万古霉素耐药肠球菌：血液科患者医院定植的危险因素：一项配对病例对照研究。
Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study.
机构信息
Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy.
Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy.
出版信息
Antimicrob Resist Infect Control. 2023 Nov 13;12(1):126. doi: 10.1186/s13756-023-01332-x.
BACKGROUND
Vancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group.
METHODS
A retrospective, single center, case-control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (≥ 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization.
RESULTS
A total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively).
CONCLUSIONS
Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches.
背景
万古霉素耐药肠球菌（VRE）是 2022 年欧洲增长最快的病原体（增长 21%），但其临床相关性尚不清楚。我们旨在确定血液科患者获得性 VRE 直肠定植的危险因素，并评估 VRE 定植对随后感染以及与匹配对照组相比的 30 天和 90 天总死亡率的临床影响。
方法
这是一项回顾性、单中心、病例对照匹配研究（比例为 1:1），于 2017 年 1 月至 2020 年 12 月在血液科进行。病例患者为从直肠拭子筛查（≥48 小时）中分离出的医院获得性 VRE，通过年龄、性别、种族和血液疾病与对照组匹配。单变量和多变量逻辑回归比较了定植的危险因素。
结果
共 83 例患者与 83 例对照匹配。VRE 定植的危险因素包括发热性中性粒细胞减少症、骨髓移植、中心静脉导管、褥疮、活动能力下降、肠道习惯改变、恶病质、既往住院和住院期间的抗生素治疗。VRE 菌血症和艰难梭菌感染（CDI）在无任何影响的情况下在病例中更频繁发生30 天和 90 天的总死亡率。万古霉素治疗和肠道习惯改变是多变量分析中 VRE 定植的唯一独立危险因素（OR：3.53 和 3.1；分别）。
结论
迫切需要制定抗菌药物管理策略，以减少血液科患者中革兰氏阳性菌覆盖的不当使用，因为本研究确定的 VRE 医院定植的独立危险因素包括万古霉素的任何使用和肠道习惯改变。VRE 定植和感染并未影响 30 天和 90 天的死亡率。CDI 和 VRE 之间存在很强的相关性，值得进一步研究以确定新的治疗方法。
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