印度一家三级护理医院成人重症监护病房（ICU）中耐碳青霉烯类肠杆菌科细菌（CRE）定植及后续感染风险的观察性研究。
An observational study on carbapenem-resistant Enterobacterales (CRE) colonisation and subsequent risk of infection in an adult intensive care unit (ICU) at a tertiary care hospital in India.
作者信息
Sharma Kirtika, Tak Vibhor, Nag Vijaya Lakshmi, Bhatia Pradeep Kumar, Kothari Nikhil
机构信息
All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
出版信息
Infect Prev Pract. 2023 Sep 30;5(4):100312. doi: 10.1016/j.infpip.2023.100312. eCollection 2023 Dec.
BACKGROUND
Carbapenem-resistant Enterobacterales (CRE) are a global health problem with a growing prevalence. India has a high prevalence of CRE. CRE infections are difficult to treat, and are associated with significant morbidity and mortality. Colonisation is generally a prerequisite for infection and the prevention of CRE colonisation is key to the prevention of CRE infection.
OBJECTIVES
To determine the prevalence of CRE colonisation and subsequent infections in an adult intensive care unit (ICU) in India.
METHODS
We conducted a prospective observational study in which perirectal swabs were obtained along with relevant clinical details of consenting adult patients upon ICU admission between January 2019 and August 2020. Rectal screening was performed using MacConkey agar plates with ertapenem disks and further identification was performed using conventional microbiological techniques. Ertapenem minimum inhibitory concentration (MIC) was determined using an epsillometer (E) test. The modified carbapenem inactivation (mCIM) test and EDTA carbapenem inactivation test (eCIM) were performed to confirm carbapenem resistance using the Clinical Laboratory Standards Institute (CLSI) 2020 guidelines.
RESULTS
192 ICU patients were screened for CRE. 37 patients were found to be colonised with CRE. (=25; 67.6%) was the most frequent CRE isolate, followed by (11; 29.7%) and one (1; 2.7%). 89.2% (33/37) patients developed CRE infection. Pneumonia was the most common CRE infection identified in 12/33 (36.4%) patients.during the hospital stay. The median duration of hospital stay was longer (17 days) for CRE colonised compared to CRE non-colonised patients (9 days) (<0.001). Death occurred in 27 % (10/37) of CRE-colonised patients during the hospital admission.
CONCLUSION
CRE colonisation is associated with high risk of subsequent CRE infection and longer ICU and hospital admission.
背景
耐碳青霉烯类肠杆菌科细菌（CRE）是一个全球性的健康问题，其患病率不断上升。印度的CRE患病率很高。CRE感染难以治疗，且与显著的发病率和死亡率相关。定植通常是感染的先决条件，预防CRE定植是预防CRE感染的关键。
目的
确定印度一家成人重症监护病房（ICU）中CRE定植及随后感染的患病率。
方法
我们进行了一项前瞻性观察性研究，在2019年1月至2020年8月期间，在ICU入院时采集入住成年患者的直肠拭子及相关临床细节。使用含厄他培南纸片的麦康凯琼脂平板进行直肠筛查，并使用传统微生物技术进行进一步鉴定。使用微量肉汤稀释法测定厄他培南最低抑菌浓度（MIC）。根据临床实验室标准协会（CLSI）2020年指南，进行改良碳青霉烯灭活试验（mCIM）和EDTA碳青霉烯灭活试验（eCIM）以确认碳青霉烯耐药性。
结果
对192名ICU患者进行了CRE筛查。发现37名患者被CRE定植。大肠埃希菌（25株；67.6%）是最常见的CRE分离株，其次是肺炎克雷伯菌（11株；29.7%）和1株产气肠杆菌（1株；2.7%）。89.2%（33/37）的患者发生了CRE感染。肺炎是在住院期间12/33（36.4%）患者中发现的最常见的CRE感染。与未被CRE定植的患者（9天）相比，被CRE定植的患者住院中位时间更长（17天）（P<0.001）。在住院期间，27%（10/37）的CRE定植患者死亡。
结论
CRE定植与随后发生CRE感染的高风险以及更长的ICU住院时间和住院时间相关。
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