医学
铜绿假单胞菌
爆发
碳青霉烯
微生物学
感染控制
重症监护医学
肾移植
肾移植
移植
内科学
病毒学
抗生素
细菌
生物
遗传学
作者
Maristela Pinheiro Freire,Carlos Henrique Camargo,Amanda Yaeko Yamada,Filipe Onishi Nagamori,José Otto Reusing,Fernanda Spadão,Arlete Emily Cury,Flávia Rossi,William C. Nahas,Elias David‐Neto,Lígia Câmera Pierrotti
标识
DOI:10.1016/j.jhin.2021.05.006
摘要
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection after kidney transplantation (KT) is associated with high mortality.To analyse an outbreak of infection/colonization with IMP-1-producing CRPA on a KT ward.A case-control study was conducted. Cases were identified through routine surveillance culture and real-time polymerase chain reaction for carbapenemase performed directly from rectal swab samples. Controls were randomly selected from patients hospitalized on the same ward during the same period, at a ratio of 3:1. Strain clonality was analysed through pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing was performed for additional strain characterization.CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The median persistence of culture positivity was 42.5 days. Thirteen patients (35.1%) presented a total of 15 infections, of which seven (46.7%) were in the urinary tract; among those, 30-day mortality rate was 46.2%. PFGE analysis showed that all of the strains shared the same pulsotype. Multilocus sequence typing analysis identified the sequence type as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, retransplantation, urological surgical reintervention after KT, use of carbapenem or ciprofloxacin in the last three months and low median lymphocyte count in the last three months.KT recipients remain colonized by CRPA for long periods and could be a source of nosocomial outbreaks. In addition, a high proportion of such patients develop infection. During an outbreak, urine culture should be added to the screening protocol for KT recipients.
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