Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
Sci Rep. 2021 Nov 3;11(1):21607. doi: 10.1038/s41598-021-01190-w.
Previous studies indicated residents in geriatric long-term care facilities (LTCFs) had much higher prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage than the general population. Most ESBL-E carriers are asymptomatic. The study tested the hypothesis that residents with ESBL-E carriage may accumulate inside geriatric LTCFs through potential cross-transmission after exposure to residents with prolonged ESBL-E carriage. 260 residents from four Japanese LTCFs underwent ESBL-E testing of fecal specimens and were divided into two cohorts: Cohort 1,75 patients with ≥ 2 months residence at study onset; Cohort 2, 185 patients with < 2 months residence at study onset or new admission during the study period. Three analyses were performed: (1) ESBL-E carriage statuses in Cohort 1 and Cohort 2; (2) changes in ESBL-E carriage statuses 3-12 months after the first testing and ≥ 12 months after the second testing; and (3) lengths of positive ESBL-E carriage statuses. Compared with the residents in Cohort 1, a significantly larger proportion of residents in Cohort 2 were positive for ESBL-E carriage (28.0% in Cohort 1 vs 40.0% in Cohort 2). In the subsequent testing results, 18.3% of residents who were negative in the first testing showed positive conversion to ESBL-E carriage in the second testing, while no patients who were negative in the second testing showed positive conversion in the third testing. The maximum length of ESBL-E carriage was 17 months. The findings indicated that some residents acquired ESBL-E through potential cross-transmission inside the LTCFs after short-term residence. However, no residents showed positive conversion after long-term residence, which indicates that residents with ESBL-E carriage may not accumulate inside LTCFs. Practical infection control and prevention measures could improve the ESBL-E prevalence in geriatric LTCFs.
先前的研究表明，与一般人群相比，老年长期护理机构（LTCF）的居民中携带产超广谱β-内酰胺酶肠杆菌科（ESBL-E）的比例要高得多。大多数 ESBL-E 携带者是无症状的。本研究检验了这样一个假设，即在接触携带 ESBL-E 时间较长的居民后，携带 ESBL-E 的居民可能会通过潜在的交叉传播在老年 LTCF 中积累。来自日本四家 LTCF 的 260 名居民接受了粪便标本的 ESBL-E 检测，并分为两组：Cohort 1，75 名患者在研究开始时居住时间超过 2 个月；Cohort 2，185 名患者在研究期间居住时间不足 2 个月或新入院。进行了三项分析：（1）Cohort 1 和 Cohort 2 中的 ESBL-E 携带状态；（2）第一次检测后 3-12 个月和第二次检测后≥12 个月 ESBL-E 携带状态的变化；（3）ESBL-E 阳性携带状态的持续时间。与 Cohort 1 中的居民相比，Cohort 2 中的居民 ESBL-E 携带阳性的比例显著更大（Cohort 1 中为 28.0%，Cohort 2 中为 40.0%）。在随后的检测结果中，在第一次检测中为阴性的居民中，有 18.3%在第二次检测中转为 ESBL-E 携带阳性，而在第二次检测中为阴性的患者在第三次检测中未转为阳性。ESBL-E 携带的最长时间为 17 个月。研究结果表明，一些居民在短期居住后通过 LTCF 内的潜在交叉传播获得了 ESBL-E。然而，长期居住后没有居民出现阳性转化，这表明 LTCF 内携带 ESBL-E 的居民不会累积。实际的感染控制和预防措施可以降低老年 LTCF 中 ESBL-E 的流行率。
