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首页> 外文期刊>The journals of gerontology.Series A. Biological sciences and medical sciences >The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities.
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The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities.

机译：长期护理设施中出现多重耐药革兰氏阴性菌的威胁。

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BACKGROUND: Infections caused by antimicrobial-resistant bacteria are associated with substantial morbidity and mortality. Residents of long-term care facilities (LTCF) are among the main reservoirs of antimicrobial-resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Multidrug-resistant gram-negative organisms (MDRGN) are emerging as important pathogens among LTCF residents. Data on the clinical epidemiology of MDRGN, especially in comparison to VRE and MRSA, are limited. METHODS: All clinical cultures collected from residents of a 750-bed LTCF for a period of 2 years were analyzed for the presence of MDRGN, VRE, and MRSA. Multidrug resistance among gram-negative bacteria was defined as resistance to three or more antimicrobials or antimicrobial groups including extended-spectrum penicillins (ampicillin/sulbactam or piperacillin/tazobactam), cephalosporins (cefazolin or ceftriaxone), gentamicin, ciprofloxacin, and trimethoprim-sulfamethoxazole (TMP/SMX). RESULTS: A total of 1,661 clinical cultures were included in the analysis. MDRGN were recovered from 180 (10.8%) cultures, MRSA from 104 (6.3%), and VRE from 11 (0.6%). MDRGN were isolated more frequently than MRSA or VRE throughout the study period. The prevalence of MDRGN increased significantly from 7% in 2003 to 13% in 2005 (p = .001). More than 80% of MDRGN isolates were resistant to ciprofloxacin, TMP/SMX, and ampicillin/sulbactam. Resistance to three, four, and five or more antimicrobials were identified among 122 (67.8%), 47 (26.1%), and 11 (6.1%) MDRGN isolates, respectively. CONCLUSIONS: Rates of MDRGN exceeded those of MRSA and VRE and increased throughout the study period. Resistance to multiple, commonly prescribed antimicrobials among MDRGN raises concerns about therapeutic options available to treat MDRGN infections among LTCF residents.
机译：背景：由抗药性细菌引起的感染与大量发病和死亡相关。长期护理机构（LTCF）的居民是主要的耐药菌库，包括耐甲氧西林的金黄色葡萄球菌（MRSA）和耐万古霉素的肠球菌（VRE）。耐多药革兰氏阴性菌（MDRGN）正在成为LTCF居民中的重要病原体。关于MDRGN的临床流行病学数据，特别是与VRE和MRSA相比，是有限的。方法：分析了从750张病床LTCF的居民收集的为期2年的所有临床培养物中是否存在MDRGN，VRE和MRSA。革兰氏阴性细菌的多药耐药性被定义为对三种或更多种抗菌剂或抗菌剂组的耐药性，包括扩大范围的青霉素（氨苄西林/舒巴坦或哌拉西林/他唑巴坦），头孢菌素（头孢唑林或头孢曲松），庆大霉素，环丙沙星和三甲氧灵（ TMP / SMX）。结果：总共包括1,661个临床培养物。从180（10.8％）个培养物中回收了MDRGN，从104（6.3％）中回收了MRSA，从11（0.6％）中回收了VRE。在整个研究期间，与MRSA或VRE相比，MDRGN的分离频率更高。 MDRGN的患病率从2003年的7％大幅增加到2005年的13％（p = .001）。超过80％的MDRGN分离株对环丙沙星，TMP / SMX和氨苄西林/舒巴坦耐药。分别在122（67.8％），47（26.1％）和11（6.1％）的MDRGN分离株中鉴定出对三种，四种和五种或更多种抗菌剂有抗药性。结论：在整个研究期间，MDRGN的发生率超过了MRSA和VRE，并有所上升。 MDRGN中对多种常用处方抗药性的耐药性引起人们对可用于治疗LTCF居民中MDRGN感染的治疗选择的担忧。

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