Duarte Laura, Arbo Antonio, Gallardo Mirna, Riquelme Irma, Delgadillo Lorena, Jiménez Hassel Jimmy
Unidad de Cuidados Intensivos Pediátricos, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay. ORCID: 0000-0002-3137-6196.
Departamento de Pediatría, Instituto de Medicina Tropical, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay. ORCID: 0000-0002-9753-7511.
Medwave. 2019 Sep 12;19(8):e7694. doi: 10.5867/medwave.2019.08.7694.
Vancomycin-resistant enterococci (VRE) infections have become widespread and a challenge in hospitalized patients. The threat of infection by intractable enterococci and the possibility that vancomycin resistance could involve pneumococci or staphylococci advocate for careful surveillance of resistant strains.
To determine the risk factors associated with VRE colonization in pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) in the period between January 2012 and June 2013.
We conducted a cross-sectional study analyzing the clinical histories of 140 patients admitted to the PICU (children from 1 month to 18 years) who underwent rectal swab cultures within 48 hours of admission. We calculated the odds ratios and confidence intervals of the risk factors for VRE colonization in the PICU, and then we used multiple logistic regression for the statistically significant variables.
VRE colonization was present in 18.6% of patients. The following variables were identified as risk factors associated with VRE colonization: prior hospitalization in the past year (odds ratio: 10.8; 95% confidence interval: 2.43 to 47.8; p = 0.001); prior use of one broad-spectrum antibiotic (odds ratio: 5.05; 95% confidence interval: 2.04 to 12.5; p = 0.000); use of two or more broad-spectrum antibiotics in past year (odds ratio: 5.4; 95% confidence interval: 1.5 to 18.4; p = 0.009); prior hospitalization in a high-risk area (odds ratio: 4.91; 95% confidence interval: 1.83 to 13.2; p = 0.000); hospitalization for more than five days in a high-risk area (odds ratio: 5.64; 95% confidence interval: 2.18 to 14.6; p = 0.000); and use of immunosuppressant drugs (odds ratio: 4.84; 95% confidence interval: 1.92 to 11.9; p = 0.001). In a logistic multiple regression the use of two or more broad-spectrum antibiotics (odds ratio: 4.81; 95% confidence interval: 1.01 to 22.8; p = 0.047) and prior hospitalization in past year (odds ratio: 7.84; 95% confidence interval: 1.24 to 49.32; p = 0.028) were identified as independent factors statistically associated with VRE colonization.
Pediatric patients admitted for intensive care with a history of prior hospitalization in the past year and exposure to two or more broad-spectrum antibiotics have a greater risk of colonization by vancomycin-resistant enterococci.
耐万古霉素肠球菌（VRE）感染已广泛传播，成为住院患者面临的一项挑战。难治性肠球菌感染的威胁以及万古霉素耐药性可能涉及肺炎球菌或葡萄球菌的可能性，促使人们对耐药菌株进行密切监测。
确定2012年1月至2013年6月期间入住儿科重症监护病房（PICU）的儿科患者中与VRE定植相关的危险因素。
我们进行了一项横断面研究，分析了140例入住PICU（年龄1个月至18岁的儿童）患者的临床病史，这些患者在入院后48小时内接受了直肠拭子培养。我们计算了PICU中VRE定植危险因素的比值比和置信区间，然后对具有统计学意义的变量进行多因素逻辑回归分析。
18.6%的患者存在VRE定植。以下变量被确定为与VRE定植相关的危险因素：过去一年曾住院（比值比：10.8；95%置信区间：2.43至47.8；p = 0.001）；既往使用过一种广谱抗生素（比值比：5.05；95%置信区间：2.04至12.5；p = 0.000）；过去一年使用过两种或更多种广谱抗生素（比值比：5.4；95%置信区间：1.5至18.4；p = 0.009）；曾在高危地区住院（比值比：4.91；95%置信区间：1.83至13.2；p = 0.000）；在高危地区住院超过五天（比值比：5.64；95%置信区间：2.18至14.6；p = 0.000）；以及使用免疫抑制药物（比值比：4.84；95%置信区间：1.92至11.9；p = 0.001）。在多因素逻辑回归分析中，使用两种或更多种广谱抗生素（比值比：4.81；95%置信区间：1.01至二十二点八；p = 0.047）和过去一年曾住院（比值比：7.84；95%置信区间：1.24至49.32；p = 0.028）被确定为与VRE定植有统计学关联的独立因素。
过去一年有住院史且接触过两种或更多种广谱抗生素的儿科重症监护患者，感染耐万古霉素肠球菌的风险更高。
