Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Infect Control Hosp Epidemiol. 2023 Sep;44(9):1423-1428. doi: 10.1017/ice.2022.225. Epub 2023 Mar 14.
Resistant gram-negative bacteria (R-GNB) colonization in nursing home patients can cause clinical infection and intrafacility transmission. Limited data exist on the roles of age and function on R-GNB colonization.
A secondary data analysis was performed from a cohort study of 896 patients admitted to 6 Michigan nursing homes between November 2013 and May 2018. Swabs obtained upon enrollment, weekly for 1 month, then monthly until nursing home discharge from 5 anatomical sites were cultured for GNB. R-GNB were defined as resistant to ciprofloxacin, ceftazidime, or imipenem. Patients with growth of the same R-GNB as the initial positive visit, from any anatomical site at any subsequent visit, were considered persistently colonized. Demographic data, antibiotic use, device use, and physical self-maintenance scales (PSMSs) were obtained upon enrollment. Characteristics were compared between patients with R-GNB colonization versus those without, and those with persistent R-GNB colonization versus those with spontaneous decolonization.
Of 169 patients with a positive R-GNB culture and ≥2 subsequent study visits, 89 (53%) were transiently colonized and 80 (47%) were persistently colonized. Compared to uncolonized patients, persistent and transient R-GNB colonization were associated with higher PSMS score: 1.14 (95% confidence interval or CI, 1.05-1.23; = .002) and 1.10 (95% CI, 1.01-1.19; = .023), respectively. Persistent colonization was independently associated with longer duration of nursing home stay (1.02; 95% CI, 1.01-1.02; < .001). Higher readmission rate among persistently colonized patients was observed on unadjusted analysis.
Persistent R-GNB colonization is associated with younger age, functional disability, and prolonged length of nursing home stay. In-depth longitudinal studies to understand new acquisition and transmission dynamics of R-GNB in nursing homes are needed.
耐革兰氏阴性菌（R-GNB）定植于疗养院患者可导致临床感染和院内传播。关于年龄和功能对 R-GNB 定植的影响，现有数据有限。
对 2013 年 11 月至 2018 年 5 月期间入住密歇根州 6 家疗养院的 896 名患者进行队列研究的二次数据分析。患者入院时、第 1 个月每周、第 2 个月每月采集 5 个解剖部位的拭子进行革兰氏阴性菌培养。R-GNB 被定义为对环丙沙星、头孢他啶或亚胺培南耐药。在任何后续就诊时，任何解剖部位出现与初始阳性就诊相同的 R-GNB 生长的患者被认为是持续定植。患者入院时获取人口统计学数据、抗生素使用、器械使用和身体自我维护量表（PSMS）。比较 R-GNB 定植患者与无定植患者、持续 R-GNB 定植患者与自发去定植患者的特征。
在 169 名 R-GNB 培养阳性且有≥2 次后续研究就诊的患者中，89 名（53%）为一过性定植，80 名（47%）为持续性定植。与未定植患者相比，持续性和一过性 R-GNB 定植与 PSMS 评分更高相关：1.14（95%置信区间或 CI，1.05-1.23； =.002）和 1.10（95% CI，1.01-1.19； =.023）。持续性定植与疗养院停留时间更长独立相关（1.02；95% CI，1.01-1.02； <.001）。未调整分析显示，持续性定植患者的再入院率更高。
持续性 R-GNB 定植与年龄较小、功能障碍和疗养院停留时间延长有关。需要深入的纵向研究来了解疗养院中 R-GNB 的新获得和传播动态。
