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儿童耐万古霉素肠球菌定植与感染:六年随访

Vancomycin-resistant enterococcus colonization and infection in children: six-year follow-up.

作者信息

Özkaya-Parlakay Aslınur, Cengiz Ali Bülent, Ceyhan Mehmet, Bağdat Arzu, Barın-Kurtoğlu Çağrı, Gürbüz Venhar, Aycan Ahmet Emre, Kara Ateş

机构信息

Division of Pediatric Infectious Diseases, Department of Pediatrics, Hacettepe University Medical Faculty, Ankara, Turkey.

出版信息

Turk J Pediatr. 2014 Nov-Dec;56(6):618-25.

Abstract

Vancomycin-resistant enterococci (VRE) have become a major concern in medical practice. Asymptomatic VRE colonization of the gastrointestinal tract may lead to infection. In this study, which included patients who stayed in our hospital between 2006 and 2011, we looked at the cases of 342 patients with VRE colonization and 19 patients with VRE infection. Vancomycin and carbapenem exposure and intestinal disorders were significantly more common in patients with VRE infection than in those with VRE colonization (p=0.02/0.04/0.04 respectively). Secondary immune deficiency was significantly more common in VRE-colonized patients than in VRE-infected patients (p=0.03). VRE colonization time was significantly related with young age, presence of intravenous catheter, presence of mechanical ventilation, length of hospital stay, length of hospitalization before and after VRE isolation, length of ICU stay before and after VRE isolation, total ICU stay, antibiotic exposure within 3 months, hospitalization (in our hospital) within 3 months, and having a site of infection other than VRE (p=0.01/ 0.01/ 0.04/ <0.001/0.02/ <0.001/ 0.002/ 0.006/ 0.002/ 0.004/ 0.01/ 0.002, respectively). Overall mortality and sepsis was more common in the VRE-infected group than in the VRE-colonized group. Taking into consideration limiting antibiotic usage in potential cases and screening for patients at risk could be beneficial in terms of limiting VRE infection and colonization.

摘要

耐万古霉素肠球菌(VRE)已成为医学实践中的一个主要问题。胃肠道无症状VRE定植可能导致感染。在这项研究中,纳入了2006年至2011年期间入住我院的患者,我们观察了342例VRE定植患者和19例VRE感染患者的病例。VRE感染患者中万古霉素和碳青霉烯类药物暴露以及肠道疾病明显比VRE定植患者更常见(分别为p = 0.02/0.04/0.04)。VRE定植患者中继发性免疫缺陷明显比VRE感染患者更常见(p = 0.03)。VRE定植时间与年轻、存在静脉导管、存在机械通气、住院时间、VRE分离前后的住院时间、VRE分离前后的ICU住院时间、总ICU住院时间、3个月内的抗生素暴露、3个月内在我院的住院情况以及存在VRE以外的感染部位显著相关(分别为p = 0.01/0.01/0.04/<0.001/0.02/<0.001/0.002/0.006/0.002/0.004/0.01/0.002)。VRE感染组的总体死亡率和败血症比VRE定植组更常见。考虑到在潜在病例中限制抗生素使用以及对高危患者进行筛查,在限制VRE感染和定植方面可能是有益的。

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