四分之一的疗养院老人被耐药菌定植

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四分之一的疗养院老人被耐药菌定植
翻译：莫延花

审核：潘红平、周超群、陈志锦



根据一项发表在5月份美国感染控制与流行病学专业协会(APIC)官方杂志——《美国感染控制杂志》上的meta分析显示，多重耐药革兰阴性菌(MDR-GNB)如大肠杆菌在疗养院老人中的存在具有重大意义，建议疗养院需要加强感染控制预防和控制措施。
由哥伦比亚大学护理学院的Sainfer Aliyu，MPhil、MSEd、MHPM、BSN、RN等人进行的系统综述和meta分析发现，多重耐药革兰阴性菌(MDR-GNB)在抽样研究的疗养院老人中 定植的程度从11.2%到59.1%，合计平均定植率约为27%。研究人员还发现，12项研究中有9项与MDR-GNB定植风险增加相关确定特定因素有关,包括高龄、性别、合并慢性疾病、复发性住院史、与医护人员的互动增加、频繁的抗菌治疗、延迟启动有效抗生素治疗、植入医疗器械、功能状态下降、老年痴呆、长期卧床、大便失禁、入院时存在严重脓毒症以及长期居住在护理机构中。
该研究被认为是对同类研究的首次系统综述和meta分析，应当引起感染控制专业人员和疗养院的关注。
2017年APIC负责人格林•琳达说：“这项研究强调了在所有疗养院和长期护理机构中实施强有力的感染防控措施的重要性，了解MDR-GNB传播的动态和原因对这些机构的针对性有效感染控制策略的确定是至关重要的。”
根据疾病预防控制中心的数据，耐药性革兰阴性菌的比例正在上升。MDR-GNB在医疗机构中可以引起严重的感染，包括肺炎、血流感染、伤口或手术部位感染和脑膜炎。它们特别令人担忧，因为它们几乎对所有可用于治疗的药物都有耐药性，而正在开发的新型抗菌药物却少之又少。
由于并发症较多、高龄和免疫功能障碍等因素，疗养院的老人特别容易受到感染。此外，生活在疗养院本身也被认为是一个危险因素，因为从疗养院到急症治疗的频繁转移有助于病原体进入医院。疗养院内MDR-GNB的预防和管理较为复杂，由于人员配备不足、资源缺乏、培训不足、监督不力等一系列面临的挑战，所以存在广泛的感控资源需求。


原文[h1]A quarter of nursing home residents are colonized with drug-resistant bacteria[/h1][h1]    The significant presence of multidrug-resistant gram-negative bacteria (MDR-GNB), such as E. coli, among nursing home residents demonstrates the need for heightened infection control prevention and control measures in nursing homes, according to a meta-analysis published in the May issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).[/h1]

The systematic literature review and meta-analysis, conducted by Sainfer Aliyu, MPhil, MSEd, MHPM, BSN, RN, and others at the Columbia University School of Nursing, found the prevalence of MDR-GNB colonization among sampled nursing home residents ranged from 11.2 percent to 59.1 percent, with a pooled average of 27 percent. Researchers also found that nine of the 12 studies involved identified specific factors that are associated with increased MDR-GNB colonization risk, including advanced age, gender, comorbid chronic diseases, history of recurrent hospitalization, increased interaction with healthcare workers, frequent antimicrobial exposure, delayed initiation of effective antibiotic therapy, presence of medical devices, decreased functional status, advanced dementia, nonambulatory status, fecal incontinence, severe sepsis present on admission, and residency in a long-term care facility.


The study is thought to be the first systematic review and meta-analysis of its kind, and should raise concerns among infection control professionals and nursing home facilities.


“This study underscores the importance of having strong infection prevention programs in all nursing homes and long-term care facilities,” said 2017 APIC President Linda Greene, RN, MPS, CIC, FAPIC. “Understanding the dynamics and cause of MDR-GNB transmission is crucial to identifying effective infection control strategies specific to these settings.”


 Nursing home residents are especially vulnerable to infections due to multiple comorbidities, advanced age, and immune dysfunction. In addition, living in a nursing home is itself considered a risk factor, as frequent transfers from nursing homes to acute care contribute to the influx of pathogens into hospital settings. Prevention and management of MDR-GNB in nursing homes are complicated and require extensive infection control resources due to challenges common to this setting such as understaffing, fewer resources, insufficient training, and inadequate surveillance.


“Identifying which patients are most prone to an increased risk of MDR-GNB will enable infection preventionists to tailor efforts and stem future contaminations,” wrote Aliyu, et al. “The results of our study suggest that there is much more to be done with regard to infection prevention within nursing homes, and that increased measures must be taken with elderly patients in regard to MDR-GNB colonization.”


According to the Centers for Disease Control and Prevention, the percentage of gram-negative bacteria that are resistant to drugs is increasing. MDR-GNB cause serious infections in healthcare settings including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. They are particularly worrisome because they are becoming resistant to nearly all drugs that would be considered for treatment, with fewer novel antibacterial agents being developed.
图文编辑：刘欢
审稿：孙庆芬 赵静