埃塞俄比亚亚的斯亚贝巴圣保罗医院千禧医学院住院患者中耐碳青霉烯类药物的粪便携带情况及相关因素
Fecal Carriage of Carbapenem Resistant and Associated Factors Among Admitted Patients in Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
作者信息
Mekonnen Yonas, Solomon Semaria, Gebreyohanns Alganesh, Teklu Dejenie Shiferaw, Ayenew Zeleke, Mihret Amete, Bonger Zelalem Tazu
机构信息
Department of Medical Microbiology, Immunology and Parasitology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Clinical Bacteriology and Mycology National Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
出版信息
Infect Drug Resist. 2023 Sep 26;16:6345-6355. doi: 10.2147/IDR.S418066. eCollection 2023.
PURPOSE
The family colonizes the human gut as normal flora in all age groups, with bacterial infections being the most common cause. Resistance is currently observed in all normal flora. The aim of this study was to determine the frequency of fecal carriage of carbapenem-resistant (CRE), carbapenemase-producing (CPE), and associated factors in the faeces of admitted patients.
METHODS
A cross-sectional study was conducted in Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. A total of 384 rectal swabs were collected from various wards in admitted patients who have consented to participate. The specimens were inoculated on a MacConkey agar plate, and then they were incubated at 37 °C for 18 to 24 hours. Using the BD Phoenix M50 compact system identification and antimicrobial susceptibility testing were performed. Using the modified carbapenem inactivation method, it was determined whether the carbapenem-resistant bacterial isolate produced carbapenemase or not.
RESULTS
Overall prevalence of carbapenem-resistant carriage and carbapenemase producing in admitted patients was 17.2% (95%, Confidence Interval: 13.3-21.1%) and 7% (95%, Confidence Interval: 4.7-9.9%), respectively. The predominate carbapenem-resistant in fecal carriage was , 15.4% (23/149), 15.4% (6/39), followed by 12.4% (37/307) of carbapenem-resistant (CRE) isolate. Carbapenem-resistant carriage isolates showed large level of resistance to ciprofloxacin, and sulfamethoxazole-trimethoprim. Prior intake of antibiotics (Odds Ratio 2.42, 95% CI: 11.186-4.95) was significantly associated with higher carbapenem-resistant carriage.
CONCLUSION
We observed a high prevalence of carbapenem-resistant carriage and carbapenemase-producing among admitted patients. There were only amikacin and colistin that could be effective for carbapenem-resistant isolates. Hence, the control of carbapenem-resistant carriage should be given priority by carbapenem-resistant screening for fecal of admitted patients, and adhering to good infection prevention practice in hospital settings.
目的
该菌在所有年龄组中作为正常菌群定殖于人体肠道，细菌感染是最常见的病因。目前在所有正常菌群中均观察到耐药情况。本研究的目的是确定住院患者粪便中耐碳青霉烯类（CRE）、产碳青霉烯酶（CPE）的携带频率及相关因素。
方法
在埃塞俄比亚亚的斯亚贝巴的圣保罗医院千禧医学院进行了一项横断面研究。从同意参与的住院患者的各个病房共采集了384份直肠拭子。将标本接种在麦康凯琼脂平板上，然后在37℃下孵育18至24小时。使用BD Phoenix M50紧凑型系统进行鉴定和抗菌药物敏感性测试。采用改良碳青霉烯灭活法确定耐碳青霉烯类细菌分离株是否产碳青霉烯酶。
结果
住院患者中耐碳青霉烯类携带和产碳青霉烯酶的总体患病率分别为17.2%（95%置信区间：13.3 - 21.1%）和7%（95%置信区间：4.7 - 9.9%）。粪便携带中主要的耐碳青霉烯类是[具体菌名未给出]，占15.4%（23/149），[具体菌名未给出]占15.4%（6/39），其次是耐碳青霉烯类（CRE）分离株中的[具体菌名未给出]占12.4%（37/307）。耐碳青霉烯类携带分离株对环丙沙星和磺胺甲恶唑 - 甲氧苄啶表现出较高水平的耐药性。先前使用抗生素（比值比2.42，95%CI：1.186 - 4.95）与较高的耐碳青霉烯类携带显著相关。
结论
我们观察到住院患者中耐碳青霉烯类携带和产碳青霉烯酶的患病率较高。仅有阿米卡星和黏菌素对耐碳青霉烯类分离株有效。因此，应优先通过对住院患者粪便进行耐碳青霉烯类筛查以及在医院环境中坚持良好的感染预防措施来控制耐碳青霉烯类携带情况。
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