PDF(Pubmed)
Abstract：
UNASSIGNED: The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) has resulted in increased morbidity, mortality, and health care costs worldwide. To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala.
UNASSIGNED: Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21).
UNASSIGNED: A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients.
UNASSIGNED: The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care-associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals.
UNASSIGNED: Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21).
UNASSIGNED: A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients.
UNASSIGNED: The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care-associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals.
摘要：
■产超广谱头孢菌素耐药肠杆菌（ESCrE）和耐碳青霉烯耐药肠杆菌（CRE）的传播导致发病率增加，死亡率,和全世界的医疗保健费用。为了确定与医院内ESCrE和CRE定植相关的因素，我们纳入了位于危地马拉的地区医院的住院患者.
■使用横断面研究设计从随机选择的患者中收集粪便样本（3月至9月，2021),并测试样品是否存在ESCrE和CRE。使用套索回归模型检查基于医院和家庭的变量与ESCrE和CRE定植的关联，按病房聚类(n=21)。
■共纳入641例患者，其中有593个完整的数据集。ESCrE定植（72.3%，n=429/593）与碳青霉烯给药呈负相关（比值比[OR]0.21，95％置信区间[CI]0.11-0.42），与头孢曲松给药呈正相关（OR1.61，95％CI1.02-2.53），在本次住院后30天内报告入院(OR2.84,95%CI1.19~6.80).CRE定植（34.6%，n=205/593）与碳青霉烯给药相关（OR2.62，95％CI1.39-4.97），在当前住院后30天内报告的先前入院（OR2.58，95％CI1.17-5.72），住院患者较多的病房(OR1.05，95%CI1.02-1.08)，住院≥4天（OR3.07，95%CI1.72-5.46），和插管（OR2.51，95%CI1.13-5.59）。没有基于家庭的变量与住院患者的ESCrE或CRE定植相关。
本研究中确定的以医院为基础的危险因素与报告的医疗保健相关感染风险相似，与由医院环境而不是社区因素驱动的殖民相一致。这也表明ESCrE和CRE定殖可能是评估诊所和医院感染和预防控制计划功效的有用指标。
■使用横断面研究设计从随机选择的患者中收集粪便样本（3月至9月，2021),并测试样品是否存在ESCrE和CRE。使用套索回归模型检查基于医院和家庭的变量与ESCrE和CRE定植的关联，按病房聚类(n=21)。
■共纳入641例患者，其中有593个完整的数据集。ESCrE定植（72.3%，n=429/593）与碳青霉烯给药呈负相关（比值比[OR]0.21，95％置信区间[CI]0.11-0.42），与头孢曲松给药呈正相关（OR1.61，95％CI1.02-2.53），在本次住院后30天内报告入院(OR2.84,95%CI1.19~6.80).CRE定植（34.6%，n=205/593）与碳青霉烯给药相关（OR2.62，95％CI1.39-4.97），在当前住院后30天内报告的先前入院（OR2.58，95％CI1.17-5.72），住院患者较多的病房(OR1.05，95%CI1.02-1.08)，住院≥4天（OR3.07，95%CI1.72-5.46），和插管（OR2.51，95%CI1.13-5.59）。没有基于家庭的变量与住院患者的ESCrE或CRE定植相关。
本研究中确定的以医院为基础的危险因素与报告的医疗保健相关感染风险相似，与由医院环境而不是社区因素驱动的殖民相一致。这也表明ESCrE和CRE定殖可能是评估诊所和医院感染和预防控制计划功效的有用指标。
