Suntharam Nila, Lankford Mary G, Trick William E, Peterson Lance R, Noskin Gary A
Department of Medicine, Division of Infectious Diseases, Northwestern University Medical School, Chicago, IL, USA.
Diagn Microbiol Infect Dis. 2002 Jul;43(3):183-8. doi: 10.1016/s0732-8893(02)00392-9.
The incidence of VRE has increased dramatically and hematology-oncology patients are at high risk for acquisition of colonization and development of infection. Therefore, we performed a prospective cohort study to determine risk factors for VRE acquisition among hematology-oncology patients. Patients admitted to a single unit at Northwestern Memorial Hospital, which was predominantly comprised of patients with hematologic malignancies and recipients of hematopoietic stem cell transplants, were enrolled. Rectal or perianal swabs were obtained on hospital day 1, 4, 7 and then weekly thereafter. Data were collected by medical record review. We evaluated 155 study patients; 12 patients (7.7%) converted from VRE negative to positive. Among these 12 patients, 3 were positive on prior admissions, and 9 acquired VRE during the study. The median time to acquisition was 9 days. The median length of stay was significantly longer for patients with VRE compared to those who were VRE negative (31 vs. 6 days, P < 0.01). Patients with VRE were significantly more likely than those without VRE to have had an ICU admission within 3 months (P = 0.003), been admitted from an acute care facility (P = 0.001), or to have received amikacin (P = 0.02). Antimicrobials were commonly prescribed to all of the patients as 87% received an antimicrobial prior to their first swab. The crude mortality rate for patients with VRE was 67%. Prolonged length of stay, prior hospitalization, previous ICU admission and receipt of amikacin were risk factors associated with VRE acquisition among hematology-oncology patients. Mortality among these patients was high, due to serious underlying disease.
耐万古霉素肠球菌（VRE）的发病率急剧上升，血液肿瘤患者获得定植和发生感染的风险很高。因此，我们进行了一项前瞻性队列研究，以确定血液肿瘤患者获得VRE的危险因素。纳入了在西北纪念医院单一科室住院的患者，该科室主要由血液系统恶性肿瘤患者和造血干细胞移植受者组成。在住院第1天、第4天、第7天采集直肠或肛周拭子，此后每周采集一次。通过查阅病历收集数据。我们评估了155名研究患者；12名患者（7.7%）从VRE阴性转为阳性。在这12名患者中，3名在先前入院时呈阳性，9名在研究期间获得VRE。获得VRE的中位时间为9天。与VRE阴性患者相比，VRE阳性患者的中位住院时间显著更长（31天对6天，P<0.01）。与没有VRE的患者相比，VRE阳性患者在3个月内入住重症监护病房（ICU）的可能性显著更高（P=0.003），从急性护理机构入院的可能性显著更高（P=0.001），或接受阿米卡星治疗的可能性显著更高（P=0.02）。所有患者均普遍使用抗菌药物，87%的患者在首次拭子检查前接受了抗菌药物治疗。VRE阳性患者的粗死亡率为67%。住院时间延长、先前住院、先前入住ICU和接受阿米卡星治疗是血液肿瘤患者获得VRE的相关危险因素。由于严重的基础疾病，这些患者的死亡率很高。
