Kim Yoonjung, Bae Sohyun, Hwang Soyoon, Kwon Ki Tae, Chang Hyun-Ha, Kim Su-Jeong, Park Han-Ki, Lee Jong-Myung, Kim Shin-Woo
Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
Yeungnam Univ J Med. 2020 Apr;37(2):112-121. doi: 10.12701/yujm.2019.00430. Epub 2020 Feb 18.
Vancomycin-resistant Enterococcus (VRE) has become more common in nosocomial infections, especially in urine samples. However, until now, no treatment regimen has been proven to effectively eradicate urine VRE colonization. Therefore, to evaluate the efficacy of doxycycline in eradicating urine VRE and shortening VRE isolation period, we compared VRE colony detection period between doxycycline-treated and untreated patients.
A retrospective cohort study of 83 patients with VRE colonization in urine cultures was conducted at a tertiary academic hospital from January 2011 to February 2018. Kaplan-Meier survival analysis was used to evaluate eradication rates in the treatment and non-treatment groups. Factors affecting urine VRE colonization persistence were analyzed by multiple logistic regression analysis.
The overall rate of VRE eradication during the entire hospital stay was higher in the doxycycline treatment group (90.5%) than in the non-treatment group (58.1%, p=0.014). Survival analysis showed that the 5-, 10-, and 20-day cumulative eradication rates were 78.3%, 100%, and 100% in the doxycycline treatment group, and 18.5%, 45.7%, and 67.8% in the non-treatment group, respectively, thereby indicating that eradication rates were higher in the doxycycline treatment group than in the non-treatment group (p<0.001). Only doxycycline treatment was shown to affect urine VRE colonization persistence in multivariate logistic regression analysis.
Doxycycline treatment enhanced the eradication rate of urine VRE colonization and appeared to be useful in shortening VRE isolation period.
耐万古霉素肠球菌（VRE）在医院感染中变得更为常见，尤其是在尿液样本中。然而，到目前为止，尚无已证实能有效根除尿液VRE定植的治疗方案。因此，为评估多西环素在根除尿液VRE及缩短VRE隔离期方面的疗效，我们比较了多西环素治疗组和未治疗组患者的VRE菌落检测期。
对2011年1月至2018年2月在一家三级学术医院进行尿液培养的83例VRE定植患者进行回顾性队列研究。采用Kaplan-Meier生存分析评估治疗组和非治疗组的根除率。通过多因素逻辑回归分析影响尿液VRE定植持续存在的因素。
多西环素治疗组在整个住院期间VRE的总体根除率（90.5%）高于非治疗组（58.1%，p=0.014）。生存分析表明，多西环素治疗组5天、10天和20天的累积根除率分别为78.3%、100%和100%，非治疗组分别为18.5%、45.7%和67.8%，这表明多西环素治疗组的根除率高于非治疗组（p<0.001）。多因素逻辑回归分析显示，只有多西环素治疗会影响尿液VRE定植的持续存在。
多西环素治疗提高了尿液VRE定植的根除率，似乎有助于缩短VRE隔离期。
