碳青霉烯耐药肠杆菌科细菌主动筛查研究进展
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摘要
耐碳青霉烯类抗菌药物的肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)的感染已成为威胁全球人类健康的严重问题。预防CRE感染已迫在眉睫。人体肠道是绝大多数细菌的储存库,而导致院内感染主要的危险因素之一是肠道中定植的耐药菌。CRE定植一般先于或同步于CRE感染,对入院48 h内患者进行CRE主动筛查并对阳性结果的患者采取主动干预措施是预防CRE感染与传播的有效途径。该文就CRE传播与流行、需要筛查的人群、主要的筛查样本及主要的筛查方法等作一综述。
The infection by carbapenem-resistant Enterobacteriaceae(CRE) has become a serious problem that threatens human health globally. Prevention of CRE infection is imminent. The human intestinal tract is a reservoir of bacteria, and resistant bacteria colonized in the intestine are potential risk factors for outbreaks of nosocomial infections. CRE colonization is generally preceded or synchronized with CRE infection. Active screening of patients with positive CRE within 48 hours after admission and active intervention in patients with positive results are effective ways to prevent CRE infection and transmission. This article provides a brief overview of the current status of CRE, populations need screening, main screening samples and screening methods.
The infection by carbapenem-resistant Enterobacteriaceae(CRE) has become a serious problem that threatens human health globally. Prevention of CRE infection is imminent. The human intestinal tract is a reservoir of bacteria, and resistant bacteria colonized in the intestine are potential risk factors for outbreaks of nosocomial infections. CRE colonization is generally preceded or synchronized with CRE infection. Active screening of patients with positive CRE within 48 hours after admission and active intervention in patients with positive results are effective ways to prevent CRE infection and transmission. This article provides a brief overview of the current status of CRE, populations need screening, main screening samples and screening methods.
引文
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[2] Centers for Disease Control and Prevention(CDC).Facility guidance for control of carbapenem-resistant Enterobacteriaceae(CRE) - 2015 Update CRE Toolkit[S/OL].(2015-11)[2018-03-01].https://www.cdc.gov /hai/pdfs/cre/CRE-guidance-508.pdf.
[3] CHEN Meilian,WANG Shoujun,KUANG Jiqiu,et al.Active screening of CRE in intensive care unit and its effect[J].Chin J Nosocomiol Vol,2017,27(18):4123-4126.(in Chinese) 陈美恋,王守军,匡季秋,等.重症监护病区CRE主动筛查及其效果评价[J].中华医院感染学杂志,2017,27(18):4123-4126.
[4] Centers for Disease Control and Prevention(CDC).Vital signs:Carbapenem-resistant Enterobacteriaceae[J].MMWR Morb Mortal Wkly Rep,2013,62(9):165-170.
[5] HU Fupin,ZHU Demei,WANG Fu,et al.CHINET surveillance of distribution and susceptibility of carbapenem-resistant Enterobacteriaceae isolates in 2012[J].Chin J Infect Chemother,2014,14(5):382-386.(in Chinese) 胡付品,朱德妹,汪复,等.2012年中国CHINET碳青霉烯类耐药肠杆菌科细菌的分布特点和耐药性分析[J].中国感染与化疗杂志,2014,14(5):382-386.
[6] 全国细菌耐药监测网.2016年全国细菌耐药监测报告[EB/OL].(2017-12-20) [2018-03-01].http://www.carss.cn/Report/Details/403.
[7] Logan LK,Weinstein RA.The epidemiology of carbapenem-resistant Enterobacteriaceae:The impact and evolution of a global menace[J].J Infect Dis,2017,215(Suppl 1):S28-S36.
[8] Yigit H,Queenan AM,Anderson GJ,et al.Novel carbapenem-hydrolyzing beta-lactamase,KPC-1,from a carbapenem-resistant strain of Klebsiella pneumoniae[J].Antimicrob Agents Chemother,2001,45(4):1151-1161.
[9] Wei ZQ,Du XX,Yu YS,et al.Plasmid-mediated KPC-2 in a Klebsiella pneumoniae isolate from China[J].Antimicrob Agents Chemother,2007,51(2):763-765.
[10] Dortet L,Poirel L,Nordmann P,et al.Worldwide dissemination of the NDM-type carbapenemases in Gram-negative bacteria[J].Biomed Res Int,2014,2014:249856.
