多耐药菌在肯尼亚医院多个科室的环境污染，增加了医院获得性感染的风险。
Environmental contamination across multiple hospital departments with multidrug-resistant bacteria pose an elevated risk of healthcare-associated infections in Kenyan hospitals.
机构信息
United States Army Medical Research Directorate-Africa, P.O. Box 606-00621, Nairobi, Kenya.
Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya.
出版信息
Antimicrob Resist Infect Control. 2023 Mar 29;12(1):22. doi: 10.1186/s13756-023-01227-x.
BACKGROUND
Healthcare-associated infections (HAIs) are often caused by multidrug-resistant (MDR) bacteria contaminating hospital environments which can cause outbreaks as well as sporadic transmission.
METHODS
This study systematically sampled and utilized standard bacteriological culture methods to determine the numbers and types of MDR Enterococcus faecalis/faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and Escherichia coli (ESKAPEE) from high-touch environments of five Kenyan hospitals; level 6 and 5 hospitals (A, B, and C), and level 4 hospitals (D and E), in 2018. Six hundred and seventeen high-touch surfaces across six hospital departments; surgical, general, maternity, newborn, outpatient and pediatric were sampled.
RESULTS
78/617 (12.6%) of the sampled high-touch surfaces were contaminated with MDR ESKAPEE; A. baumannii, 23/617 (3.7%), K. pneumoniae, 22/617 (3.6%), Enterobacter species, 19/617 (3.1%), methicillin resistant S. aureus (MRSA), 5/617 (0.8%), E. coli, 5/617 (0.8%), P. aeruginosa, 2/617 (0.3%), and E. faecalis and faecium, 2/617 (0.3%). Items found in patient areas, such as beddings, newborn incubators, baby cots, and sinks were the most frequently contaminated. Level 6 and 5 hospitals, B, 21/122 (17.2%), A, 21/122 (17.2%), and C, 18/136 (13.2%), were more frequently contaminated with MDR ESKAPEE than level 4 hospitals; D, 6/101 (5.9%), and E, 8/131 (6.1%). All the sampled hospital departments were contaminated with MDR ESKAPEE, with high levels observed in newborn, surgical and maternity. All the A. baumannii, Enterobacter species, and K. pneumoniae isolates were non-susceptible to piperacillin, ceftriaxone and cefepime. 22/23 (95.6%) of the A. baumannii isolates were non-susceptible to meropenem. In addition, 5 K. pneumoniae isolates were resistant to all the antibiotics tested except for colistin.
CONCLUSION
The presence of MDR ESKAPEE across all the hospitals demonstrated gaps in infection prevention practices (IPCs) that should be addressed. Non-susceptibility to last-line antibiotics such as meropenem threatens the ability to treat infections.
背景
医疗保健相关感染（HAI）通常是由污染医院环境的多药耐药（MDR）细菌引起的，这些细菌可导致暴发和散发性传播。
方法
本研究系统地采样并利用标准细菌培养方法，从肯尼亚五家医院的高接触环境中确定耐多药粪肠球菌/屎肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、肠杆菌属和大肠杆菌（ESKAPEE）的数量和类型；2018 年，水平 6 和 5 医院（A、B 和 C）和水平 4 医院（D 和 E）。从六个医院科室（外科、普通、产科、新生儿、门诊和儿科）的 617 个高接触表面进行采样。
结果
78/617（12.6%）个采样的高接触表面被耐多药 ESKAPEE 污染；鲍曼不动杆菌 23/617（3.7%），肺炎克雷伯菌 22/617（3.6%），肠杆菌属 19/617（3.1%），耐甲氧西林金黄色葡萄球菌（MRSA）5/617（0.8%），大肠杆菌 5/617（0.8%），铜绿假单胞菌 2/617（0.3%），粪肠球菌和屎肠球菌 2/617（0.3%）。在患者区域发现的物品，如被褥、新生儿孵化器、婴儿床和水槽，是最常被污染的物品。水平 6 和 5 医院 B、21/122（17.2%）、A、21/122（17.2%）和 C、18/136（13.2%）比水平 4 医院 D、6/101（5.9%）和 E、8/131（6.1%）更容易被耐多药 ESKAPEE 污染。所有采样的医院科室都被耐多药 ESKAPEE 污染，新生儿、外科和产科的污染程度较高。所有鲍曼不动杆菌、肠杆菌属和肺炎克雷伯菌分离株对哌拉西林、头孢曲松和头孢吡肟均不敏感。23/23（95.6%）株鲍曼不动杆菌对美罗培南不敏感。此外，5 株肺炎克雷伯菌对除粘菌素以外的所有测试抗生素均耐药。
结论
所有医院均存在耐多药 ESKAPEE，表明感染预防实践（IPC）存在差距，需要加以解决。对美罗培南等最后一线抗生素的不敏感性威胁到治疗感染的能力。
Zotero 插件