大型教学医院成人重症监护病房患者耐万古霉素肠球菌肠道定植筛查及相关危险因素分析
Screening for Intestinal Colonization with Vancomycin Resistant Enterococci and Associated Risk Factors among Patients Admitted to an Adult Intensive Care Unit of a Large Teaching Hospital.
作者信息
Amberpet Rajesh, Sistla Sujatha, Parija Subhash Chandra, Thabah Molly Mary
机构信息
PhD Scholar, Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry, India .
Professor and Head, Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry, India .
出版信息
J Clin Diagn Res. 2016 Sep;10(9):DC06-DC09. doi: 10.7860/JCDR/2016/20562.8418. Epub 2016 Sep 1.
INTRODUCTION
Gut colonization with Vancomycin Resistant Enterococci (VRE) increases the risk of acquiring infection during hospital stay. Patients admitted in the ICU's are the major reservoirs for VRE colonization due to higher antibiotic pressure.
AIM
To determine the rate of VRE colonization among patients admitted in the Medical Intensive Care Unit (MICU) and to assess the various risk factors which are associated with VRE colonization.
MATERIALS AND METHODS
This was a prospective study carried out over a period of 18 months from September 2013 to February 2015 in the Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Pondicherry, South India. After 48 hours of ICU admission rectal swabs were collected from a total of 302 patients, admitted in MICU. The samples were inoculated on to Bile Esculin Sodium Azide agar with 6mg/L of vancomycin. Vancomycin resistance was confirmed by determination of Minimum Inhibitory Concentration (MIC) by agar dilution method. Isolates were identified up to species level by standard biochemical tests. Vancomycin resistance genes such as were detected by Polymerase Chain Reaction (PCR). Risk factors were assessed by multivariate logistic regression analysis.
RESULTS
The rates of VRE colonization in patients admitted to MICU was 29%. Majority of the isolates were (77.2 %) followed by (23.8%). All the VRE isolates were positive for gene. Increased duration of hospital stay, younger age, consumption of ceftriaxone and vancomycin were found to be significantly associated with VRE colonization in MICU. Among VRE colonized patients, six (4.5%) acquired VRE infection.
CONCLUSION
The rates of VRE colonization in our ICU were similar to other hospitals worldwide. Educating health care workers on the importance of adherence to hand hygiene is essential to bring down VRE colonization rates.
引言
耐万古霉素肠球菌（VRE）在肠道内定植会增加住院期间获得感染的风险。由于抗生素压力较高，入住重症监护病房（ICU）的患者是VRE定植的主要宿主。
目的
确定入住内科重症监护病房（MICU）的患者中VRE定植率，并评估与VRE定植相关的各种风险因素。
材料与方法
这是一项前瞻性研究，于2013年9月至2015年2月在印度南部本地治里的贾瓦哈拉尔研究生医学教育与研究学院（JIPMER）进行，为期18个月。在入住ICU 48小时后，从MICU收治的302例患者中采集直肠拭子。将样本接种到含6mg/L万古霉素的胆汁七叶苷叠氮化钠琼脂上。通过琼脂稀释法测定最低抑菌浓度（MIC）来确认万古霉素耐药性。通过标准生化试验将分离株鉴定到种水平。通过聚合酶链反应（PCR）检测万古霉素耐药基因，如 。通过多因素逻辑回归分析评估风险因素。
结果
入住MICU的患者中VRE定植率为29%。大多数分离株为 （77.2%），其次是 （23.8%）。所有VRE分离株的 基因均为阳性。发现住院时间延长、年龄较小、使用头孢曲松和万古霉素与MICU中的VRE定植显著相关。在VRE定植患者中，有6例（4.5%）发生了VRE感染。
结论
我们ICU的VRE定植率与世界其他医院相似。对医护人员进行关于坚持手部卫生重要性的教育对于降低VRE定植率至关重要。
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