https://scholars.lib.ntu.edu.tw/handle/123456789/578021
標題: | Carbapenem-Resistant Enterobacterales in Long-Term Care Facilities: A Global and Narrative Review | 作者: | Chen, Hsin-Yu Jean, Shio-Shin Lee, Yu-Lin Lu, Min-Chi Ko, Wen-Chien Liu, Po-Yu PO-REN HSUEH |
關鍵字: | Enterobacteriaceae; carbapenemases; long-term care facilities; metallo-beta-lactamase; oxacillinase | 公開日期: | 2021 | 卷: | 11 | 來源出版物: | Frontiers in cellular and infection microbiology | 摘要: | The emergence of carbapenem-resistant Enterobacterales (CRE) has become a major public health concern. Moreover, its colonization among residents of long-term care facilities (LTCFs) is associated with subsequent infections and mortality. To further explore the various aspects concerning CRE in LTCFs, we conducted a literature review on CRE colonization and/or infections in long-term care facilities. The prevalence and incidence of CRE acquisition among residents of LTCFs, especially in California, central Italy, Spain, Japan, and Taiwan, were determined. There was a significant predominance of CRE in LTCFs, especially in high-acuity LTCFs with mechanical ventilation, and thus may serve as outbreak centers. The prevalence rate of CRE in LTCFs was significantly higher than that in acute care settings and the community, which indicated that LTCFs are a vital reservoir for CRE. The detailed species and genomic analyses of CRE among LTCFs reported that Klebsiella pneumoniae is the primary species in the LTCFs in the United States, Spain, and Taiwan. KPC-2-containing K. pneumoniae strains with sequence type 258 is the most common sequence type of KPC-producing K. pneumoniae in the LTCFs in the United States. IMP-11- and IMP-6-producing CRE were commonly reported among LTCFs in Japan. OXA-48 was the predominant carbapenemase among LTCFs in Spain. Multiple risk factors associated with the increased risk for CRE acquisition in LTCFs were found, such as comorbidities, immunosuppressive status, dependent functional status, usage of gastrointestinal devices or indwelling catheters, mechanical ventilation, prior antibiotic exposures, and previous culture reports. A high CRE acquisition rate and prolonged CRE carriage duration after colonization were found among residents in LTCFs. Moreover, the patients from LTCFs who were colonized or infected with CRE had poor clinical outcomes, with a mortality rate of up to 75% in infected patients. Infection prevention and control measures to reduce CRE in LTCFs is important, and could possibly be controlled via active surveillance, contact precautions, cohort staffing, daily chlorhexidine bathing, healthcare-worker education, and hand-hygiene adherence. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/578021 | ISSN: | 2235-2988 | DOI: | 10.3389/fcimb.2021.601968 | SDG/關鍵字: | antibiotic agent; aztreonam; beta lactamase; carbapenem; carbapenemase; cefepime; cefotaxime; ceftazidime; chlorhexidine; ertapenem; extended spectrum beta lactamase; imipenem; meropenem; metallo beta lactamase; metronidazole; vancomycin; bacterial protein; carbapenem derivative; active surveillance; antibiotic resistance; antibiotic sensitivity; artificial ventilation; bacteremia; bacterial colonization; bacterium culture; bloodstream infection; carbapenem-resistant Enterobacteriaceae; carbapenemase producing Enterobacteriaceae; Clostridium difficile infection; cognition; disease surveillance; feces incontinence; functional status; geographic distribution; health care facility; hospital infection; human; incidence; infection control; infection prevention; intensive care unit; length of stay; minimum inhibitory concentration; molecular epidemiology; mortality; mouth hygiene; nonhuman; nucleic acid amplification; nursing home; outcome assessment; prevalence; public health; Review; risk factor; species distribution; Enterobacteriaceae infection; Italy; Japan; Klebsiella pneumoniae; long term care; Spain; Taiwan; United States; Bacterial Proteins; beta-Lactamases; Carbapenems; Enterobacteriaceae Infections; Humans; Italy; Japan; Klebsiella pneumoniae; Long-Term Care; Spain; Taiwan; United States |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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