早产儿肠道中产超广谱β-内酰胺酶肺炎克雷伯菌的获得：肠内喂养和新生儿重症监护病房（NICU）中的气管内导管的关键作用。
Gut acquisition of Extended-spectrum β-lactamases-producing Klebsiella pneumoniae in preterm neonates: Critical role of enteral feeding, and endotracheal tubes in the neonatal intensive care unit (NICU).
机构信息
Faculty of Medicine and Pharmacy, Human Pathology Biomedicine and Environment Laboratory, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
Faculty of Medicine and Pharmacy, Microbiology and Molecular Biology Laboratory, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
出版信息
PLoS One. 2023 Nov 7;18(11):e0293949. doi: 10.1371/journal.pone.0293949. eCollection 2023.
BACKGROUND
Klebsiella spp. can colonize the intestine of preterm neonates, and over-growth has been associated with necrotizing enterocolitis, hospital-acquired infections, and late-onset sepsis. This could lead us to suggest that the clinical pertinence of intestinal colonization with ESBL in preterm neonates appears to be important. We conducted this study to characterize the genetic proprieties of ESBL-producing Klebsiella pneumoniae (ESBL-KP) under clinical isolates and to describe the risk factors for the intestinal tract acquisition event during hospitalization.
METHODS
One hundred and thirteen premature infants were recruited from the neonatal intensive care unit (NICU). All newborns are issued from the birth suites of the pregnancy department. Two rectal swabs were planned to define K. Pneumoniae intestinal carriage status. ESBL-KP was confirmed by Brilliance ESBL selective chromogenic Agar. Antimicrobial susceptibility testing including phenotypic testing and genotypic detection of the most commonly described ESBL genes was done. Logistic regression models were performed to find the variables associated with the acquisition event of ESBL-KP.
RESULTS
A total of 62 (54.86%) premature neonates were colonized with ESBL-KP. The rate of blaSHV, blaTEM, blaCTX-M1, blaCTX-M2, blaCTX-M9, and blaOXA-48 genes among the isolates was 82, 48, 93.5, 4.8, 11.2 and 3.22%, respectively. We found that ESBLs K. Pneumoniae isolates were 100% resistant to amoxicillin, clavulanic acid-amoxicillin, cefotaxime, ceftazidime, and gentamicin. The regression model is for a given significant association between the tract intestinal of ESBL-KP acquisition events and the use of enteral tube feeding (OR = 38.46, 95% CI: 7.86-188.20, p-Value: 0.001), and endotracheal tubes (OR = 4.86, 95% CI: 1.37-17.19, p-Value 0.014).
CONCLUSION
Our finding supposes that the enteral feeding tube and endotracheal tube might have a critical role in colonizing the intestinal tract of preterm infants. This highlights the current status of both practices that will require updated procedures in the NICU.
背景
肺炎克雷伯菌可以定植于早产儿的肠道，过度生长与坏死性小肠结肠炎、医院获得性感染和晚发性败血症有关。这可能导致我们认为肠内产超广谱β-内酰胺酶（ESBL）克雷伯菌定植在早产儿中的临床相关性很重要。我们进行了这项研究，以描述临床分离的产 ESBL 肺炎克雷伯菌（ESBL-KP）的遗传特性，并描述住院期间肠道获得事件的危险因素。
方法
从新生儿重症监护病房（NICU）招募了 113 名早产儿。所有新生儿均来自妇产科的产房。计划进行两次直肠拭子以确定肺炎克雷伯菌的肠道携带状态。通过 Brilliance ESBL 选择性显色琼脂确认 ESBL-KP。进行了药敏试验，包括表型检测和最常见描述的 ESBL 基因的基因检测。使用逻辑回归模型寻找与 ESBL-KP 获得事件相关的变量。
结果
共有 62 名（54.86%）早产儿定植了 ESBL-KP。分离株 blaSHV、blaTEM、blaCTX-M1、blaCTX-M2、blaCTX-M9 和 blaOXA-48 基因的检出率分别为 82%、48%、93.5%、4.8%、11.2%和 3.22%。我们发现，ESBLs 肺炎克雷伯菌分离株对阿莫西林、克拉维酸-阿莫西林、头孢噻肟、头孢他啶和庆大霉素 100%耐药。回归模型显示，肠内 ESBL-KP 获得事件与肠内管饲（OR = 38.46，95%CI：7.86-188.20，p 值：0.001）和气管内插管（OR = 4.86，95%CI：1.37-17.19，p 值：0.014）之间存在显著关联。
结论
我们的发现表明，肠内喂养管和气管内插管可能在早产儿肠道定植中发挥关键作用。这突显了这两种做法的现状，需要在 NICU 中更新程序。
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