Chanderraj Rishi, Millar Jess A, Patel Twisha S, Read Andrew F, Washer Laraine, Kaye Keith S, Woods Robert J
University of Michigan, Ann Arbor.
Pennsylvania State University, State College.
Open Forum Infect Dis. 2019 Mar 15;6(4):ofz139. doi: 10.1093/ofid/ofz139. eCollection 2019 Apr.
Vancomycin-resistant (VRE) is a leading cause of healthcare-associated infections, and asymptomatic colonization precedes infection. VRE continues to spread despite widespread application of pathogen-specific control guidelines. A better understanding of the risk factors for transmission is needed.
A retrospective matched case-control study was performed from June 2013 through December 2016 in a single institution. Patients in 6 intensive care units, 1 hematology and oncology unit, and 1 bone marrow transplant unit were screened by means of rectal swab sampling on admission and weekly thereafter. Case patients had a negative swab sample followed by a positive sample >3 days after admission. Controls were closely matched to case patients based on time from admission to the second swab sample, unit in which the second sample was obtained, and date of admission. Comorbidity data, procedures, healthcare settings and exposures, culture data, and duration of antibiotic and proton pump inhibitor (PPI) therapy were abstracted from the electronic medical record. A multivariable risk factor model for conversion was generated using purposeful selection.
A total of 551 case patients were matched with controls. The largest modifiable effects on VRE acquisition were ≥1 day of vancomycin therapy (odd ratio, 1.98; < .001), ≥1 day of aerobic antibiotic therapy (1.90; < .001), and a dose-dependent effect of PPI therapy (odds ratio per day of therapy, 1.09; < .001). Colonization pressures from patients identified to be carriers and placed in contact precautions did not confer increased risk.
Decreasing PPI use and preventing the inappropriate initiation of antibiotic therapy are modifiable targets to decrease VRE transmission in the hospital.
耐万古霉素肠球菌（VRE）是医疗保健相关感染的主要原因，无症状定植先于感染发生。尽管广泛应用了针对病原体的控制指南，但VRE仍在继续传播。需要更好地了解传播的风险因素。
2013年6月至2016年12月在一家单一机构进行了一项回顾性匹配病例对照研究。对6个重症监护病房、1个血液学和肿瘤学病房以及1个骨髓移植病房的患者在入院时通过直肠拭子采样进行筛查，此后每周进行一次。病例患者入院时拭子样本为阴性，入院后3天以上样本转为阳性。根据从入院到第二次拭子采样的时间、获得第二次样本的病房以及入院日期，将对照与病例患者进行密切匹配。从电子病历中提取合并症数据、操作、医疗保健环境和暴露情况、培养数据以及抗生素和质子泵抑制剂（PPI）治疗的持续时间。使用有目的选择生成了一个用于转换的多变量风险因素模型。
总共551例病例患者与对照进行了匹配。对获得VRE影响最大的可改变因素是万古霉素治疗≥1天（比值比，1.98；P <.001）、需氧抗生素治疗≥1天（1.90；P <.001）以及PPI治疗的剂量依赖性效应（每日治疗的比值比，1.09；P <.001）。被确定为携带者并采取接触预防措施的患者的定植压力并未增加风险。
减少PPI的使用并防止不适当开始抗生素治疗是降低医院内VRE传播的可改变目标。
