Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Nursing School, Universidade de Sao Paulo, Sao Paulo, Brazil.
Eur J Clin Microbiol Infect Dis. 2024 Dec;43(12):2323-2333. doi: 10.1007/s10096-024-04953-1. Epub 2024 Sep 25.
Limited information exists on carriage of multidrug-resistant organisms (MDRO) by health workers (HWs) in primary care settings. This study aims to determine the prevalence of MDRO carriage among HWs in primary care and to identify associated risk factors.
A cross-sectional study was conducted across all 12 primary care units in São Caetano do Sul-SP, Brazil, from October to December 2023. Self-collected samples (nasal, oropharyngeal, and inguinal) were obtained. Environment cultures (potable water, sewage and stream water) were evaluated. Stenotrophomonas maltophilia isolates (human and environmental) were typed.
The study included 265/288 (92%) of HWs in primary care teams, mostly women with a median age of 47 years (IQR 38-57); 78% had no comorbidities. MDRO colonisation was found in 8.7% (23 HWs). The following bacteria were found: S. maltophilia (n = 9; 3.4%) in inguinal swabs; methicillin-resistant Staphylococcus aureus (n = 8; 3%) from all sites; extended-spectrum ß-lactamase-producing bacteria (n = 5; 2%) in inguinal swabs; and vancomycin-resistant enterococci in an inguinal swab (n = 1; 0.4%). Previous antibiotic use was significantly associated with MDRO colonisation (OR 2.91, 95% CI 1.19-7.09, p = 0.018), mainly narrow spectrum oral beta-lactams and macrolides. S. malthophilia was polyclonal and human and environmental isolates differed.
Colonisation by MRSA, VRE, and ESBL-producing bacteria was low; however, 4% were surprisingly colonized by polyclonal S. maltophilia. This pathogen may also suggest using narrow-spectrum rather than the expected broad-spectrum antimicrobials. Antibiotic use was the only risk factor found, mainly with oral narrow-spectrum drugs.
在初级保健环境中，卫生工作者（HWs）携带多药耐药菌（MDRO）的信息有限。本研究旨在确定初级保健 HWs 中 MDRO 携带的流行率，并确定相关的危险因素。
本研究为巴西圣卡塔琳娜州圣卡塔琳娜市的所有 12 个初级保健单位于 2023 年 10 月至 12 月进行的横断面研究。采集了自我采集的样本（鼻腔、口腔和腹股沟）。评估了环境培养物（饮用水、污水和溪流水）。对 Stenotrophomonas maltophilia 分离株（人源和环境源）进行了分型。
研究包括 265/288（92%）名初级保健团队的 HWs，大多数为女性，中位年龄为 47 岁（IQR 38-57）；78%没有合并症。发现 MDRO 定植率为 8.7%（23 名 HWs）。发现以下细菌：腹股沟拭子中分离出的嗜麦芽寡养单胞菌（n=9；3.4%）；所有部位均分离出的耐甲氧西林金黄色葡萄球菌（n=8；3%）；腹股沟拭子中分离出的产超广谱β-内酰胺酶的细菌（n=5；2%）；腹股沟拭子中分离出的万古霉素耐药肠球菌（n=1；0.4%）。先前使用抗生素与 MDRO 定植显著相关（OR 2.91，95%CI 1.19-7.09，p=0.018），主要是窄谱口服β-内酰胺类和大环内酯类药物。S. maltophilia 呈多克隆，人与环境分离株不同。
MRSA、VRE 和产 ESBL 细菌的定植率较低；然而，令人惊讶的是，4%的人被多克隆嗜麦芽寡养单胞菌定植。该病原体也可能表明使用窄谱而不是预期的广谱抗生素。抗生素使用是唯一发现的危险因素，主要与口服窄谱药物有关。
