Epidemiological study on active surveillance of multidrug-resistant organism in emergency intensive care unit_West China Medical Journal

Authors：

KANG Xia ¹ , HUANG Wenzhi ^1,2 , WEI Li ¹ ,  QIAO Fu ¹ , YIN Weijia ¹ , ZONG Zhiyong ¹

1. Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

QIAO Fu, Email: qiaofu2005@gmail.com

Keywords：

Carbapenem-resistant Klebsiella pneumoniae; Carbapenem-resistant Acinetobacter baumannii; Active surveillance; Rectal swab; Risk factors

DOI：

10.7507/1002-0179.202102011

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Objectives To detect the admission rate and hospital acquired rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) of active surveillance in Emergency Intensive Care Unit patients of West China Hospital of Sichuan University, to examine whether rectal colonization of CRKP and CRAB are associated with nosocomial infection, so as to provide a scientific basis for the prevention and control of CRKP and CRAB.Methods A nested case-control study was conducted between April and September 2018 in Emergency Intensive Care Unit. Rectal swabs were obtained to screen CRAB and CRKP, and the admission rate of colonization was calculated. According to whether infected with CRKP/CRAB, the patients were divided into case group (infection group) and control group (noninfection group) to determine whether colonization of CRKP/CRAB were independent risk factors for nosocomial infection using logistic regression model.Results The admission rate of CRKP and CRAB patients were 4.08% (18/441) and 8.78% (38/433), and the nosocomial infection rate was 3.63% (16/441) and 18.01% (78/433) separately. Multivariate analysis showed that rectal colonization of CRKP [odds ratio=5.438, 95% confidence interval (1.643, 17.999), P=0.006] was an independent risk factor for nosocomial infection. However, there was no statistical correlation between rectal colonization of CRAB and nosocomial infection [odds ratio=1.449, 95% confidence interval (0.714, 2.942), P=0.305].Conclusions The rectal colonization rate of CRAB is higher than that of CRKP, but it does not increase the risk of CRAB infection in patients. Rectal colonization of CRKP is an important factor for infection of patients. Therefore, early detection of CRKP through active surveillance and taking control measures can help reduce the risk of its spread in the hospital.

Citation： KANG Xia, HUANG Wenzhi, WEI Li, QIAO Fu, YIN Weijia, ZONG Zhiyong. Epidemiological study on active surveillance of multidrug-resistant organism in emergency intensive care unit. West China Medical Journal, 2021, 36(3): 328-333. doi: 10.7507/1002-0179.202102011 Copy

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1. 廣何. 專家呼吁: 應積極應對多重耐藥菌的挑戰. (2019-05-20)[2021-03-05]. https://baijiahao.baidu.com/s?id=1634057386504265905&wfr=spider&for=pc.
2. 胡付品, 郭燕, 朱德妹, 等. 2017 年 CHINET 中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
3. Huang W, Qiao F, Zhang Y, et al. In-hospital medical costs of infections caused by Carbapenem-resistant Klebsiella pneumoniae. Clin Infect Dis, 2018, 67(suppl 2): S225-S230.
4. 張建娜, 陳曉莉, 葉磊. 急診 ICU 多重耐藥菌醫院感染控制的綜合干預效果評價. 護理管理雜志, 2017, 17(12): 926-928.
5. Qiao F, Huang W, Gao S, et al. Risk factor for intestinal carriage of carbapenem-resistant Acinetobacter baumannii and the impact on subsequent infection among patients in an intensive care unit: an observational study. BMJ Open, 2020, 10(9): e035893.
6. World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. (2017-11-01)[2021-03-05]. https://www.who.int/infection-prevention/publications/guidelines-cre/en/.
7. Centers for Disease Control. Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE). (2015-11-01)[2021-03-05]. https://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf.
8. Nutman A, Lerner A, Schwartz D, et al. Evaluation of carriage and environmental contamination by carbapenem-resistant Acinetobacter baumannii. Clin Microbiol Infect, 2016, 22(11): 949.e5-949.e7.
9. Cheng VC, Chen JH, So SY, et al. Use of fluoroquinolones is the single most important risk factor for the high bacterial load in patients with nasal and gastrointestinal colonization by multidrug-resistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis, 2015, 34(12): 2359-2366.
10. 陳美戀, 王守軍, 匡季秋, 等. 重癥監護病區 CRE 主動篩查及其效果評價. 中華醫院感染學雜志, 2017, 27(18): 4123-4126.
11. Chen X, Liu Q, Liu WE, et al. Risk factors for subsequential carbapenem-resistant Klebsiella pneumoniae clinical infection among rectal carriers with carbapenem-resistant Klebsiella pneumoniae. Infect Drug Resist, 2020, 13: 1299-1305.
12. Mammina C, Bonura C, Vivoli AR, et al. Co-colonization with carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii in intensive care unit patients. Scand J Infect Dis, 2013, 45(8): 629-634.
13. Karaaslan A, Soysal A, Altinkanat Gelmez G, et al. Molecular characterization and risk factors for carbapenem-resistant Gram-negative bacilli colonization in children: emergence of NDM-producing Acinetobacter baumannii in a newborn intensive care unit in Turkey. J Hosp Infect, 2016, 92(1): 67-72.
14. Latibeaudiere R, Rosa R, Laowansiri P, et al. Surveillance cultures growing carbapenem-resistant Acinetobacter baumannii predict the development of clinical infections: a retrospective cohort study. Clin Infect Dis, 2015, 60(3): 415-422.
15. Dickstein Y, Edelman R, Dror T, et al. Carbapenem-resistant Enterobacteriaceae colonization and infection in critically ill patients: a retrospective matched cohort comparison with non-carriers. J Hosp Infect, 2016, 94(1): 54-59.
16. Tischendorf J, de Avila RA, Safdar N. Risk of infection following colonization with carbapenem-resistant Enterobactericeae:a systematic review. Am J Infect Control, 2016, 44(5): 539-543.
17. van Loon K, Voor In’t Holt AF, Vos MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother, 2017, 62(1): e01730-17.
18. Sultan AM, Seliem WA. Identifying risk factors for healthcare-associated infections caused by carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. Sultan Qaboos Univ Med J, 2018, 18(1): e75-e80.
19. 楊艷兵, 李從榮. 基于顯色培養法多重耐藥鮑曼不動桿菌快速篩查方法的建立. 中華實驗和臨床感染病雜志(電子版), 2015(1): 32-34.
20. 衛麗, 喬甫, 林吉, 等. 經修飾 CHROMagar 不動桿菌顯色培養聯合 MALDI-TOF-MS 快速篩查腸道耐碳青霉烯鮑氏不動桿菌的研究. 中華醫院感染學雜志, 2018, 28(19): 2893-2897.

West China Medical Journal

Epidemiological study on active surveillance of multidrug-resistant organism in emergency intensive care unit

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