Banerjee Tuhina, Anupurba Shampa, Filgona Joel, Singh Dinesh K
Department of Microbiology, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Anaesthesiology and Intensive Care Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
J Lab Physicians. 2015 Jul-Dec;7(2):108-11. doi: 10.4103/0974-2727.163123.
Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one.
This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India.
Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization.
VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis.
A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.
耐万古霉素肠球菌（VRE）的惊人增长是一个全球关注的问题。多种因素被认为对此增长负有责任，其中抗生素的使用是一个突出因素。
本研究旨在确定印度一所三级护理大学医院重症监护病房（ICU）住院患者中肠道VRE定植率与各种抗生素使用之间的关系。
在6个月的时间里，每周从成人ICU的所有患者中采集粪便样本，并对其进行处理，以分离VRE菌株并进行表型和基因型特征分析。记录患者和治疗细节，并对病例（粪便中检测到VRE的患者）和对照（粪便中未检测到VRE的患者）进行统计学比较。此外，进行多变量分析以确定哪些抗生素是VRE定植的独立危险因素。
在所研究的患者中，34.56%（28/81）发现有VRE定植，其中大多数75%（21/28）携带vanA基因。病例的住院时间和抗生素暴露时间明显更长（P < 0.05）。在单变量和多变量分析中，甲硝唑、万古霉素和哌拉西林 - 他唑巴坦的使用均被确定为显著危险因素。
因此，即使在VRE患病率较低的情况下，也揭示了VRE的潜在储存库。基于这种高定植状态，建议限制经验性抗生素使用、审查现行抗生素政策，并将积极的VRE监测作为感染控制策略的一个组成部分。
