ICU患者感染耐万古霉素肠球菌的环境因素

荷塘月色

美国波士顿学者Drees等进行的研究显示,在重症监护病房中,患者暴露于耐万古霉素肠球菌(VRE)环境中,其感染VRE的危险显著增加,其中病房前一例住院患者有VRE定植等是重要危险因素[Clin Infect Dis 2008046(5)∶678]。

     暴露与携带VRE环境对患者发生VRE感染的影响尚不清楚。

     研究者对两个ICU进行了为期14个月的研究,对ICU环境每周监测一次,对患者每两周监测一次,以分析环境对患者感染VRE危险的影响。VRE感染定义为入院后48小时所取的标本培养阳性。

     结果显示,在1330例次ICU住院者中,638例有VRE感染危险,50例发生VRE感染。

     引起VRE感染的危险因素包括平均定植压力[平均定植压力每增加10%,风险比(HR)为1.4]、使用抗生素的种类(每增加一种抗生素,HR为1.7)、白血病(HR为3.1),还有病房前一例住院者有VRE定植(HR为3.1)、前2周内病房住院者有VRE定植(HR为2.5)、之前病房培养VRE阳性(HR为3.4)。

     对定植压力及抗生素暴露进行校正后,上述危险因素中的后3项是独立危险因素,HR分别为3.8、2.7和4.4。

楚楚

看来当ICU发生耐药菌感染时对环境彻底的清洁消毒十分重要。

二进制

进入ICU的病人免疫力低下.存在于环境中耐药菌对其极易造成感染.故二楼楚楚管理员提及ICU环境彻底清洁消毒完全必要的。:look

荷塘月色

这是国外循证医学的精品文章,什么时候我国的科研论文都能这样严谨认真,我国的医疗水平就是真正提高了!

绿叶

数据能说明我们感染控制的方向,让我们朝这方面去努力

David

英文全文在此，请对照学习:handshake

Clinical Infectious Diseases 2008;46:678–685

MAJOR ARTICLE
Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci

Marci Drees,1,2,3 David R. Snydman,1,2,3 Christopher H. Schmid,1,2 Laurie Barefoot,1 Karen Hansjosten,1 Padade M. Vue,3 Michael Cronin,4 Stanley A. Nasraway,1,3 and Yoav Golan1,3

1Tufts–New England Medical Center and 2Sackler School of Graduate Biomedical Sciences and 3School of Medicine, Tufts University, Boston, and 4Tufts University, Medford, Massachusetts

Background.  Patients colonized with vancomycin-resistant enterococci (VRE) frequently contaminate their environment, but the environmental role of VRE transmission remains controversial.

Methods.  During a 14-month study in 2 intensive care units, weekly environmental and twice-weekly patient surveillance cultures were obtained. VRE acquisition was defined as a positive culture result >48 h after admission. To determine risk factors for VRE acquisition, Cox proportional hazards models using time-dependent covariates for colonization pressure and antibiotic exposure were examined.

Results.  Of 1330 intensive care unit admissions, 638 patients were at risk for acquisition, and 50 patients (8%) acquired VRE. Factors associated with VRE acquisition included average colonization pressure (hazard ratio [HR], 1.4 per 10% increase; 95% confidence interval [CI], 1.2–1.8), mean number of antibiotics (HR, 1.7 per additional antibiotic; 95% CI, 1.2–2.5), leukemia (HR, 3.1; 95% CI, 1.2–7.8), a VRE-colonized prior room occupant (HR, 3.1; 95% CI, 1.6–5.8), any VRE-colonized room occupants within the previous 2 weeks (HR, 2.5; 95% CI, 1.3–4.8), and previous positive room culture results (HR, 3.4; 95% CI, 1.2–9.6). In separate multivariable analyses, a VRE-colonized prior room occupant (HR, 3.8; 95% CI, 2.0–7.4), any VRE-colonized room occupants within the previous 2 weeks (HR, 2.7; 95% CI, 1.4–5.3), and previous positive room culture results (HR, 4.4; 95% CI, 1.5–12.8) remained independent predictors of VRE acquisition, adjusted for colonization pressure and antibiotic exposure.

Conclusions.  We found that prior room contamination, whether measured via environmental cultures or prior room occupancy by VRE-colonized patients, was highly predictive of VRE acquisition. Increased attention to environmental disinfection is warranted.

[ 本帖最后由 David 于 2008-4-30 10:26 编辑 ]

David

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EDITORIAL COMMENTARY
How Important Is the Environment in the Emergence of Nosocomial Antimicrobial-Resistant Bacteria?
环境在医院内耐药细菌传播中的重要性如何？

Anthony D. Harris

Division of Healthcare Outcomes Research, Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore

荷塘月色

既学习了院感知识,又提高了英语水平,一举两得!论坛真好!:) :) :victory: :victory: :ok :ok :ok

紫陌红尘

很感谢版主,能不能请大家扩展一下相关的知识链接,比如这个问题提到环境对MRSA感染的影响,可以引出相关的问题---如何进行相关环境消毒和隔离,实际效果如何,我是搞临床的,对这个方面关注会多些,虽然感管科也做了很多工作,但临床医师对这方面的知识仍较匮乏,所以希望多多学习.多谢!:)

David

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