Lee Y L, Cesario T, McCauley V, Flionis L, Pax A, Thrupp L
Infectious Disease Division, Department of Medicine, University of California Irvine, USA.
Am J Infect Control. 1998 Dec;26(6):552-7. doi: 10.1053/ic.1998.v26.a88774.
We report a 1-year surveillance study that evaluates colonization and infection with ciprofloxacin-resistant gram-negative bacilli (CR GNB) and the relation to quinolone use and other possible risk factors in a proprietary skilled nursing facility (SNF) with no history of outbreaks.
Rectal swabs obtained quarterly were streaked on MacConkey agar with ciprofloxacin discs (5 microg) to screen for CR GNB and later were speciated and the antimicrobial susceptibilities were confirmed by standardized disc-diffusion tests.
The mean prevalence of CR GNB colonization was 2.6% (range 0.9% to 5.3%). The colonization frequency was higher in the last survey than it was in the first survey. CR GNB-colonized strains included Pseudomonas species (21%), but more than half were non-Pseudomonas enterics such as Acinetobacter baumannii (25%), Proteus mirabilis (17%), and Providencia stuartii (13%). None of the patients who had colonization with CR GNB had subsequent infections with the same species. Patients with colonization had more exposure to ciprofloxacin and they were more likely to have been recently admitted from an acute-care hospital and have decubitus ulcers. During the study period, of 336 patients surveyed, 98 (29%) patients developed suspected infections and cultures were done; the infection rate was 4.7 per 1000 patient days. Of these infected patients, 59 (60%) were infected by GNBs; the infection rate was 2.3 per 1000 patient days. Nineteen percent of the GNB infections were treated with a quinolone. (Overall, quinolones constituted about 17% of antibiotic usage in the SNF). Only 3 (5%) of the patients infected with GNB were infected with CR GNB, including Pseudomonas and Providenci a species. The CR GNB infections involved multiple sites, multiple organisms, and long length of stay in the SNF.
The findings indicate that in this community SNF, a low frequency of colonization or infection with CR GNB existed. Whether continued moderate use of quinolones will lead to increasing levels of CR GNB will require further study.
我们报告了一项为期1年的监测研究，该研究评估了耐环丙沙星革兰氏阴性杆菌（CR-GNB）的定植和感染情况，以及在一家无疫情爆发史的私立专业护理机构（SNF）中与喹诺酮类药物使用及其他可能危险因素的关系。
每季度采集的直肠拭子接种在含环丙沙星纸片（5微克）的麦康凯琼脂平板上，以筛选CR-GNB，随后进行菌种鉴定，并通过标准化纸片扩散试验确认抗菌药物敏感性。
CR-GNB定植的平均患病率为2.6%（范围为0.9%至5.3%）。上次调查中的定植频率高于首次调查。CR-GNB定植菌株包括假单胞菌属（21%），但超过一半是非假单胞菌属肠道菌，如鲍曼不动杆菌（25%）、奇异变形杆菌（17%）和斯氏普罗威登斯菌（13%）。没有CR-GNB定植的患者随后发生同一种菌的感染。定植患者更多地接触环丙沙星，并且更有可能近期从急性护理医院转入，并有压疮。在研究期间，336名接受调查的患者中，98名（29%）患者出现疑似感染并进行了培养；感染率为每1000患者日4.7例。在这些感染患者中，59名（60%）被革兰氏阴性菌感染；感染率为每1000患者日2.3例。19%的革兰氏阴性菌感染使用喹诺酮类药物治疗。（总体而言，喹诺酮类药物约占SNF抗生素使用量的17%）。仅3名（5%）革兰氏阴性菌感染患者感染了CR-GNB，包括假单胞菌属和普罗威登斯菌属菌种。CR-GNB感染涉及多个部位、多种微生物，且在SNF中的住院时间较长。
研究结果表明，在这个社区SNF中，CR-GNB的定植或感染频率较低。持续适度使用喹诺酮类药物是否会导致CR-GNB水平升高，需要进一步研究。
