Cho Sun Young, Kim Hye Mee, Chung Doo Ryeon, Choi Jong Rim, Lee Myeong-A, Huh Hee Jae, Lee Nam Yong, Huh Kyungmin, Kang Cheol-In, Peck Kyong Ran
Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea.
Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Infect Control Hosp Epidemiol. 2022 May;43(5):603-608. doi: 10.1017/ice.2021.189. Epub 2021 May 17.
To evaluate the impact of a vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated (HA)-VRE bacteremia in an endemic hospital setting.
A quasi-experimental before-and-after study.
A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.
Since May 2010, our hospital has diminished VRE screening for admitted patients transferred from other healthcare facilities. We assessed the impact of this policy change on the incidence of HA-VRE bacteremia using segmented autoregression analysis of interrupted time series from January 2006 to December 2014 at the hospital and unit levels. In addition, we compared the molecular characteristics of VRE blood isolates collected before and after the screening policy change using multilocus sequence typing and pulsed-field gel electrophoresis.
After the VRE screening policy change, the incidence of hospital-wide HA-VRE bacteremia increased, although no significant changes of level or slope were observed. In addition, a significant slope change in the incidence of HA-VRE bacteremia (change in slope, 0.007; 95% CI, 0.001-0.013; P = .02) was observed in the hemato-oncology department. Molecular analysis revealed that various VRE sequence types appeared after the policy change and that clonally related strains became more predominant (increasing from 26.1% to 59.3%).
The incidence of HA-VRE bacteremia increased significantly after VRE screening policy change, and this increase was mainly driven by high-risk patient populations. When planning VRE control programs in hospitals, different approaches that consider risk for severe VRE infection in patients may be required.
评估耐万古霉素肠球菌（VRE）筛查政策的改变对一家地方性医院中医疗保健相关（HA）-VRE菌血症发病率的影响。
一项前后对照的准实验研究。
韩国首尔一家拥有1989张床位的三级医疗转诊中心。
自2010年5月起，我们医院减少了对从其他医疗机构转入的住院患者的VRE筛查。我们使用2006年1月至2014年12月在医院和科室层面的中断时间序列分段自回归分析，评估了这一政策改变对HA-VRE菌血症发病率的影响。此外，我们使用多位点序列分型和脉冲场凝胶电泳比较了筛查政策改变前后收集的VRE血液分离株的分子特征。
VRE筛查政策改变后，全院HA-VRE菌血症的发病率有所上升，尽管未观察到水平或斜率的显著变化。此外，血液肿瘤科HA-VRE菌血症的发病率出现了显著的斜率变化（斜率变化，0.007；95%CI，0.001-0.013；P=0.02）。分子分析显示，政策改变后出现了多种VRE序列类型，且克隆相关菌株变得更加占主导地位（从26.1%增至59.3%）。
VRE筛查政策改变后，HA-VRE菌血症的发病率显著上升，且这种上升主要由高危患者群体推动。在制定医院VRE控制计划时，可能需要考虑患者严重VRE感染风险的不同方法。
