介護施設の複数の抗生物質耐性クレブシエラ菌とエシェリキヤ大腸菌
J Wiener1, J P Quinn, P A Bradford
1Michael Reese Hospital and Medical Center, Chicago, Ill, USA.
JAMA
|February 18, 1999
まとめ
介護施設は,拡張スペクトルベータ・ラクタマゼ (ESBL) のような多剤耐性細菌の貯蔵庫です. 介護施設での抗生物質管理と感染制御の改善は,これらの耐性グラム陰性バチルの拡散を防ぐために不可欠です.
科学分野:
- 感染症 感染症は感染症です.
- 微生物学 微生物学とは
- エピデミオロジー エピデミオロジー
背景:
- 米国の病院で,拡張スペクトルベータ・ラクタマゼ (ESBLs) を含むセフタジジム耐性グラム陰性細菌による感染症の発生率が増加しています.
- ESBLを生成する生物は,治療の選択肢が限られているため,重大な脅威となっています.
研究 の 目的:
- ESBLを生成するグラム陰性バシリ感染症の全市規模の介護施設中心の発生を調査する.
- このアウトブレイクの臨床および分子疫学を特徴づけるために.
主な方法:
- 病院での症例対照研究と,介護老人ホームでのポイント流行調査を実施しました.
- 耐性菌株を分析するために分子疫学技術を使用した.
- セフタジジームに耐性のあるエシェリキア・コライやクレブシエラ・プネオモニア菌に感染した,またはコロニー化した患者が確認されています.
主要な成果:
- 耐性のあるE. coliやK.pneumoniaeを患った55人の入院患者を特定し,介護施設に入院した35人のうち31人が到着時にコロニー化されました.
- コロニゼーションの危険因子には,機能的状態の悪さ,胃口管またはの潰瘍の存在,および以前の広範囲の抗生物質の使用が含まれていました.
- セフタジジム耐性 (TEM-10 ESBL経由) と他の複数の抗生物質耐性を授与する一般的な54キロベースプラズミッドは,ほとんどの単離体で特定されました.
結論:
- 介護老人ホームの患者は,ESBLを生成する,多剤耐性のE. coliとK. pneumoniaeの重要な貯蔵庫を表しています.
- 主要な耐性プラズミドの広範な拡散が起こり,広範囲の抗生物質の使用と潜在的に不十分な感染制御によって促進されています.
- 推奨事項には,抗生物質管理の強化,抗生物質耐性パターンの定期的な監視,介護施設での感染制御の改善などが含まれています.
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