비병원 장기 요양기관에서 입원하는 노인의 다제내성 그람음성균 보유
Multidrug-Resistant, Gram-Negative Bacteria in Hospitalized Elderly Patients from Non-Hospital Long-Term Care Facilities
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Background/Aims: We investigated the risk of multidrug-resistant, gram-negative bacteria (MDRGNB) in hospitalized elderly patients from non-hospital long-term care facilities (LTCFs) and the antibiotic prescription pattern. Methods: All clinical cultures obtained within 48 hours of hospitalization from elderly patients of at least 55 years of age arriving at a 623-bed, public teaching hospital in Seoul, Republic of Korea from LTCFs between April 1, 2011 and April 1, 2012 were collected retrospectively. Results: During this period, 365 elderly persons from 13 LTCFs were hospitalized. This study enrolled 135 patients who had cultures performed. In this group, 27.4% harbored MDRGNB at hospitalization. The presence of MDRGNB during prior hospitalization was the only risk factor that predicted harboring it (p = 0.043, odds ratio = 5.00, confidence interval = 1.049-23.834). Combinations of antibiotics or carbapenems were used initially in 35.6% of the patients, and this did not affect the mortality rate in this population. Conclusions: Hospitalized elderly patients from non-hospital LTCFs need more attention. Judicious antibiotic selection is needed according to the risk factor of harboring MDRGNB for antibiotics stewardship.
Abstract
Background/Aims: We investigated the risk of multidrug-resistant, gram-negative bacteria (MDRGNB) in hospitalized elderly patients from non-hospital long-term care facilities (LTCFs) and the antibiotic prescription pattern. Methods: All clinical cultures obtained within 48 hours of hospitalization from elderly patients of at least 55 years of age arriving at a 623-bed, public teaching hospital in Seoul, Republic of Korea from LTCFs between April 1, 2011 and April 1, 2012 were collected retrospectively. Results: During this period, 365 elderly persons from 13 LTCFs were hospitalized. This study enrolled 135 patients who had cultures performed. In this group, 27.4% harbored MDRGNB at hospitalization. The presence of MDRGNB during prior hospitalization was the only risk factor that predicted harboring it (p = 0.043, odds ratio = 5.00, confidence interval = 1.049-23.834). Combinations of antibiotics or carbapenems were used initially in 35.6% of the patients, and this did not affect the mortality rate in this population. Conclusions: Hospitalized elderly patients from non-hospital LTCFs need more attention. Judicious antibiotic selection is needed according to the risk factor of harboring MDRGNB for antibiotics stewardship.
참고문헌 (13)
- D'Agata EM, "Rapidly rising prevalence of nosocomial multidrug-resistant, gram-negative bacilli : a 9-year surveillance study", Infect Control Hosp Epidemiol, 25, pp.842~846 (2004)
- Pop-Vicas A, "Influx of multidrug-resistant, gram-negative bacteria in the hospital setting and the role of elderly patients with bacterial bloodstream infection", Infect Control Hosp Epidemiol, 30, pp.325~331 (2009)
- Lautenbach E, "Epidemiology of antimicrobial resistance among gram-negative organisms recovered from patients in a multistate network of long-term care facilities", Infect Control Hosp Epidemiol, 30, pp.790~793 (2009)
- American Thoracic Society, "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia", Am J Respir Crit Care Med, 171, pp.388~416 (2005)
- Loeb M, "Antibiotic use in long-term-care facilities : many unanswered questions", Infect Control Hosp Epidemiol, 21, pp.680~683 (2000)
- Pop-Vicas A, "Multidrug-resistant gram-negative bacteria in a long-term care facility : prevalence and risk factors", J Am Geriatr Soc, 56, pp.1276~1280 (2008)
- Yoo JS, "High prevalence of extended-spectrum beta-lactamases and plasmid-mediated AmpC beta-lactamases in Enterobacteriaceae isolated from long-term care facilities in Korea", Diagn Microbiol Infect Dis, 67, pp.261~265 (2010)
- Choi JP, "Influx of multidrug resistant, gram-negative bacteria(MDRGNB)in a public hospital among elderly patients from long-term care facilities : a single-center pilot study", Arch Gerontol Geriatr, 54, pp.e19~e22 (2012)
- Magiorakos AP, "Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria : an international expert proposal for interim standard definitions for acquired resistance", Clin Microbiol Infect, 18, pp.268~281 (2012)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Bone RC, "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP", SCCM Consensus Conference Committee. American College of Chest Physicians, Chest, pp.1992, 101[DOI]
- Friedmann R, "Prospective evaluation of colonization with extended-spectrum beta-lactamase(ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization", Infect Control Hosp Epidemiol, 30, pp.534~542 (2009)
- Prabaker K, "Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae : a multihospital study", Infect Control Hosp Epidemiol, 33, pp.1193~1199 (2012)