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عوامل خطر کلونیزاسیون روده‌ای و کسب باسیل‌های گرم منفی مقاوم به کرباپنم در بیماران بستری در بخش‌های مراقبت‌های ویژه

نوع مقاله : مقاله پژوهشی

نویسندگان

1 گروه باکتری شناسی و ویروس شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

2 دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی شیراز، شیراز، ایران

3 گروه میکروبشناسی، دانشکده پزشکی، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران

چکیده

زمینه و هدف: باسیل‌های گرم منفی مقاوم به کرباپنم (CR-GNB) یک مشکل جهانی در درمان به‌ویژه بیماران بستری در بخش مراقبت‌های ویژه (ICU) به شمار می‌ر‌‌وند. هدف مطالعه حاضر‌ بررسی شیوع کولونیزاسیون روده‌ای و کسب CR-GNB در بیماران بستری در بخش‌های ICU بیمارستان نمازی و تعیین فاکتورهای خطر کسب آن‌ها بوده است.
.مواد و روش­ها: مطالعه حاضر‌ در سال 1400-1404 بر روی 78 بیمار بستری‌شده انجام گردید. از بیماران طی 48 ساعت بدو ورود و 24 ساعت پس از ترخیص، نمونه‌های‌ سوآب رکتال گرفته شد. نمونه‌ها جهت کولونیزاسیون روده‌ای و کسب (عفونت) CR-GNB با استفاده از روش‌های استاندارد باکتریولوژیک ارزیابی شدند. عوامل خطر مرتبط با هر دو گروه نیز بررسی شدند.
یافته­ها: میزان کلونیزاسیون و کسب این باکتری‌ها به ترتیب) 78/16، 5/20 %) و ( 51/11، 6/21%) به دست آمد. کلبسیلا پنومونیه با مقاومت 100 درصدی نسبت به آمپی‌سیلین شایع‌ترین گونه جداشده از هر دو گروه بیماران بود. میانگین طول مدت کسب این باکتری‌ها طی بستری 36/13 روز بود. سابقه بستری شدن و سکته مغزی (P< 0.003)، شایع‌ترین فاکتورهای خطر کولونیزاسیون و دیابت، بیماری مزمن کلیوی و مدت بستری در ICU (P< 0.002) نیز مهم‌ترین فاکتورهای خطر کسب عفونت بوده‌اند. تفاوت معنی‌داری در مقاومت آنتی‌بیوتیکی در باکتری‌های جداشده دو گروه کولونیزه شده و کسب‌شده طی بستری مشاهده نشد.
نتیجه‌گیری: در مطالعه حاضر نرخ بالایی از کولونیزاسیون و کسب CR-GNB در بیماران بستری مشاهده شد. اطلاعات به‌دست‌آمده اهمیت اجرای دستگاه‌های کنترل عفونت را جهت کاهش انتشار این‌گونه باکتری‌ها در بخش‌های بیمارستانی گوشزد می‌نماید.

تازه های تحقیق

https://scholar.google.com/citations?user=f1yX354AAAAJ&hl=en

https://pubmed.ncbi.nlm.nih.gov/?term=Rajaee+Behbahani,++Mahrokh

https://scholar.google.com/citations?user=oA8PwTkAAAAJ&hl=en&citsig=ACUpqDc4SJ8d2j8W_TcivFpeSQNn

https://pubmed.ncbi.nlm.nih.gov/?term=Moghadam,+Maryam

https://scholar.google.com/citations?hl=en&user=bTepo88AAAAJ

https://pubmed.ncbi.nlm.nih.gov/?term=Khashei,+Reza

 

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Risk Factors for Intestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacilli among Inpatients in Intensive Care Units

نویسندگان [English]

  • Mahrokh Rajaee Behbahani 1
  • Maryam Moghadam 2
  • Reza Khashei 3

1 Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Medical student, Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Microbiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran

چکیده [English]

Introduction: Carbapenem-resistant Gram-negative bacilli (CR-GNB) pose a significant global therapeutic challenge, particularly in intensive care units (ICUs), due to resistance to most antibiotics, including carbapenems. This study aimed to investigate the risk factors for fecal colonization and acquisition of CR-GNB among inpatients admitted to the ICUs of Shiraz Namazi Hospital.
Materials and Methods: This study was conducted between 2021 and 2022. Rectal swabs were collected from 78 inpatients within 48 hours of ICU admission and again within 24 hours of discharge. Specimens were analyzed using bacteriologic techniques to determine fecal carriage (colonization) and acquisition rate of CR-GNB. Risk factors for both colonization and acquisition were evaluated.
Results: The rate of CR-GNB colonization was 20.5% (16/78), and the rate of acquisition was 21.6% (11/51). Klebsiella pneumoniae was the most common isolate in both groups, displaying 100% resistance to ampicillin. The median time to CR-GNB acquisition during hospitalization was 13.36 days. Prior hospitalization and a history of stroke were significant risk factors for colonization (P < 0.003). Diabetes mellitus, chronic kidney disease, and the duration of ICU stay were risk factors for acquisition (P < 0.002). No statistically significant difference in antibiotic resistance was observed between CR-GNB colonized and those acquired during hospitalization.
Conclusion: This study reveals a high prevalence of CR-GNB colonization and acquisition among ICU inpatients. These findings underscore the critical need for stringent infection control measures to limit the dissemination of CR-GNB in hospital settings.

کلیدواژه‌ها [English]

  • Gram-negative bacilli
  • Carbapenem resistance
  • Intestinal colonization
  • Intensive Care Unit
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مجله دانشگاه علوم پزشکی سبزوار
دوره 32، شماره 6
بهمن و اسفند 1404
صفحه 687-703
فایل ها
سابقه مقاله
  • تاریخ دریافت: 14 خرداد 1404
  • تاریخ بازنگری: 30 تیر 1404
  • تاریخ پذیرش: 31 تیر 1404
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