Quale J, Landman D, Saurina G, Atwood E, DiTore V, Patel K
Department of Medicine, Department of Veterans Affairs Medical Center, Brooklyn, New York 11209, USA.
Clin Infect Dis. 1996 Nov;23(5):1020-5. doi: 10.1093/clinids/23.5.1020.
Infection control practices are not uniformly successful in limiting outbreaks of vancomycin-resistant enterococci (VRE). Despite the implementation of barrier precautions for VRE-infected patients, nearly one-half of the inpatients at our center were found to have gastrointestinal colonization by VRE. In an attempt to control the outbreak, we altered the antibiotic formulary by restricting the use of cefotaxime and vancomycin and adding beta-lactamase inhibitors to replace third-generation cephalosporins. The use of clindamycin was also restricted because of a concomitant outbreak of Clostridium difficile colitis. After 6 months, the average monthly use of cefotaxime, ceftazidime, vancomycin, and clindamycin had decreased by 84%, 55%, 34%, and 80%, respectively (P < .02). The point prevalence of fecal colonization with VRE decreased from 47% to 15% (P < .001), and the number of patients whose clinical specimens were culture positive also gradually decreased. A change in antibiotic use appears to have significantly affected our VRE outbreak when previous measures failed.
感染控制措施在限制耐万古霉素肠球菌（VRE）暴发方面并非始终成功。尽管对VRE感染患者实施了屏障预防措施，但我们中心近一半的住院患者被发现胃肠道有VRE定植。为了控制疫情，我们通过限制头孢噻肟和万古霉素的使用以及添加β-内酰胺酶抑制剂来替代第三代头孢菌素，从而改变了抗生素处方集。由于同时暴发了艰难梭菌结肠炎，克林霉素的使用也受到了限制。6个月后，头孢噻肟、头孢他啶、万古霉素和克林霉素的月平均使用量分别下降了84%、55%、34%和80%（P <.02）。VRE粪便定植的点患病率从47%降至15%（P <.001），临床标本培养阳性的患者数量也逐渐减少。当先前的措施失败时，抗生素使用的改变似乎对我们的VRE疫情产生了显著影响。
