The Ralph H. Johnson VAMC,Charleston,South Carolina.
National Institutes of Health,Bethesda,Maryland.
Infect Control Hosp Epidemiol. 2019 Apr;40(4):414-419. doi: 10.1017/ice.2019.15. Epub 2019 Feb 7.
In the National Institutes of Health (NIH) Clinical Center, patients colonized or infected with vancomycin-resistant Enterococcus (VRE) are placed in contact isolation until they are deemed "decolonized," defined as having 3 consecutive perirectal swabs negative for VRE. Some decolonized patients later develop recurrent growth of VRE from surveillance or clinical cultures (ie, "recolonized"), although that finding may represent recrudescence or new acquisition of VRE. We describe the dynamics of VRE colonization and infection and their relationship to receipt of antibiotics.
In this retrospective cohort study of patients at the National Institutes of Health Clinical Center, baseline characteristics were collected via chart review. Antibiotic exposure and hospital days were calculated as proportions of VRE decolonized days. Using survival analysis, we assessed the relationship between antibiotic exposure and time to VRE recolonization in a subcohort analysis of 72 decolonized patients.
In total, 350 patients were either colonized or infected with VRE. Among polymerase chain reaction (PCR)-positive, culture (Cx)-negative (PCR+/Cx-) patients, PCR had a 39% positive predictive value for colonization. Colonization with VRE was significantly associated with VRE infection. Among 72 patients who met decolonization criteria, 21 (29%) subsequently became recolonized. VRE recolonization was 4.3 (P = .001) and 2.0 (P = .22) times higher in patients with proportions of antibiotic days and antianaerobic antibiotic days above the median, respectively.
Colonization is associated with clinical VRE infection and increased mortality. Despite negative perirectal cultures, re-exposure to antibiotics increases the risk of VRE recolonization.
在美国国立卫生研究院（NIH）临床中心，定植或感染万古霉素耐药肠球菌（VRE）的患者将被置于接触隔离状态，直到他们被认为“去定植”，即连续 3 次直肠拭子检测 VRE 均为阴性。一些去定植的患者后来从监测或临床培养中再次出现 VRE 的生长（即“再定植”），尽管这一发现可能代表 VRE 的复发或新获得。我们描述了 VRE 定植和感染的动态及其与抗生素使用的关系。
本研究是一项在美国国立卫生研究院临床中心进行的患者回顾性队列研究，通过病历回顾收集基线特征。抗生素暴露和住院天数计算为 VRE 去定植天数的比例。在 72 例去定植患者的亚组分析中，使用生存分析评估抗生素暴露与 VRE 再定植时间之间的关系。
共有 350 例患者定植或感染 VRE。在聚合酶链反应（PCR）阳性、培养（Cx）阴性（PCR+/Cx-）患者中，PCR 对定植的阳性预测值为 39%。VRE 定植与 VRE 感染显著相关。在符合去定植标准的 72 例患者中，有 21 例（29%）随后发生再定植。抗生素天数和抗厌氧抗生素天数比例高于中位数的患者，VRE 再定植的风险分别增加 4.3 倍（P =.001）和 2.0 倍（P =.22）。
定植与临床 VRE 感染和死亡率增加相关。尽管直肠拭子培养阴性，但再次接触抗生素会增加 VRE 再定植的风险。
