Is intestinal colonization with multidrug-resistant Enterobacterales associated with higher rates of nosocomial Enterobacterales bloodstream infections?

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Noureddine Henoun Loukili, Agnes Perrin, Olivier Gaillot, Amelie Bruandet, Fabio Boudis, Boualem Sendid, Saadalla Nseir, Jean-Ralph Zahar
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引用次数: 0

Abstract

Objectives: Intestinal colonization with multidrug-resistant Enterobacterales (MDRE-IC) increases the risk of MDRE bloodstream infection (BSI). However, its impact on the overall risk of nosocomial Enterobacterales bloodstream infections (nE-BSIs) remains unclear. This study aimed to determine this risk and identify associated factors in hospitalized patients.

Design: This retrospective cohort study at a 3200-bed tertiary institution including patients hospitalized in 2019 who underwent MDRE rectal swab (RS) screening. Inclusion criteria were age ≥18 years, first RS in 2019, follow-up ≥7 days, and Enterobacterales BSIs >48 hours after RS. The primary outcome was the first nE-BSI during the follow-up period, analyzed using a Cox model.

Results: Among 7006 patients, 817 (11.9%) had MDRE-IC. Most were male and primarily hospitalized in acute wards. nE-BSIs occurred in 433 (6.1%) patients and were more frequent in patients with MDRE-IC than the non-colonized group (adjusted hazard ratio [aHR] = 1.78, 95% confidence interval [CI]: 1.40-2.26). Intestinal colonization with extended-spectrum β-lactamase-producing and carbapenemase-resistant Enterobacterales showed similar risks for Enterobacterales BSI onset: aHR = 1.73 (95% CI: 1.33-2.24) and aHR = 2.02 (95% CI: 1.27-3.22), respectively.

Conclusions: In hospitalized patients, MDRE-IC is associated with a higher rate of nE-BSI than those without MDRE-IC, underscoring the urgent need for improved infection prevention and control measures, as well as optimized antibiotic use to mitigate this risk.

耐多药肠道菌的肠道定植与较高的院内肠道菌血流感染率有关吗?
目的:多重耐药肠杆菌(MDRE-IC)的肠道定植会增加多重耐药肠杆菌血流感染(MDRE-BSI)的风险。然而,其对医院内肠杆菌血流感染(nE-BSI)总体风险的影响仍不清楚。本研究旨在确定住院患者的这一风险并找出相关因素:这项回顾性队列研究在一家拥有 3200 张病床的三级医院进行,纳入了 2019 年接受 MDRE 直肠拭子(RS)筛查的住院患者。纳入标准为年龄≥18岁、2019年首次接受RS筛查、随访时间≥7天、RS筛查后E-BSI>48小时。主要结果是随访期间首次出现 nE-BSI,采用 Cox 模型进行分析:结果:在 7006 名患者中,817 人(11.9%)患有 MDRE-IC。433例(6.1%)患者发生了nE-BSI,与非定植组相比,MDRE-IC患者的发生率更高(aHR = 1.78,95%CI:1.40-2.26)。肠道定植产ESBL肠杆菌和耐碳青霉烯酶肠杆菌对E-BSI发病的风险相似:aHR=1.73(95%CI:1.33-2.24)和aHR=2.02(95%CI:1.27-3.22):结论:在住院患者中,与无 MDRE-IC 的患者相比,MDRE-IC 与较高的 nE-BSI 发生率相关,这表明迫切需要改进感染预防和控制措施,并优化抗生素的使用以降低这一风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
18.90
自引率
2.40%
发文量
1020
审稿时长
30 days
期刊介绍: International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.
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