[11] Ho KW,Ng WT,Ip M,et al.Active surveillance of carbapenem-resistant Enterobacteriaceae in intensive care units:Is it cost-effective in a nonendemic region?[J].Am J Infect Control,2016,44(4):394-399.
[12] Hayden MK,Lin MY,Lolans K,et al.Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals[J].Clin Infect Dis,2015,60(8):1153-1161.
[13] Bartsch SM,McKinnell JA,Mueller LE,et al.Potential economic burden of carbapenem-resistant Enterobacteriaceae(CRE) in the United States[J].Clin Microbiol Infect,2017,23(1):48.
[14] WHO.Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae,Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities[M].Geneva:World Health Organization,2017:1-76.
[15] Papadimitriou-Olivgeris M,Bartzavali C,Christofidou M,et al.Performance of chromID? CARBA medium for carbapenemases-producing Enterobacteriaceae detection during rectal screening[J].Eur J Clin Microbiol Infect Dis,2014,33(1):35-40.
[16] Zarakolu P,Day KM,Sidjabat HE,et al.Evaluation of a new chromogenic medium,chromID OXA-48,for recovery of carbapenemase-producing Enterobacteriaceae from patients at a university hospital in Turkey[J].Eur J Clin Microbiol Infect Dis,2015,34(3):519-525.
[17] Adler A,Navon-Venezia S,Moran-Gilad J,et al.Laboratory and clinical evaluation of screening agar plates for detection of carbapenem-resistant Enterobacteriaceae from surveillance rectal swabs[J].J Clin Microbiol,2011,49(6):2239-2242.
[18] Schechner V,Straus-Robinson K,Schwartz D,et al.Evaluation of PCR-based testing for surveillance of KPC-producing carbapenem-resistant members of the Enterobacteriaceae family[J].J Clin Microbiol,2009,47(10):3261-3265.
[19] ZENG Xiuyu,ZHANG Huaping,CHEN Xiarong,et al.Value of active screening of multidrug-resistant organisms in control of nosocomial infections in ICU[J].Chin J Nosocomiol Vol,2016,26(10):2373-2375.(in Chinese) 曾秀玉,张华平,陈夏容,等.多药耐药菌主动筛查在ICU医院感染预防控制中的价值[J].中华医院感染学杂志,2016,26(10):2373-2375.
[20] XU Gang,WANG Yiqun,NI Xiaomei.A new strategy for anti-infection treatment of multi-drug resistant Klebsiella pneumoniae infection[J].Chin J Microecol,2018,30(10):1169-1172.(in Chinese) 徐刚,王益群,倪笑媚.多重耐药肺炎克雷伯菌肺部感染的抗感染治疗新策略[J].中国微生态学杂志,2018,30(10):1169-1172.
[21] JIANG Dongping,GU Chengwu,LI Yanxia,et al.Risk factors of multidrug resistant Acinetobacter baumannii infection and mortality of patients in intensive care unit[J].Chin J Microecol,2018,30(6):677-682.(in Chinese) 江冬萍,顾成武,李艳霞,等.重症监护病房患者多重耐药鲍曼不动杆菌感染及病死危险因素分析[J].中国微生态学杂志,2018,30(6):677-682.
[2] Centers for Disease Control and Prevention(CDC).Facility guidance for control of carbapenem-resistant Enterobacteriaceae(CRE) - 2015 Update CRE Toolkit[S/OL].(2015-11)[2018-03-01].https://www.cdc.gov /hai/pdfs/cre/CRE-guidance-508.pdf.
[3] CHEN Meilian,WANG Shoujun,KUANG Jiqiu,et al.Active screening of CRE in intensive care unit and its effect[J].Chin J Nosocomiol Vol,2017,27(18):4123-4126.(in Chinese) 陈美恋,王守军,匡季秋,等.重症监护病区CRE主动筛查及其效果评价[J].中华医院感染学杂志,2017,27(18):4123-4126.
[4] Centers for Disease Control and Prevention(CDC).Vital signs:Carbapenem-resistant Enterobacteriaceae[J].MMWR Morb Mortal Wkly Rep,2013,62(9):165-170.
[5] HU Fupin,ZHU Demei,WANG Fu,et al.CHINET surveillance of distribution and susceptibility of carbapenem-resistant Enterobacteriaceae isolates in 2012[J].Chin J Infect Chemother,2014,14(5):382-386.(in Chinese) 胡付品,朱德妹,汪复,等.2012年中国CHINET碳青霉烯类耐药肠杆菌科细菌的分布特点和耐药性分析[J].中国感染与化疗杂志,2014,14(5):382-386.
