Reynolds Jenna L, Trudeau Raelene E, Seville Maria Teresa, Chan Lynn
Department of Pharmacy, Mayo Clinic Hospital, Phoenix, Arizona.
Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, Texas.
Antimicrob Steward Healthc Epidemiol. 2021 Nov 3;1(1):e41. doi: 10.1017/ash.2021.215. eCollection 2021.
Vancomycin-resistant (VRE) infections have been associated with increased mortality and poor outcomes. VRE screening has been used to identify colonized patients to prevent transmission; however, little is known about the utility of screening results to guide antibiotic therapy.
A retrospective review was performed at a tertiary-care center between June 1, 2015, and May 31, 2018.
All patients who underwent VRE polymerase chain reaction assay (PCR) screening and had a bacterial culture from 7 days before to 90 days after the screening test were included. In total, 1,374 patients who had a VRE screening test met inclusion criteria.
Sensitivity, specificity, and positive and negative predictive values of VRE screening for VRE infection were calculated. The appropriateness of the antibiotic therapy for each patient based on screening results was also assessed.
We detected no difference in the appropriateness of antibiotic therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; = .8657). The VRE PCR demonstrated 54% sensitivity, 89% specificity, a positive predictive value (PPV) of 13% and a negative predictive value (NPV) of 98%.
The high NPV and specificity indicate that patients with a negative VRE screening results may not require empiric antibiotic coverage for VRE. Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for an antibiotic with VRE culture-directed coverage.
耐万古霉素（VRE）感染与死亡率增加及不良预后相关。VRE筛查已用于识别定植患者以预防传播；然而，关于利用筛查结果指导抗生素治疗的效用知之甚少。
在一家三级医疗中心于2015年6月1日至2018年5月31日进行了一项回顾性研究。
纳入所有接受VRE聚合酶链反应（PCR）筛查且在筛查试验前7天至试验后90天有细菌培养结果的患者。共有1374例进行VRE筛查试验的患者符合纳入标准。
计算VRE筛查对VRE感染的敏感性、特异性、阳性预测值和阴性预测值。还根据筛查结果评估了每位患者抗生素治疗的适宜性。
我们发现筛查结果为阳性的患者与筛查结果为阴性的患者在抗生素治疗适宜性方面没有差异（59.3%对61.0%；P = 0.8657）。VRE PCR显示敏感性为54%，特异性为89%，阳性预测值（PPV）为13%，阴性预测值（NPV）为98%。
高阴性预测值和特异性表明VRE筛查结果为阴性的患者可能不需要针对VRE进行经验性抗生素覆盖。虽然VRE筛查可能有助于检测高危患者的定植情况，但VRE筛查结果为阳性在确定是否需要使用针对VRE培养结果指导的抗生素方面价值有限。
