Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel; Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel.
National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel.
Clin Microbiol Infect. 2021 Oct;27(10):1481-1487. doi: 10.1016/j.cmi.2021.02.002. Epub 2021 Feb 12.
Compared to cephalosporin-based prophylaxis, ertapenem prophylaxis lowers the risk of surgical site infection among carriers of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PEs) undergoing colorectal surgery. We aimed to determine whether ertapenem prophylaxis leads to increased postoperative colonization with carbapenem-resistant Enterobacterales (CREs) and third-generation-cephalosporin-resistant Enterobacterales (3GCR-Es).
This study was nested within a quality improvement study of prophylaxis for ESBL-PE carriers undergoing colorectal surgery. Patients were screened 4-6 days after surgery for carriage of ESBL-PEs or other 3GCR-Es and CREs. When CREs were detected, pre- and postsurgical clones were compared using Fourier-transform infrared (FT-IR) spectroscopy.
The sample consisted of 56 patients who carried ESBL-PEs before surgery and received cefuroxime/metronidazole prophylaxis (Group 1), 66 who carried ESBL-PEs before surgery and received ertapenem (Group 2), and 103 ESBL-PE non-carriers who received cefuroxime/metronidazole prophylaxis (Group 3). CRE carriage was detected postoperatively in one patient (1.5%) in Group 2 versus eight patients (14.3%) in Group 1 (RD -12.8%; 95%CI -22.4% to -3.1%). For seven out of nine patients, preoperative ESBL-PE and postoperative CRE isolates were compared; in five of them, the pre- and postoperative clones were identical. Postoperative 3GCR-E carriage was detected in 37 patients (56.1%) in Group 2 versus 46 patients in Group 1 (82.1%) (aRD -20.7%, 95%CI -37.3% to -4.1%).
Among ESBL-PE carriers undergoing colorectal surgery, detection of short-term postsurgical colonization by CREs and 3GCR-Es was significantly lower among patients who received ertapenem prophylaxis than those who received cephalosporin-metronidazole prophylaxis. Resistance development in a colonizing bacterial clone, rather than carbapenemase acquisition, was the major mechanism of carbapenem resistance.
与头孢菌素类预防相比，厄他培南预防可降低产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）的结直肠手术携带者的手术部位感染风险。我们旨在确定厄他培南预防是否会导致术后产碳青霉烯类肠杆菌科细菌（CRE）和第三代头孢菌素类耐药肠杆菌科细菌（3GCR-Es）定植增加。
本研究嵌套在 ESBL-PE 携带者结直肠手术预防的质量改进研究中。术后 4-6 天对 ESBL-PE 或其他 3GCR-Es 和 CREs 携带者进行筛查。当检测到 CRE 时，使用傅里叶变换红外（FT-IR）光谱比较术前和术后的克隆。
该样本包括 56 名术前携带 ESBL-PE 并接受头孢呋辛/甲硝唑预防的患者（组 1）、66 名术前携带 ESBL-PE 并接受厄他培南预防的患者（组 2）和 103 名接受头孢呋辛/甲硝唑预防的 ESBL-PE 非携带者（组 3）。术后在组 2 中检测到 1 例（1.5%）患者携带 CRE，而组 1 中检测到 8 例（14.3%）（RD-12.8%；95%CI-22.4%至-3.1%）。在 9 例中的 7 例中，对术前 ESBL-PE 和术后 CRE 分离株进行了比较；其中 5 例的术前和术后克隆完全相同。组 2 中有 37 例（56.1%）患者术后携带 3GCR-E，而组 1 中有 46 例（82.1%）（aRD-20.7%；95%CI-37.3%至-4.1%）。
在接受结直肠手术的 ESBL-PE 携带者中，与接受头孢菌素-甲硝唑预防的患者相比，接受厄他培南预防的患者术后 CRE 和 3GCR-E 短期定植的检出率明显更低。定植细菌克隆的耐药性发展而不是碳青霉烯酶的获得是碳青霉烯类耐药的主要机制。
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