Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA.
Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA.
Int J Antimicrob Agents. 2017 May;49(5):565-572. doi: 10.1016/j.ijantimicag.2017.01.008. Epub 2017 Mar 20.
The objective of this study was to estimate the rate and significance of colonisation with vancomycin-resistant enterococci (VRE) among hospitalised children. The PubMed and EMBASE databases were systematically searched (last accessed on 29 May 2016) to identify studies evaluating VRE colonisation of the gastrointestinal tract of hospitalised children in non-outbreak periods. Of 945 non-duplicate citations, 19 studies enrolling 20 234 children were included. The overall and paediatric intensive care unit (PICU) rate of VRE colonisation were both 5% [95% confidence interval (CI) 3-8% overall and 95% CI 2-9% in the PICU] but was 23% in haematology/oncology units (95% CI 18-29%). Studies that were exclusively performed in haematology/oncology units reported significantly higher rates compared with all other studies in the univariate and multivariate analyses (P = 0.001). Previous vancomycin [risk ratio (RR) = 4.34, 95% CI 2.77-6.82] or ceftazidime (RR = 4.15, 95% CI 2.69-6.40) use was a risk factor for VRE colonisation. Importantly, VRE colonisation increased the risk of subsequent VRE infection (RR = 8.75, 95% CI 3.19-23.97). In conclusion, a high rate of VRE colonisation was found among hospitalised children in institutions that performed targeted screening. Importantly, colonised children were almost 9 times more likely to develop subsequent VRE infection. Judicious use of specific antibiotics along with intensification of infection control measures should be considered in high-prevalence institutions. Also, the high incidence of VRE colonisation among children with haematological/oncological diseases identifies a high-risk population.
本研究旨在评估住院患儿中万古霉素耐药肠球菌（VRE）定植的发生率和意义。系统检索了 PubMed 和 EMBASE 数据库（最后检索日期为 2016 年 5 月 29 日），以确定评估非暴发期间住院患儿胃肠道 VRE 定植的研究。在 945 篇非重复引文 ，纳入了 19 项纳入 20234 名患儿的研究。总体和儿科重症监护病房（PICU）VRE 定植率均为 5%[总体 95%置信区间（CI）为 3-8%，PICU 为 95%CI 为 2-9%]，但血液科/肿瘤科为 23%[95%CI 为 18-29%]。单变量和多变量分析均显示，仅在血液科/肿瘤科进行的研究报告的定植率显著高于其他所有研究（P=0.001）。先前使用万古霉素[风险比（RR）=4.34，95%CI 2.77-6.82]或头孢他啶（RR=4.15，95%CI 2.69-6.40）是 VRE 定植的危险因素。重要的是，VRE 定植增加了随后发生 VRE 感染的风险（RR=8.75，95%CI 3.19-23.97）。总之，在进行靶向筛查的医疗机构中，住院患儿 VRE 定植率较高。重要的是，定植患儿发生随后 VRE 感染的可能性几乎增加了 9 倍。在高流行率机构中，应考虑合理使用特定抗生素并加强感染控制措施。此外，血液系统/肿瘤科患儿 VRE 定植发生率较高，表明该人群为高危人群。
