胺酶[ESBL]产生和氟喹诺酮耐药性）、嗜麦芽窄食单胞菌和阴沟肠杆菌。
在一项单中心研究中，MDRGN 定植率低于非 HD 高危人群和美国 HD 单位的定植率。造成这种情况的原因可能是高卫生标准和严格的抗生素管理政策，我们的 HD 单位和附属医院的氟喹诺酮类和碳青霉烯类药物的使用量较低。
