危地马拉住院患者中耐超广谱头孢菌素和耐碳青霉烯类肠杆菌科细菌定植的危险因素：一项社区与医院抗生素耐药性（ARCH）研究。

Risk factors for colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales among hospitalized patients in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) study.

作者信息

Caudell Mark A, Castillo Carmen, Santos Lucas F, Grajeda Laura, Romero Juan Carlos, Lopez Maria Renee, Omulo Sylvia, Ning Mariangeli Freitas, Palmer Guy H, Call Douglas R, Cordon-Rosales Celia, Smith Rachel M, Herzig Carolyn T A, Styczynski Ashley, Ramay Brooke M

机构信息

Washington State University, Paul G. Allen School for Global Health, Pullman, USA.

Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala.

出版信息

IJID Reg. 2024 Mar 30;11:100361. doi: 10.1016/j.ijregi.2024.100361. eCollection 2024 Jun.

DOI:10.1016/j.ijregi.2024.100361

PMID:38634070

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11021947/

Abstract

OBJECTIVES

The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) has resulted in increased morbidity, mortality, and health care costs worldwide. To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala.

METHODS

Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21).

RESULTS

A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients.

CONCLUSION

The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care-associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals.

摘要

目的

耐超广谱头孢菌素肠杆菌科细菌（ESCrE）和耐碳青霉烯类肠杆菌科细菌（CRE）的传播已导致全球发病率、死亡率和医疗保健成本增加。为了确定与医院内ESCrE和CRE定植相关的因素，我们在危地马拉一家地区医院招募了住院患者。

方法

采用横断面研究设计（2021年3月至9月）从随机选择的患者中收集粪便样本，并检测样本中ESCrE和CRE的存在情况。使用套索回归模型检查医院和家庭变量与ESCrE和CRE定植的关联，并按病房进行聚类（n = 21）。

结果

共招募了641名患者，其中593名患者有完整的数据集。ESCrE定植（72.3%，n = 429/593）与碳青霉烯类药物使用呈负相关（比值比[OR] 0.21，95%置信区间[CI] 0.11 - 0.42），与头孢曲松使用呈正相关（OR 1.61，95% CI 1.02 - 2.53），当前住院前30天内有住院史也与之呈正相关（OR 2.84，95% CI 1.19 - 6.80）。CRE定植（34.6%，593名患者中的205名）与碳青霉烯类药物使用相关（OR 二点六二，95% CI 1.39 - 4.97），当前住院前30天内有住院史也与之相关（OR 2.58，95% CI 1.17 - 5.72），在患者较多的病房住院（OR 1.05，95% CI 1.02 - 1.08），住院≥4天（OR 3.07，95% CI 1.72 - 5.46），以及插管（OR 2.51，95% CI 1.13 - 5.59）。没有家庭相关变量与住院患者的ESCrE或CRE定植相关。