[6] 全国细菌耐药监测网.2016年全国细菌耐药监测报告[EB/OL].(2017-12-20) [2018-03-01].http://www.carss.cn/Report/Details/403.
[7] Logan LK,Weinstein RA.The epidemiology of carbapenem-resistant Enterobacteriaceae:The impact and evolution of a global menace[J].J Infect Dis,2017,215(Suppl 1):S28-S36.
[8] Yigit H,Queenan AM,Anderson GJ,et al.Novel carbapenem-hydrolyzing beta-lactamase,KPC-1,from a carbapenem-resistant strain of Klebsiella pneumoniae[J].Antimicrob Agents Chemother,2001,45(4):1151-1161.
[9] Wei ZQ,Du XX,Yu YS,et al.Plasmid-mediated KPC-2 in a Klebsiella pneumoniae isolate from China[J].Antimicrob Agents Chemother,2007,51(2):763-765.
[10] Dortet L,Poirel L,Nordmann P,et al.Worldwide dissemination of the NDM-type carbapenemases in Gram-negative bacteria[J].Biomed Res Int,2014,2014:249856.
[11] Ho KW,Ng WT,Ip M,et al.Active surveillance of carbapenem-resistant Enterobacteriaceae in intensive care units:Is it cost-effective in a nonendemic region?[J].Am J Infect Control,2016,44(4):394-399.
[12] Hayden MK,Lin MY,Lolans K,et al.Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals[J].Clin Infect Dis,2015,60(8):1153-1161.
[13] Bartsch SM,McKinnell JA,Mueller LE,et al.Potential economic burden of carbapenem-resistant Enterobacteriaceae(CRE) in the United States[J].Clin Microbiol Infect,2017,23(1):48.
[14] WHO.Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae,Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities[M].Geneva:World Health Organization,2017:1-76.
[15] Papadimitriou-Olivgeris M,Bartzavali C,Christofidou M,et al.Performance of chromID? CARBA medium for carbapenemases-producing Enterobacteriaceae detection during rectal screening[J].Eur J Clin Microbiol Infect Dis,2014,33(1):35-40.
[16] Zarakolu P,Day KM,Sidjabat HE,et al.Evaluation of a new chromogenic medium,chromID OXA-48,for recovery of carbapenemase-producing Enterobacteriaceae from patients at a university hospital in Turkey[J].Eur J Clin Microbiol Infect Dis,2015,34(3):519-525.
[17] Adler A,Navon-Venezia S,Moran-Gilad J,et al.Laboratory and clinical evaluation of screening agar plates for detection of carbapenem-resistant Enterobacteriaceae from surveillance rectal swabs[J].J Clin Microbiol,2011,49(6):2239-2242.
[18] Schechner V,Straus-Robinson K,Schwartz D,et al.Evaluation of PCR-based testing for surveillance of KPC-producing carbapenem-resistant members of the Enterobacteriaceae family[J].J Clin Microbiol,2009,47(10):3261-3265.
[19] ZENG Xiuyu,ZHANG Huaping,CHEN Xiarong,et al.Value of active screening of multidrug-resistant organisms in control of nosocomial infections in ICU[J].Chin J Nosocomiol Vol,2016,26(10):2373-2375.(in Chinese) 曾秀玉,张华平,陈夏容,等.多药耐药菌主动筛查在ICU医院感染预防控制中的价值[J].中华医院感染学杂志,2016,26(10):2373-2375.
[20] XU Gang,WANG Yiqun,NI Xiaomei.A new strategy for anti-infection treatment of multi-drug resistant Klebsiella pneumoniae infection[J].Chin J Microecol,2018,30(10):1169-1172.(in Chinese) 徐刚,王益群,倪笑媚.多重耐药肺炎克雷伯菌肺部感染的抗感染治疗新策略[J].中国微生态学杂志,2018,30(10):1169-1172.
[21] JIANG Dongping,GU Chengwu,LI Yanxia,et al.Risk factors of multidrug resistant Acinetobacter baumannii infection and mortality of patients in intensive care unit[J].Chin J Microecol,2018,30(6):677-682.(in Chinese) 江冬萍,顾成武,李艳霞,等.重症监护病房患者多重耐药鲍曼不动杆菌感染及病死危险因素分析[J].中国微生态学杂志,2018,30(6):677-682.