一项关于印度一家三级护理医院成人重症监护室（ICU）耐碳青霉烯肠杆菌（CRE）定植和随后感染风险的观察性研究。

IF 1.8 Q3 INFECTIOUS DISEASES Infection Prevention in Practice Pub Date : 2023-09-30 DOI:10.1016/j.infpip.2023.100312

Kirtika Sharma, Vibhor Tak, Vijaya Lakshmi Nag, Pradeep Kumar Bhatia, Nikhil Kothari

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引用次数: 0

摘要

背景：碳青霉烯类耐药肠杆菌（CRE）是一个全球性的健康问题，其发病率越来越高。印度CRE的患病率很高。CRE感染很难治疗，并且与显著的发病率和死亡率相关。定植通常是感染的先决条件，预防CRE定植是预防CRE感染的关键。目的：确定印度成人重症监护室（ICU）CRE定植和随后感染的流行率。方法：我们进行了一项前瞻性观察性研究，在该研究中，获得了2019年1月至2020年8月入住ICU时同意的成年患者的直肠周围拭子以及相关临床细节。使用带有厄他培南圆盘的MacConkey琼脂平板进行直肠筛查，并使用常规微生物学技术进行进一步鉴定。使用epsillometer（E）试验测定额尔坦最小抑制浓度（MIC）。使用临床实验室标准研究所（CLSI）2020指南进行改良碳青霉烯失活（mCIM）试验和EDTA碳青霉烯灭活试验（eCIM），以确认碳青霉烯耐药性。结果：对192例ICU患者进行CRE筛查。发现37例患者被CRE定植。肺炎克雷伯菌（N=25；67.6%）是最常见的CRE分离株，其次是大肠杆菌（N=11；29.7%）和一种肠杆菌（N=1；2.7%）。89.2%（33/37）的患者出现CRE感染。在住院期间，肺炎是最常见的CRE感染，在12/33（36.4%）患者中发现。入院期间，CRE定植患者的中位住院时间（17天）比CRE非定植患者（9天）更长（PN=10/37）。结论：CRE定植与随后CRE感染的高风险以及更长的ICU和住院时间有关。

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An observational study on carbapenem-resistant Enterobacterales (CRE) colonisation and subsequent risk of infection in an adult intensive care unit (ICU) at a tertiary care hospital in India

Background

Carbapenem-resistant Enterobacterales (CRE) are a global health problem with a growing prevalence. India has a high prevalence of CRE. CRE infections are difficult to treat, and are associated with significant morbidity and mortality. Colonisation is generally a prerequisite for infection and the prevention of CRE colonisation is key to the prevention of CRE infection.

Objectives

To determine the prevalence of CRE colonisation and subsequent infections in an adult intensive care unit (ICU) in India.

Methods

We conducted a prospective observational study in which perirectal swabs were obtained along with relevant clinical details of consenting adult patients upon ICU admission between January 2019 and August 2020. Rectal screening was performed using MacConkey agar plates with ertapenem disks and further identification was performed using conventional microbiological techniques. Ertapenem minimum inhibitory concentration (MIC) was determined using an epsillometer (E) test. The modified carbapenem inactivation (mCIM) test and EDTA carbapenem inactivation test (eCIM) were performed to confirm carbapenem resistance using the Clinical Laboratory Standards Institute (CLSI) 2020 guidelines.

Results

192 ICU patients were screened for CRE. 37 patients were found to be colonised with CRE. Klebsiella pneumoniae (N=25; 67.6%) was the most frequent CRE isolate, followed by Escherichia coli (N=11; 29.7%) and one Enterobacter species (N=1; 2.7%). 89.2% (33/37) patients developed CRE infection. Pneumonia was the most common CRE infection identified in 12/33 (36.4%) patients.during the hospital stay. The median duration of hospital stay was longer (17 days) for CRE colonised compared to CRE non-colonised patients (9 days) (P<0.001). Death occurred in 27 % (N=10/37) of CRE-colonised patients during the hospital admission.