J Trauma Acute Care Surg. 2014 May;76(5):1192-200. doi: 10.1097/TA.0000000000000203.
Vancomycin-resistant Enterococcus (VRE) screening is routine practice in many intensive care units despite the question of its clinical significance. The value of VRE screening at predicting subsequent VRE or other hospital-acquired infection (HAI) is unknown. The purpose of this investigation was to examine the rate of subsequent VRE HAI in patients undergoing VRE screening.
This study was conducted in a 24-bed surgical intensive care unit (SICU) at a Level I trauma center. Patients admitted to the SICU between February and August 2011 who had rectal swab for VRE screening within 72 hours were followed prospectively for the development of VRE and other HAIs. Demographics, clinical characteristics, and infection rates were compared between VRE-positive and VRE-negative patients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VRE screening for predicting subsequent VRE HAI were calculated.
A total of 341 patients had VRE screening within 72 hours of SICU admission, with 32 VRE-positive (9%) and 309 VRE-negative (91%) patients. VRE-positive patients had a higher incidence of any HAI (78% vs. 35%, p < 0.001). Eight VRE-positive patients (25%) developed VRE HAI compared with only 3 VRE-negative patients (1%) (p < 0.001). VRE screening had a 73% sensitivity, 93% specificity, 25% PPV, and 99% NPV for determining subsequent VRE HAI.
VRE colonization was present in 9% of SICU patients at admission. Negative VRE screen result had a high specificity and NPV for the development of subsequent VRE HAI. Empiric treatment of VRE infection may be unnecessary in VRE-negative patients.
Prognostic/epidemiologic study, level III. Therapeutic study, level IV.
尽管万古霉素耐药肠球菌（VRE）筛查的临床意义存在争议，但在许多重症监护病房中，这种筛查已成为常规做法。VRE 筛查在预测随后发生 VRE 或其他医院获得性感染（HAI）方面的价值尚不清楚。本研究旨在检查接受 VRE 筛查的患者随后发生 VRE HAI 的发生率。
本研究在一家一级创伤中心的 24 张床位外科重症监护病房（SICU）进行。2011 年 2 月至 8 月期间入住 SICU 且在 72 小时内接受直肠拭子 VRE 筛查的患者前瞻性随访，以观察是否发生 VRE 和其他 HAI。比较 VRE 阳性和 VRE 阴性患者的人口统计学、临床特征和感染率。计算 VRE 筛查预测随后发生 VRE HAI 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
共有 341 例患者在入住 SICU 后 72 小时内进行了 VRE 筛查，其中 32 例（9%）为 VRE 阳性，309 例（91%）为 VRE 阴性。VRE 阳性患者的任何 HAI 发生率较高（78%比 35%，p<0.001）。8 例 VRE 阳性患者（25%）发生 VRE HAI，而仅 3 例 VRE 阴性患者（1%）发生 VRE HAI（p<0.001）。VRE 筛查对确定随后发生的 VRE HAI 的敏感性为 73%，特异性为 93%，PPV 为 25%，NPV 为 99%。
SICU 患者入院时 VRE 定植率为 9%。VRE 阴性筛查结果对随后发生 VRE HAI 的特异性和 NPV 较高。VRE 阴性患者可能无需经验性治疗 VRE 感染。
预后/流行病学研究，III 级。治疗研究，IV 级。
