Prevalence of Acinetobacter baumannii and Candida auris in Patients Receiving Mechanical Ventilation
JAMA Early Recent, Oct 12, 2023 10.1001/jama.2023.21083
Key Points
Question
What is the statewide prevalence of 2 emerging pathogens, Acinetobacter baumannii and Candida auris, among patients receiving mechanical ventilation?在接受机械通气的患者中，鲍曼不动杆菌和耳念珠菌这两种新出现的病原体在全州的流行率是多少？
Findings
A baumannii was identified in 30.7%, carbapenem-resistant A baumannii (CRAB) in 59.5% of those samples, and Candida auris was identified in 6.6% of all patients receiving mechanical ventilation in Maryland. Patients in long-term care facilities were more likely to be colonized with A baumannii, CRAB, and C auris compared with patients in acute care facilities.在马里兰州接受机械通气的所有患者中，30.7%的样本中发现了鲍曼不动杆菌，59.5%的样本中出现了碳青霉烯耐药的鲍曼不动杆菌（CRAB），6.6%的患者中发现了耳念珠菌。与急性护理机构的患者相比，长期护理机构中的患者更有可能被鲍曼不动杆菌定植、CRAB型和金黄色葡萄球菌定植。
Meaning
This study should be repeated in other US states to determine the burden of these pathogens among patients receiving mechanical ventilation. Increased surveillance and prevention efforts should be directed at long-term care facilities.这项研究应在美国其他州重复进行，以确定接受机械通气的患者中这些病原体的负担。应针对长期护理机构加强监测和预防工作。
Importance
To date, only 1 statewide prevalence survey has been performed for Acinetobacter baumannii (2009) in the US, and no statewide prevalence survey has been performed for Candida auris, making the current burden of these emerging pathogens unknown.到目前为止，美国仅对鲍曼不动杆菌（2009年）进行了1次全州范围的流行率调查，对耳念珠菌也没有进行全州范围的患病率调查，这使得目前这些新出现的病原体的负担尚不清楚。
Objective
To determine the prevalence of A baumannii and C auris among patients receiving mechanical ventilation in Maryland.确定马里兰州接受机械通气的患者中鲍曼不动杆菌和金黄色葡萄球菌的患病率。
Design, Setting, and Participants
The Maryland Multi-Drug Resistant Organism Prevention Collaborative performed a statewide cross-sectional point prevalence of patients receiving mechanical ventilation admitted to acute care hospitals (n = 33) and long-term care facilities (n = 18) between March 7, 2023, and June 8, 2023. Surveillance cultures (sputum, perianal, arm/leg, and axilla/groin) were obtained from all patients receiving mechanical ventilation. Sputum, perianal, and arm/leg cultures were tested for A baumannii and antibiotic susceptibility testing was performed. Axilla/groin cultures were tested by polymerase chain reaction for C auris.马里兰耐多药生物预防合作组织对急性护理医院接受机械通气的患者进行了全州范围的横断面点患病率（n = 33）和长期护理设施（n = 18） 在2023年3月7日至2023年6月8日期间。对所有接受机械通气的患者进行监测培养（痰、肛周、胳膊/腿和腋窝/腹股沟）。对痰、肛周和手臂/腿部培养物进行鲍曼氏菌检测，并进行抗生素敏感性检测。通过聚合酶链式反应检测Axilla/腹股沟培养物中的金黄色葡萄球菌。
Main Outcomes and Measures
Prevalence of A baumannii, carbapenem-resistant A baumannii (CRAB), and C auris. Prevalence was stratified by type of facility.鲍曼不动杆菌、碳青霉烯类耐药的鲍曼不动杆菌（CRAB）和金黄色葡萄球菌的患病率。患病率按设施类型分层。
Results
All 51 eligible health care facilities (100%) participated in the survey. A total of 482 patients receiving mechanical ventilation were screened for A baumannii and 470 were screened for C auris. Among the 482 patients who had samples collected, 30.7% (148/482) grew A baumannii, 88 of the 148 (59.5%) of these A baumannii were CRAB, and C auris was identified in 31 of 470 (6.6%). Patients in long-term care facilities were more likely to be colonized with A baumannii (relative risk [RR], 7.66 [95% CI, 5.11-11.50], P P C auris (RR, 1.97 [95% CI,0.99-3.92], P = .05) compared with patients in acute care hospitals. Nine patients (29.0%) with cultures positive for C auris were previously unreported to the Maryland Department of Health.所有51家符合条件的卫生保健机构（100%）都参加了调查。共有482名接受机械通气的患者接受了鲍曼不动杆菌筛查，470名患者接受了金黄色葡萄球菌筛查。在采集样本的482名患者中，30.7%（148/482）患有鲍曼不动杆菌，148名患者中88名（59.5%）患有CRAB，470名中31名（6.6%）患有金黄色葡萄球菌。长期护理机构中的患者更有可能被鲍曼不动杆菌定植（相对风险 [RR]，7.66 [95% CI，5.11-11.50]，P < .001）、CRAB（RR，5.48 [95% CI， 3.38-8.91]，P < .001) 和耳念珠菌 (RR，1.97 [95% CI，0.99-3.92]，P = .05) 与急症护理医院的患者相比。九名耳念珠菌培养呈阳性的患者 (29.0%) 此前未向马里兰州卫生部报告。结论 鲍曼不动杆菌、耐碳青霉烯类鲍曼不动杆菌和耳念珠菌在急症护理医院和长期护理机构接受机械通气的患者中很常见。这两种病原体在长期护理机构中比在急症护理医院中更为常见。在长期护理机构中接受机械通气的患者是新出现病原体的高危人群，监测和预防工作应针对这些机构。
Conclusions
A baumannii, carbapenem-resistant A baumannii, and C auris were common among patients receiving mechanical ventilation in both acute care hospitals and long-term care facilities. Both pathogens were significantly more common in long-term care facilities than in acute care hospitals. Patients receiving mechanical ventilation in long-term care facilities are a high-risk population for emerging pathogens, and surveillance and prevention efforts should be targeted to these facilities.在急性护理医院和长期护理机构接受机械通气的患者中，鲍曼不动杆菌、碳青霉烯耐药的鲍曼不动杆菌和金黄色葡萄球菌很常见。这两种病原体在长期护理机构中明显比在急性护理医院中更常见。在长期护理机构接受机械通气的患者是新发病原体的高危人群，应针对这些机构开展监测和预防工作。
Figures
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Prevalence of Acinetobacter baumannii and Candida auris in Patients Receiving Mechanical Ventilation
JAMA Early Recent, Oct 12, 2023 10.1001/jama.2023.21083
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