博茨瓦纳社区中产超广谱头孢菌素耐药肠杆菌科细菌（ESCrE）定植的危险因素：社区和医院抗生素耐药性研究（ARCH）。
Risk Factors for Community Colonization With Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) in Botswana: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.
机构信息
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S89-S96. doi: 10.1093/cid/ciad259.
BACKGROUND
The epidemiology of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low- and middle-income countries (LMICs) is poorly described. Identifying risk factors for ESCrE colonization is critical to inform antibiotic resistance reduction strategies because colonization is typically a precursor to infection.
METHODS
From 15 January 2020 to 4 September 2020, we surveyed a random sample of clinic patients at 6 sites in Botswana. We also invited each enrolled participant to refer up to 3 adults and children. All participants had rectal swabs collected that were inoculated onto chromogenic media followed by confirmatory testing. Data were collected on demographics, comorbidities, antibiotic use, healthcare exposures, travel, and farm and animal contact. Participants with ESCrE colonization (cases) were compared with noncolonized participants (controls) to identify risk factors for ESCrE colonization using bivariable, stratified, and multivariable analyses.
RESULTS
A total of 2000 participants were enrolled. There were 959 (48.0%) clinic participants, 477 (23.9%) adult community participants, and 564 (28.2%) child community participants. The median (interquartile range) age was 30 (12-41) and 1463 (73%) were women. There were 555 cases and 1445 controls (ie, 27.8% of participants were ESCrE colonized). Independent risk factors (adjusted odds ratio [95% confidence interval]) for ESCrE included healthcare exposure (1.37 [1.08-1.73]), foreign travel [1.98 (1.04-3.77]), tending livestock (1.34 [1.03-1.73]), and presence of an ESCrE-colonized household member (1.57 [1.08-2.27]).
CONCLUSIONS
Our results suggest healthcare exposure may be important in driving ESCrE. The strong links to livestock exposure and household member ESCrE colonization highlight the potential role of common exposure or household transmission. These findings are critical to inform strategies to curb further emergence of ESCrE in LMICs.
背景
在中低收入国家（LMICs）中，广谱头孢菌素耐药肠杆菌科（ESCrE）的流行病学情况描述甚少。确定 ESCR 定植的危险因素对于减少抗生素耐药性策略至关重要，因为定植通常是感染的前兆。
方法
2020 年 1 月 15 日至 9 月 4 日，我们在博茨瓦纳的 6 个地点对诊所患者进行了随机抽样调查。我们还邀请每个入组的参与者最多再推荐 3 名成人和儿童。所有参与者都采集了直肠拭子，接种在显色培养基上，然后进行确认性检测。收集了参与者的人口统计学、合并症、抗生素使用、医疗保健暴露、旅行、农场和动物接触等数据。将 ESCR 定植（病例）的参与者与未定植的参与者（对照）进行比较，以确定 ESCR 定植的危险因素，使用单变量、分层和多变量分析。
结果
共纳入 2000 名参与者。其中，959 名（48.0%）为诊所参与者，477 名（23.9%）为成年社区参与者，564 名（28.2%）为儿童社区参与者。中位数（四分位间距）年龄为 30（12-41）岁，1463 名（73%）为女性。共发现 555 例病例和 1445 例对照（即 27.8%的参与者定植 ESCR）。ESCR 定植的独立危险因素（调整后的优势比[95%置信区间]）包括医疗保健暴露（1.37[1.08-1.73]）、国外旅行[1.98（1.04-3.77]）、接触家畜（1.34[1.03-1.73]）和有 ESCR 定植的家庭成员（1.57[1.08-2.27]）。
结论
我们的结果表明，医疗保健暴露可能是 ESCR 定植的一个重要因素。与家畜接触和家庭成员 ESCR 定植之间的强烈关联突显了常见暴露或家庭传播的潜在作用。这些发现对于制定遏制中低收入国家 ESCR 进一步出现的策略至关重要。
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