Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit
Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit
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DOI：
10.1001/archinte.163.16.1905
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发表时间：
2003-09-08
影响因子：
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通讯作者：
Snydman, DR
中科院分区：
文献类型：
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作者：
Martínez, JA;Ruthazer, R;Snydman, DR
背景：定植压力、接近另一病例、接触照顾另一病例的护士、肠内喂养以及使用硫糖铝、盐酸万古霉素、头孢菌素或抗生素是重症监护病房 (ICU) 中感染万古霉素耐药肠球菌 (VRE) 的明确危险因素。然而，环境表面受污染的房间的作用尚未得到很好的描述。方法：对三级护理、大学附属医疗中心的内科重症监护病房（MICU）入住的患者进行为期 9 个月的回顾性病例对照研究。获得 VRE 的患者（病例）与 2 名随机选择的未获得 VRE 且在 MICU 入住至少相同天数的对照受试者进行匹配。结果：30 例病例与 60 名适当对照相匹配。病例更有可能在 MICU 入院前住院时间超过 7 天 (P=.009)；居住在表面持续受污染的特定房间（P=.06）；曾有中心静脉导管（P=.05）；在 MICU 入院前接受过万古霉素 (P=.02)、头孢菌素 (P=.03) 和喹诺酮类 (P=.006) 治疗；入院后接受万古霉素（P=.02）和甲硝唑磷酸钠（P=.03）治疗。多变量分析显示，MICU 入院前住院时间超过 1 周 (P=.04)、MICU 入院前后使用万古霉素 (P=.03)、MICU 入院前使用喹诺酮类药物 (P=.03) 以及安置在受污染的房间 (P=.02) 是 VRE 感染的最佳预测因素。 结论：在与 VRE 传播相关的所有其他因素中，VRE 的感染可能取决于房间污染，即使在广泛清洁后也是如此。这项研究强调了更好清洁的必要性以及环境在 VRE 传播中的作用。
Background: Colonization pressure, proximity to another case, exposure to a nurse who cares for another case, enteral feeding, and the use of sucralfate, vancomycin hydrochloride, cephalosporins, or antibiotics are among the defined risk factors for acquisition of vancomycin-resistant enterococci (VRE) in the intensive care unit (ICU) setting. However, the role of rooms with contaminated environmental surfaces has not been well delineated.Methods: Retrospective case-control study conducted on patients admitted to the medical ICU (MICU) of a tertiary-care, university-affiliated medical center during a 9-month period. Patients who acquired VRE (cases) were matched with 2 randomly selected control subjects who did not acquire VRE and had been in the MICU for at least the same number of days.Results: Thirty cases were matched with 60 appropriate controls. Cases were more likely to have been in the hospital for longer than 7 days before MICU admission (P=.009); to have occupied a specific room with persisting contaminated surfaces (P=.06); to have had a central venous catheter (P=.05); to have received vancomycin (P=.02), cephalosporins (P=.03), and quinolones (P =.006) before MICU admission; and to have received vancomycin (P=.02) and metronidazole sodium phosphate (P=.03) after MICU admission. Multivariate analysis showed that a hospital stay of longer than 1 week before MICU admission (P=.04), use of vancomycin before or after MICU admission (P=.03), use of quinolones before MICU admission (P=.03), and placement in a contaminated room (P=.02) were the best predictors of VRE acquisition.Conclusions: Among all other factors associated with VRE transmission, VRE acquisition may depend on room contamination, even after extensive cleaning. This study underscores the need for better cleaning and the role of the environment in transmission of VRE.