Laboratori Clínic ICS-Terres de l'Ebre, Hospital de Tortosa Verge de la Cinta, Tortosa, Spain.
Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain.
Microb Drug Resist. 2021 Jul;27(7):879-888. doi: 10.1089/mdr.2020.0201. Epub 2020 Oct 19.
The aim of this work was to assess the prevalence of carbapenemase-producing and extended-spectrum β-lactamase-producing Enterobacterales (ESBLPE) intestinal carriage among private dwelling residents (PDR) and nursing home residents (NHR) from the catchment area of Hospital Verge de la Cinta (Tortosa. North-Eastern Spain), and to depict clinicoepidemiological features of colonized individuals. Prevalence of ESBLPE carriage amid 762 PDR (0-94 years) who had feces collected for routine culture was 7.3% and 31% among 71 NHR (68-98 years) screened upon hospital admission. The mean age of colonized and noncolonized subjects was 30 and 32.8 years in PDR ( = 0.58) and 85 and 87 years in NHR ( = 0.32). The predominant ESBLPE was CTX-M-15-producing (42.8% in PDR and 68.2% in NHR [25% and 86.7% belonging to O25b-ST131 clone; < 0.0001]), followed by CTX-M-9-group- and SHV-producing and by CTX-M-15-producing Overall, 72.7% of ESBLPE were multidrug resistant and 46.2% carried transferable quinolone determinants. Institutionalization in a nursing home was a risk factor for ESBLPE and extended-spectrum β-lactamase (ESBL)-producing O25b-ST131 carriage in individuals over 67 years (odds ratio 7.7 and 14.1). Previous antibiotic use and skin ulcers were significantly associated with ESBLPE carriage in NHR. Age <25 years in PDR and amoxicillin/clavulanate exposure in NHR protected against ESBL-producing O25b-ST131 colonization. Only two PDR, with known risk factors, bore OXA-48-producing isolates. These results highlight the role of nonhospitalized intestinal carriers, particularly NHR, as ESBLPE reservoirs and the preponderance of CTX-M-15, mainly linked to O25b-ST131 clone, as well as the emergence of carbapenemase-producing Enterobacterales carriers.
这项工作的目的是评估来自西班牙东北部韦尔盖德拉辛塔医院（Tortosa）服务区的私人住宅居民（PDR）和养老院居民（NHR）中产碳青霉烯酶和扩展谱β-内酰胺酶肠携带的流行率，并描述定植个体的临床流行病学特征。对 762 名 PDR（0-94 岁）进行常规培养粪便采集，其中产 ESBLPE 的携带率为 7.3%，对 71 名 NHR（68-98 岁）入院时筛查的产 ESBLPE 的携带率为 31%。定植和未定植人群的平均年龄在 PDR 中分别为 30 岁和 32.8 岁（=0.58），在 NHR 中分别为 85 岁和 87 岁（=0.32）。主要的产 ESBLPE 为 CTX-M-15（PDR 中为 42.8%，NHR 中为 68.2%[25%和 86.7%属于 O25b-ST131 克隆；<0.0001]），其次是 CTX-M-9 组和 SHV 产酶和 CTX-M-15 产酶。总体而言，72.7%的 ESBLPE 是多药耐药的，46.2%携带可转移的喹诺酮决定簇。在养老院中机构化是 67 岁以上个体产 ESBLPE 和产 ESBL-O25b-ST131 的危险因素（比值比为 7.7 和 14.1）。在 NHR 中，既往使用抗生素和皮肤溃疡与 ESBLPE 定植显著相关。在 PDR 中，年龄<25 岁和 NHR 中使用阿莫西林/克拉维酸可预防产 ESBL-O25b-ST131 的定植。只有两名有已知危险因素的 PDR 携带 OXA-48 产分离株。这些结果突出了非住院肠道携带者的作用，特别是 NHR，他们是 ESBLPE 的储库，以及 CTX-M-15 的优势，主要与 O25b-ST131 克隆有关，以及碳青霉烯酶产肠杆菌科携带者的出现。
