Implications for vancomycin-resistant Enterococcus colonization associated with Clostridium difficile infections
Implications for vancomycin-resistant Enterococcus colonization associated with Clostridium difficile infections
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DOI：
10.1016/j.ajic.2010.10.024
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发表时间：
2011-04-01
影响因子：
4.9
通讯作者：
Murthy, A. Rekha
中科院分区：
文献类型：
--
作者：
Fujitani, Shigeki;George, W. Lance;Murthy, A. Rekha
背景：胃肠道万古霉素耐药肠球菌(VRE)定植与艰难梭菌感染有相似的危险因素。我们试图阐明与艰难梭菌感染相关的VRE定植的患病率和危险因素。方法：对2006年7月至2006年10月所有住院的成人艰难梭菌感染患者进行前瞻性评估。对所有艰难梭菌毒素阳性的粪便样本进行VRE检测。比较有无VRE定植的艰难梭菌感染患者VRE定植的危险因素。结果：在158例艰难梭菌感染患者中，88例(55.7%)涉及VRE定植。VRE定植的独立危险因素是长期护理机构入院(P=.013)、痴呆症(P=.017)和前2个月住院(P=.014)。多因素分析显示，有无VRE定植的艰难梭菌感染病例与无VRE定植的艰难梭菌感染病例相比，既往(1个月内)接受包括甲硝唑和万古霉素在内的抗生素的情况差异无统计学意义。VRE定植的艰难梭菌感染合并耐甲氧西林金黄色葡萄球菌(P=.002)和不动杆菌属(P=.006)的比例较高。结论：VRE定植与50%的艰难梭菌感染有关，合并多重耐药病原菌的比例较高。鉴于艰难梭菌感染与VRE定植相关的高比率，在高危环境中积极监测艰难梭菌感染患者的VRE是合理的。
Background: Vancomycin-resistant Enterococcus (VRE) colonization of the gastrointestinal tract shares similar risk factors with Clostridium difficile infection. We sought to elucidate the prevalence and risk factors of VRE colonization associated with C difficile infection.Methods: All adult inpatients with C difficile infection from July 2006 to October 2006 were prospectively evaluated. All C difficile toxin-positive stool samples were screened for detection of VRE. Risk factors for VRE colonization were compared in patients with C difficile infection with and without VRE colonization.Results: Of the 158 cases of C difficile infection evaluated, 88 (55.7%) involved VRE colonization. Independent risk factors for VRE colonization were admission from long-term care facilities (P = .013), dementia (P = .017), and hospitalization in the previous 2 months (P = .014). No statistically significant difference between C difficile infection cases with and without VRE colonization in terms of previous receipt (within 1 month) of antibiotics, including metronidazole and vancomycin, was found on multivariate analysis. C difficile infection cases with VRE colonization had a higher prevalence of coinfection with methicillin-resistant Staphylococcus aureus (P = .002) and Acinetobacter spp (P = .006).Conclusion: VRE colonization was associated with >50% of C difficile infection cases and with a higher rate of coinfection with multidrug-resistant pathogens. Given the high rate of C difficile infection associated with VRE colonization, active surveillance of VRE in patients with C difficile infection is reasonable in high-risk settings.