Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore.
Antimicrob Agents Chemother. 2018 Nov 26;62(12). doi: 10.1128/AAC.01507-18. Print 2018 Dec.
Vancomycin-resistant enterococci (VRE) are an important cause of nosocomial infections in acute-care hospitals (ACHs), intermediate-care facilities (ITCFs), and long-term care facilities (LTCFs). This study contemporaneously compared the epidemiology and risk factors for VRE colonization in different care settings in a health care network. We conducted a serial cross-sectional study in a 1,700-bed ACH and its six closely affiliated ITCFs and LTCFs in June and July of 2014 to 2016. Rectal swab or stool specimens were cultured for VRE. Multivariable logistic regression was used to assess for independent risk factors associated with VRE colonization. Of 5,357 participants, 523 (9.8%) were VRE colonized. VRE prevalence was higher in ACHs (14.2%) than in ITCFs (7.6%) and LTCFs (0.8%). Common risk factors between ACHs and ITCFs included prior VRE carriage, a longer duration of antibiotic therapy, surgery in the preceding 90 days, and the presence of a skin ulcer. Independent risk factors specific to ACH-admitted patients were prior methicillin-resistant carriage, a higher number of beds per room, prior proton pump inhibitor use, and a length of stay of >14 days. For ITCFs, a length of stay of >14 days was inversely associated with VRE colonization. Similarities and differences in risk factors for VRE colonization were observed between health care settings. VRE prevention efforts should target the respective high-risk patients.
耐万古霉素肠球菌（VRE）是急性护理医院（ACH）、中级护理设施（ITCF）和长期护理设施（LTCF）中医院获得性感染的重要原因。本研究同时比较了医疗保健网络中不同护理环境中 VRE 定植的流行病学和危险因素。我们于 2014 年 6 月至 2016 年 7 月在一个拥有 1700 张床位的 ACH 及其六个紧密附属的 ITCF 和 LTCF 中进行了一项连续的横断面研究。采集直肠拭子或粪便标本培养 VRE。采用多变量逻辑回归评估与 VRE 定植相关的独立危险因素。在 5357 名参与者中，有 523 名（9.8%）被 VRE 定植。ACH 中的 VRE 患病率（14.2%）高于 ITCF（7.6%）和 LTCF（0.8%）。ACH 和 ITCF 之间的共同危险因素包括既往 VRE 定植、抗生素治疗时间较长、90 天内接受过手术以及存在皮肤溃疡。仅在 ACH 入院患者中独立的危险因素是既往耐甲氧西林 定植、每个房间的床位较多、既往质子泵抑制剂使用以及住院时间 >14 天。对于 ITCF，住院时间 >14 天与 VRE 定植呈负相关。在不同的医疗保健环境中观察到 VRE 定植的危险因素存在相似性和差异。VRE 预防措施应针对各自的高危患者。
