Effectiveness of patient and staff cohorting to reduce the risk of vancomycin-resistant enterococcus (VRE) acquisition: a retrospective cohort study during a VRE outbreak in Japan
Effectiveness of patient and staff cohorting to reduce the risk of vancomycin-resistant enterococcus (VRE) acquisition: a retrospective cohort study during a VRE outbreak in Japan
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DOI：
10.1016/j.jhin.2022.11.024
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发表时间：
2023-02-21
影响因子：
6.9
通讯作者：
Yamagishi, T.
中科院分区：
文献类型：
--
作者：
Kakimoto, K.;Nishiki, S.;Yamagishi, T.
背景资料：患者和工作人员聚集是应对多重耐药微生物的捆绑方法的一部分，但其有效性尚未完全阐明。本研究比较了在VREfm爆发期间在医院获得万古霉素耐药屎肠球菌（VREfm）的风险，以更好地了解聚集的有效性。研究方法：暴露来自与VREfm患者（感染者）的接触，包括现有VREfm患者和研究期间获得VREfm的患者。接触的定义是接触时间的长短，共享空间的程度，以及2018年1月至3月期间由同一名护士照顾感染者的护理。结果是通过每月粪便或直肠筛查培养确定的VREfm采集。根据接触模式计算发病率，并比较发病率比（IRR）。结果：在272例住院患者（4038患者-天）中，43例患者获得了相同或相似脉型的VREfm。与感染者在同一病房但由不同护士照顾的患者，其发病率为8.45/1000人日（参考），16.96，当易感住院患者与感染者在同一病房并由相同护士护理时[IRR 2.01，95%置信区间（CI）0.62-10.28]，易感者与感染者同住一室时的IRR为52.91（IRR 6.26，95% CI 1.61-35.40）。结论：与感染者不同房间的易感住院患者相比，与感染者在同一房间的易感住院患者的VREfm获得风险可能高出6倍，与感染者在同一房间的易感住院患者的VREfm获得风险可能高出一倍。(c)2023作者。由Elsevier Ltd代表The Healthcare Infection Society出版。这是一个在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Background: Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting. Methods: Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared. Findings: Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when sus-ceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62-10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61-35.40). Conclusion: Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).