全院范围耐万古霉素肠球菌暴发的控制
Control of a hospital-wide vancomycin-resistant Enterococci outbreak.
作者信息
Kurup Asok, Chlebicki M P, Ling M L, Koh T H, Tan K Y, Lee L C, Howe K B M
机构信息
Infection Control Unit, Singapore General Hospital, Singapore.
出版信息
Am J Infect Control. 2008 Apr;36(3):206-11. doi: 10.1016/j.ajic.2007.06.005.
BACKGROUND
To analyze control measures used to eradicate a large vancomycin-resistant Enterococci (VRE) outbreak in a nonendemic 1600-bed tertiary care institution.
METHODS
In mid-March 2005, VRE Van B was isolated from 2 clinical samples from different wards. Despite such measures as screening patients sharing rooms with index cases and isolating VRE patients, 43 isolates from different wards were detected by the end of March 2005. To eradicate a hospital-wide outbreak, a coordinated strategy between March and June 2005 comprised (1) formation of a VRE task force, (2) hospital-wide screening, (3) isolation of carriers, (4) physical segregation of contacts, (5) surveillance of high-risk groups, (6) increased cleaning, (7) electronic tagging of VRE status, and (8) education and audits. This is a retrospective study of this multipronged approach to containing VRE. The adequacy of rectal swab sampling for VRE was assessed in a substudy of 111 patients. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA)/VRE co-colonization or co-infection also was determined.
RESULTS
A total of 19,574 contacts were identified. Between April and June 2005, 5095 patients were screened, yielding 104 VRE carriers, 54 of whom (52%) were detected in the first 2 weeks of hospital-wide screening. The initial positive yield of 11.4% of persons actively screened declined to 4.2% by the end of June 2005. Pulsed-field typing revealed 1 major clone and several minor clones among the 151 total VRE cases, including 4 clinical cases. Hospital-wide physical segregation of contacts from other patients was difficult to achieve in communal wards. Co-colonization or co-infection with MRSA, which was present in 52 of 151 cases (34%) and the indefinite electronic tagging of positive VRE status strained limited isolation beds. Analysis of 2 fecal or rectal specimens collected 1 day apart may detect at least 83% of VRE carriers.
CONCLUSION
A multipronged strategy orchestrated by a central task force curbed but could not eradicate VRE. Control measures were confounded by hospital infrastructure and high MRSA endemicity.
背景
分析在一家拥有1600张床位的非地方性三级医疗机构中，为根除耐万古霉素肠球菌（VRE）大规模暴发所采取的控制措施。
方法
2005年3月中旬，从不同病房的2份临床样本中分离出VRE Van B。尽管采取了诸如对与索引病例同室的患者进行筛查以及隔离VRE患者等措施，但到2005年3月底，仍从不同病房检测到43株分离株。为根除全院范围内的暴发，2005年3月至6月实施了一项协调策略，包括（1）组建VRE特别工作组，（2）全院筛查，（3）隔离携带者，（4）对接触者进行物理隔离，（5）对高危人群进行监测，（6）加强清洁，（7）对VRE状态进行电子标记，以及（8）开展教育和审计。这是一项关于这种多管齐下控制VRE方法的回顾性研究。在对111名患者的子研究中评估了直肠拭子采样检测VRE的充分性。还确定了耐甲氧西林金黄色葡萄球菌（MRSA）/VRE共定植或共感染的患病率。
结果
共识别出19574名接触者。2005年4月至6月期间，对5095名患者进行了筛查，发现104名VRE携带者，其中54名（52%）是在全院筛查的前2周内检测到的。积极筛查人群的初始阳性检出率为11.4%，到2005年6月底降至4.2%。脉冲场分型显示，在总共151例VRE病例（包括4例临床病例）中，有1个主要克隆和几个次要克隆。在公共病房中，很难实现将接触者与其他患者进行全院范围内的物理隔离。151例病例中有52例（34%）存在与MRSA的共定植或共感染，且对VRE阳性状态进行不确定的电子标记使有限的隔离床位紧张。对间隔1天采集的2份粪便或直肠标本进行分析，可能检测出至少83%的VRE携带者。
结论
由中央特别工作组精心策划的多管齐下策略遏制了但未能根除VRE。控制措施因医院基础设施和高MRSA流行率而受到干扰。
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