摘要
       长期护理机构（LTCF）居民因耐多药（MDR）微生物感染引起的公共卫生问题。这项多中心研究调查了意大利LTCF居民临床标本中产ESBL的病原体和艰难梭菌艰难梭菌的频率。在2014年10月至2015年3月期间，分别对位于不同城市的4家医院实验室收到的疑似尿路感染或艰难梭菌感染的LTCF居民（≥65岁）的尿液和腹泻粪便样本进行了分析。进行抗生素敏感性测试，抗性基因表征和病原体分子分型。在44个不同LTCF中从626位居民收集的806个尿液培养物中，492个微生物感染阳性。其中，至少产ESBL的肠杆菌科细菌158种为阳性（32.1％），大肠埃希菌为最常见的ESBL病原体（23.4％），其次为肺炎克雷伯菌（4.5％）。此外，检测到4个碳青霉烯酶生产者（0.8％）（1个大肠杆菌，VIM-1和3个肺炎克雷伯菌KPC-3）。 CTX-M-15型ESBL在大肠杆菌（71.3％）和肺炎克雷伯菌（77.3％）中都占优势。大多数大肠杆菌分离物（82.6％）属于ST131 / H30克隆/亚克隆。对于肺炎克雷伯菌，ST307和ST15频繁发生（分别为31.8％和22.7％），但含有blaKPC-3的菌株属于CC258。在从26名不同LTCFs的111名居民中收集的136个腹泻粪便样品中，21个（15.4％）对产毒性艰难梭菌呈阳性;其中13（62％）是MDR（耐受3种或更多种不同类型的抗微生物剂）。主要的艰难梭菌聚合酶链反应核糖体型为356/607（42.9％），其次为018,449和078（各14％）。需要公共卫生努力来控制LTCF环境中产生CTX-M的肠杆菌科和MDR艰难梭菌的扩散。

       Infections due to multidrug-resistant (MDR) organisms in long-term care facilities (LTCFs) residents constitute a public health concern. This multicenter study investigated the frequency of ESBL-producing pathogens and MDR Clostridium difficile in clinical specimens from LTCF residents in Italy. During October 2014-March 2015, all urine and diarrheic fecal samples from LTCF residents (≥65 years) with suspected urinary tract infection or C. difficile infection, respectively, received for diagnosis by 4 hospital laboratories located in different cities were analyzed. Antibiotic susceptibility testing, characterization of resistancegenes, and molecular typing of pathogens were performed. Of 806 urine cultures collected from 626 residents at 44 different LTCFs, 492 were positive for microbial infection. Of these, 158 were positive for at least an ESBL-producing Enterobacteriaceae species (32.1%), with Escherichia coli as the most frequent ESBL pathogen (23.4%) followed by Klebsiella pneumoniae (4.5%). Furthermore, 4 carbapenemase producers (0.8%) (1 E. coli with VIM-1and 3 K. pneumoniae with KPC-3) were detected. The CTX-M-15 type ESBL predominated in both E. coli (71.3%) and K. pneumoniae (77.3%). Most E. coli isolates (82.6%) belonged to the ST131/H30 clone/subclone. For K. pneumoniae, ST307 and ST15 were frequent (31.8% and 22.7%, respectively), but isolates harboring blaKPC-3 belonged to CC258. Of 136 diarrheic fecal samples collected from 111 residents at 26 different LTCFs, 21 (15.4%) were positive for toxigenic C. difficile; of these, 13 (62%) were MDR (resistant to 3 or more antimicrobial agents of different classes). The predominant C. difficile polymerase chain reaction ribotype was 356/607 (42.9%), followed by 018, 449, and 078 (14% each). Public health efforts are needed to contain the diffusion of CTX-M-producing Enterobacteriaceae and MDR C. difficile in LTCF settings.

https://www.ncbi.nlm.nih.gov/pubmed/29571838