Askarian Mehrdad, Afkhamzadeh Rahim, Monabbati Ahmad, Daxboeck Florian, Assadian Ojan
Department of Community Medicine, Shiraz University of Medical Sciences, PO Box 71345-1737, Shiraz, Iran.
Int J Infect Dis. 2008 Mar;12(2):171-5. doi: 10.1016/j.ijid.2007.04.020. Epub 2007 Sep 12.
In order to determine the risk factors for rectal colonization with vancomycin-resistant enterococci (VRE) at the Shiraz Namazi Hospital, we performed a nested case-control study.
From December 2003 to July 2004 rectal swabs were taken from 700 randomly selected hospitalized patients every 5 days.
A total of 99 of the 700 patients (14%) were colonized with VRE (cases) and 59 patients were colonized with vancomycin-sensitive strains (VSE), serving as controls. In the univariate analysis, history of antibiotic use (p=0.04), underlying disease (p=0.013), hemodialysis (p=0.03), use of third generation cephalosporins (p=0.04), use of vancomycin (p=0.04), and duration of vancomycin therapy longer than 7 days (p=0.02) were significantly associated with VRE colonization. In a multivariate analysis, underlying disease and the duration of vancomycin use longer than 7 days were independently associated with VRE colonization.
Our study, the first on VRE carriage in Iran, demonstrates that VRE prevalence is high in Shiraz and confirms earlier observations in other countries. The identified risk factor 'use of vancomycin longer than 7 days' may be avoidable, indicating a feasible intervention strategy in the control of VRE.
为了确定设拉子纳马齐医院耐万古霉素肠球菌（VRE）直肠定植的危险因素，我们开展了一项巢式病例对照研究。
2003年12月至2004年7月，每5天从700名随机选取的住院患者中采集直肠拭子。
700名患者中共有99名（14%）被VRE定植（病例组），59名患者被万古霉素敏感菌株（VSE）定植，作为对照组。单因素分析中，抗生素使用史（p=0.04）、基础疾病（p=0.013）、血液透析（p=0.03）、第三代头孢菌素的使用（p=0.04）、万古霉素的使用（p=0.04）以及万古霉素治疗持续时间超过7天（p=0.02）与VRE定植显著相关。多因素分析中，基础疾病和万古霉素使用持续时间超过7天与VRE定植独立相关。
我们的研究是伊朗首次关于VRE携带情况的研究，表明设拉子的VRE患病率很高，并证实了其他国家早期的观察结果。已确定的危险因素“万古霉素使用超过7天”可能是可以避免的，这表明在控制VRE方面有可行的干预策略。
