背景:在住院患者中越来越多地观察到由柠檬酸杆菌引起的感染,并且通常具有多重耐药性。然而,柠檬酸杆菌属的数量和负担。医院环境中的阻力尚未报告。我们旨在评估柠檬酸杆菌属的流行病学。住院患者的感染,它们的主要抗性模式和柠檬酸杆菌属。参与医院爆发。
方法:我们对已发表的文献进行了系统评价和荟萃分析(PROSPERO注册1月-2023年,CRD42023390084)。我们搜查了Embase,Medline和灰色文献对诊断为柠檬酸杆菌属的住院患者的研究。感染,和因柠檬酸杆菌属引起的医院暴发。在2000-2022年间出版。我们包括观察,介入,监测研究和疫情报告。感兴趣的结果是柠檬酸杆菌属的频率。住院患者中的感染以及这些感染中的第3代头孢菌素和/或碳青霉烯耐药百分比。我们使用随机效应模型来生成汇总结果估计,并评估偏倚风险和疫情报告质量。
结果:我们筛选了1609个去重复出版物,评估了148个全文,并包括41项研究(15项观察性研究,13项监测和13项暴发研究)。柠檬酸杆菌属。尿路和血流感染是最常见的报告,主要的致病物种是freundii柠檬酸杆菌。85%(838/990)的住院患者发生医院获得性感染。2010年以后,越来越多的柠檬酸杆菌属患者。在观察性研究中报告了感染。柠檬酸杆菌属的集合频率估计。由于缺乏数据,无法产生感染。柠檬酸杆菌分离株中ESBL和碳青霉烯酶生产者的合并患病率为22%(95CI4-50%,7项研究)和18%(95CI0-63%,4项研究),分别。在2016年之后,观察到报告的柠檬酸杆菌暴发的频率增加,感染/定植比为1:3,病死率为7%(6/89名患者)。常见的爆发源是汇,厕所,受污染的食物和注射材料。实施的预防措施包括环境清洁,隔离阳性患者并加强手卫生。13次疫情中只有7次(54%)得到了明确控制。
结论:这篇综述强调了地方性和流行性柠檬酸杆菌属的临床重要性。在医疗保健环境中。作为一个新兴的,多药耐药的医院病原体需要提高认识和进一步的专门监测工作。
BACKGROUND: Infections due to Citrobacter species are increasingly observed in hospitalized patients and are often multidrug-resistant. Yet, the magnitude and burden of Citrobacter spp. resistance in the hospital setting have not been reported. We aimed to evaluate the epidemiology of Citrobacter spp. infections among hospitalized patients, their main resistance patterns and Citrobacter spp. involvement in hospital outbreaks.
METHODS: We conducted a systematic review and meta-analysis of published literature (PROSPERO registration Jan-2023, CRD42023390084). We searched Embase, Medline and grey literature for studies on hospitalized patients diagnosed with Citrobacter spp. infections, and nosocomial outbreaks due to Citrobacter spp. published during the years 2000-2022. We included observational, interventional, surveillance studies and
outbreak reports. Outcomes of interest were the frequency of Citrobacter spp. infections among hospitalized patients and 3rd generation cephalosporin and/or carbapenem resistance percentages in these infections. We used random-effects models to generate pooled outcome estimates and evaluated risk of bias and quality of reporting of outbreaks.
RESULTS: We screened 1609 deduplicated publications, assessed 148 full-texts, and included 41 studies (15 observational, 13 surveillance and 13
outbreak studies). Citrobacter spp. urinary tract- and bloodstream infections were most frequently reported, with Citrobacter freundii being the main causative species. Hospital-acquired infection occurred in 85% (838/990) of hospitalized patients with Citrobacter infection. After 2010, an increasing number of patients with Citrobacter spp. infections was reported in observational studies. Pooled frequency estimates for Citrobacter spp. infections could not be generated due to lack of data. The pooled prevalence of ESBL and carbapenemase producers among Citrobacter isolates were 22% (95%CI 4-50%, 7 studies) and 18% (95%CI 0-63%, 4 studies), respectively. An increased frequency of reported Citrobacter outbreaks was observed after 2016, with an infection/colonization ratio of 1:3 and a case-fatality ratio of 7% (6/89 patients). Common
outbreak sources were sinks, toilets, contaminated food and injection material. Implemented preventive measures included environmental cleaning, isolation of positive patients and reinforcement of hand hygiene. Only seven out of 13 outbreaks (54%) were definitively controlled.
CONCLUSIONS: This review highlights the clinical importance of endemic and epidemic Citrobacter spp. in healthcare settings. As an emerging, multidrug‑resistant nosocomial pathogen it requires heightened awareness and further dedicated surveillance efforts.