Shamalov Loren, Heath Madison, Lynch Elissa, Green Daniel A, Gomez-Simmonds Angela, Freedberg Daniel E
CUNY School of Medicine, 160 Convent Ave, New York, NY, 10031, USA.
Department of Medicine, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
Gut Pathog. 2024 Feb 21;16(1):10. doi: 10.1186/s13099-024-00605-z.
Microbiome restitution therapies are being developed to prevent gut pathogen colonization among patients in the intensive care unit (ICU) and in other select populations. If preventive therapies are to be effective, they must be administered prior to pathogen acquisition. The timing and risk factors for early acquisition of gut pathogen colonization (within 72 h) are currently unknown and could be helpful to guide ICU trial design.
This was a prospective cohort study. Patients in the ICU had deep rectal swabs performed within 4 h of ICU admission and exactly 72 h later. Early gut pathogen colonization was classified as the new presence (based on culture of rectal swabs) of one or more of the following organisms of interest: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant (VRE), and Gram-negative bacteria that showed multidrug resistance (MDR) or third generation Cephalosporin resistance (Ceph-R). Clinical risk factors for early acquisition of gut pathogen colonization were captured using the Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scoring system.
Among 131 patients who were swabbed at ICU admission and 72 h later, the rates of gut pathogen colonization at ICU admission were 11.4%, 10.6%, 38.6%, and 8.3% for MRSA, VRE, MDR and Ceph-R Gram-negatives respectively. Among the patients who were negative for a given pathogen at ICU admission, the rates of early acquisition of gut pathogen colonization were 7.8% for MRSA (95% CI 3.6 to 14.2%), 7.7% for VRE (95% CI 3.6 to 14.1%), 11.3% for MDR Gram-negatives (95% CI 4.4 to 18.8%), and 4.2% for Ceph-R Gram-negatives (95% CI 1.4 to 9.5%). There were no clinical risk factors which independently predicted early acquisition of gut pathogen colonization.
Early gut pathogen colonization was common in the ICU, but our single-center study could not identify any clinical risk factors which were significantly associated with acquisition of gut pathogens.
微生物群恢复疗法正在研发中，旨在预防重症监护病房（ICU）患者及其他特定人群肠道病原体的定植。若预防性疗法要发挥作用，必须在病原体感染之前进行给药。目前尚不清楚肠道病原体定植早期（72小时内）的发生时间及危险因素，而这些信息可能有助于指导ICU试验设计。
这是一项前瞻性队列研究。ICU患者在入院4小时内及恰好72小时后进行深部直肠拭子检查。早期肠道病原体定植被定义为直肠拭子培养发现以下一种或多种目标微生物新出现：耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌（VRE）以及表现出多重耐药（MDR）或对第三代头孢菌素耐药（Ceph-R）的革兰氏阴性菌。使用急性生理学与慢性健康状况评分系统IV（APACHE IV）获取早期肠道病原体定植的临床危险因素。
在131例入院时及72小时后接受拭子检查的患者中，入院时MRSA、VRE、MDR革兰氏阴性菌和Ceph-R革兰氏阴性菌的肠道病原体定植率分别为11.4%、10.6%、38.6%和8.3%。在入院时某特定病原体检测为阴性的患者中，MRSA早期肠道病原体定植率为7.8%（95%CI 3.6至14.2%），VRE为7.7%（95%CI 3.6至14.1%），MDR革兰氏阴性菌为11.3%（95%CI 4.4至18.8%），Ceph-R革兰氏阴性菌为4.2%（95%CI 1.4至9.5%）。没有任何临床危险因素能独立预测早期肠道病原体定植。
早期肠道病原体定植在ICU中很常见，但我们的单中心研究未能识别出与肠道病原体感染显著相关的任何临床危险因素。
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