期刊
PATHOGENS
卷 11, 期 9, 页码 -出版社
MDPI
DOI: 10.3390/pathogens11091019
关键词
extended-spectrum beta-lactam antibiotics; Enterobacterales; resistance; colonization; epidemiological surveillance
类别
ESBL- and carbapenemase-producing bacteria are prevalent in long-term care facilities (LTCFs) in Portugal, highlighting the importance of LTCFs as a reservoir. The prevalence of healthcare-associated infections (HAIs) caused by these bacteria remained stable over time, but varied significantly based on LTCF typology. Prior colonization was observed in a significant proportion of patients, emphasizing the need for systematic colonization screening at LTCF admission.
Extended-spectrum- beta-lactamase (ESBL)- and carbapenemase-producing bacteria are widespread in hospitals, but the extent of this problem in long-term care facilities (LTCFs) is poorly understood. We aimed to elucidate, in the Portuguese regional clinical context, the relevance of LTCFs as a reservoir of Escherichia coli and Klebsiella spp. producing ESBL- and/or carbapenemases (Ec/Kp-ESBL/CARB). Fourteen LTCFs from Portugal, corresponding to units of convalescence (UC/n = 3), medium-term internment and rehabilitation (UMDR/ n = 5), or long-term internment and maintenance (ULDM/n = 6), were analyzed (2016-2019). All patients with Ec/Kp-ESBL/CARB infections acquired during LTCF stay were included, and detailed information was collected. Prevalence of patients with healthcare-associated infections (HAIs) by Ec/Kp-ESBL/CARB did not vary significantly over time (1.48% in 2016-2017, 1.89% in 2017-2018, and 1.90% in 2018-2019), but a statistically significant association with the LTCF typology (ULDM, UMDR) was observed. HAIs were caused by K. pneumoniae (n = 51/54.3%), E. coli (n = 41/43.6%), or both (n = 2/2.1%), producing ESBL (96%) or carbapenemases (4%). Prior colonization (n = 14/16%) corresponded to seven Kp-CARB and seven Ec/Kp-ESBL. The worrying prevalence of patients acquiring HAIs by Ec/Kp-ESBL/CARB, associated with the estimated rates of those already colonized at admission, highlights a relevant role for LTCFs as a reservoir of Ec/Kp-ESBL/CARB. Epidemiological surveillance should be extended to the national level, and colonization screening at LTCF admission implemented systematically.
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