1David Geffen School of Medicine at University of California-Los Angeles (UCLA),Los Angeles,California.
2UCLA Pathology and Laboratory Medicine,David Geffen School of Medicine at UCLA,Los Angeles,California.
Infect Control Hosp Epidemiol. 2018 Oct;39(10):1178-1182. doi: 10.1017/ice.2018.178. Epub 2018 Sep 4.
We evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling.
Prospective, patient-level surveillance program of incident VRE colonization.
Liver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.PatientsAll patients admitted to the SICU from June to August 2015.
We conducted a point-prevalence estimate followed by admission and weekly surveillance by perirectal swabbing and/or stool sampling. Incident colonization was defined as a negative screen followed by positive surveillance. VRE was detected by culture on Remel Spectra VRE chromogenic agar. Microbiologically-confirmed VRE bloodstream infections (BSIs) were tracked for 2 months. Statistical analyses were calculated using the McNemar test, the Fisher exact test, the t test, and the χ2 test.
In total, 91 patients underwent VRE surveillance testing. The point prevalence of VRE colonization was 60.9%; VRE prevalence on admission was 30.1%. Weekly surveillance identified an additional 7 of 28 patients (25.0%) with incident colonization. VRE BSIs were more common in VRE-colonized patients than in noncolonized patients (8 of 43 vs 2 of 48; P=.028). In a direct comparison, perirectal swabs were more sensitive than stool samples in detecting VRE (64 of 67 vs 56 of 67; P=.023). Compliance with perirectal swabbing was 89% (201 of 226) compared to 56% (127 of 226) for stool collection (P≤0.001).
We recommend weekly VRE surveillance over admission-only screening in high-burden units such as liver transplant SICUs. Perirectal swabs had greater collection compliance and sensitivity than stool samples, making them the preferred methodology. Further work may have implications for antimicrobial stewardship and infection control.
通过改变 2 个参数，即入院时与每周监测以及直肠拭子与粪便取样，来评估耐万古霉素肠球菌（VRE）监测的实用性。
对 VRE 定植的患者进行前瞻性、患者水平的监测计划。
三级转诊医疗中心的肝移植外科重症监护病房（SICU），该中心 VRE 患病率较高。
2015 年 6 月至 8 月期间入住 SICU 的所有患者。
我们进行了一次时点患病率评估，随后进行了直肠拭子和/或粪便取样的入院时和每周监测。将阴性筛查后阳性监测定义为定植。通过 Remel Spectra VRE 显色琼脂培养检测 VRE。对确诊的 VRE 血流感染（BSI）进行了为期 2 个月的追踪。使用 McNemar 检验、Fisher 确切检验、t 检验和 χ2 检验进行统计学分析。
共有 91 例患者接受了 VRE 监测检测。VRE 定植的时点患病率为 60.9%；入院时 VRE 的患病率为 30.1%。每周监测发现另外 7 例（28%）有新发定植。VRE BSI 在 VRE 定植患者中比在非定植患者中更常见（43 例中有 8 例 vs 48 例中有 2 例；P=.028）。直接比较时，直肠拭子比粪便样本更敏感地检测到 VRE（67 例中有 64 例 vs 67 例中有 56 例；P=.023）。直肠拭子采集的依从性为 89%（226 例中有 201 例），而粪便采集的依从性为 56%（226 例中有 127 例）（P≤0.001）。
我们建议在肝脏移植 SICU 等高负担单位进行每周 VRE 监测，而不是仅在入院时进行筛查。直肠拭子比粪便样本具有更高的采集依从性和敏感性，是首选方法。进一步的工作可能对抗菌药物管理和感染控制有影响。
