Shamhuyashe Godknows, van Zyl Nicoline, van Rooyen Cornel, Bisiwe Feziwe, Musoke Jolly
Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
Division of Nephrology, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
S Afr J Infect Dis. 2024 Jul 9;39(1):607. doi: 10.4102/sajid.v39i1.607. eCollection 2024.
While most infections with multidrug-resistant organisms (MDROs) affect colonised people, there is limited evidence on MDRO colonisation in South African dialysis patients.
This study evaluated the prevalence of MDRO colonisation among dialysis patients, the resistance patterns of each MDRO and the risk factors for colonisation.
Rectal and nasal swabs were collected from dialysis patients who consented to participate in a 5-month study to identify selected MDROs (April 2021 - August 2021). Specimens were cultured on selected chromogenic media. Data collected included demographics, clinical information from medical records and laboratory results.
Multidrug-resistant organisms were isolated from 17 (23.9%) of the 71 enrolled participants. Of the 23 MDRO strains from rectal swabs ( = 71), extended-spectrum beta-lactamase-producing Enterobacterales accounted for 21.1% (15/71), vancomycin-resistant enterococci 2.8% ( = 2/71) and carbapenem-resistant Enterobacterales 4.2% ( = 3/71). Klebsiella pneumoniae (65.2%, = 15/23) was the most prevalent MDRO. More than 80% resistance to trimethoprim and sulfamethoxazole, cefotaxine, and ciprofloxacin was noted. Significant risk factors included previous hospitalisation, proton pump inhibitor use and antibiotic exposure in the past 6 months.
Multidrug-resistant organisms' carriage was high in our dialysis population. The infection prevention and control measures need to be revised and strengthened.
This study falls within the scope of the SAJID journal as it is the first within sub-Sahara Africa to report that approximately one-fifth of dialysis patients were colonised with MDRO, which is a significant risk for MDRO infections.
虽然大多数耐多药微生物（MDRO）感染影响定植人群，但关于南非透析患者中MDRO定植的证据有限。
本研究评估了透析患者中MDRO定植的患病率、每种MDRO的耐药模式以及定植的危险因素。
从同意参与一项为期5个月的研究以鉴定特定MDRO的透析患者中采集直肠和鼻拭子（2021年4月至2021年8月）。标本在选定的显色培养基上培养。收集的数据包括人口统计学信息、病历中的临床信息和实验室结果。
在71名登记参与者中，有17名（23.9%）分离出耐多药微生物。在直肠拭子的23株MDRO菌株中（n = 71），产超广谱β-内酰胺酶肠杆菌占21.1%（15/71），耐万古霉素肠球菌占2.8%（n = 2/71），耐碳青霉烯肠杆菌占4.2%（n = 3/71）。肺炎克雷伯菌（65.2%，n = 15/23）是最常见的MDRO。观察到对甲氧苄啶和磺胺甲恶唑、头孢噻肟和环丙沙星的耐药率超过80%。显著的危险因素包括既往住院、使用质子泵抑制剂以及过去6个月内接触过抗生素。
我们的透析人群中耐多药微生物的携带率很高。需要修订和加强感染预防与控制措施。
本研究属于SAJID期刊的范畴，因为它是撒哈拉以南非洲地区首个报告约五分之一透析患者被MDRO定植的研究，这是MDRO感染的重大风险。
