神经外科重症监护病房耐万古霉素肠球菌感染的流行特征及危险因素研究
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摘要
目的:探讨神经外科重症监护病房(ICU)耐万古霉素肠球菌(VRE)感染的流行特征及危险因素,为临床防控提供参考依据。方法:选择2014年1月至2016年1月在我院接受手术治疗的神经外科ICU住院患者420例为研究对象。比较VRE感染患者在感染前抗生素的应用情况,并分别应用单因素及多因素Logistic回归分析分析VRE感染患者的危险因素,提出防控措施。结果:420例ICU住院患者中,VRE感染者58例,占13.81%。VRE感染患者在感染前应用的抗生素以三代头孢最多,占37.93%,以四代头孢最少,占6.90%。由单因素及多因素Logistic回归分析显示,ICU住院时间≥14 d、留置尿管≥14 d、格拉斯哥昏迷量表(GCS)评分<8分以及附近存在VRE感染者均为VRE感染患者的危险因素(P<0.05)。结论:VRE感染患者在感染前应用的抗生素以三代头孢最多,ICU住院时间>14 d、留置尿管>14 d、GCS评分<8分以及附近存在VRE感染者均为VRE感染患者的危险因素,临床上应合理应用抗生素,采取相应的防控措施,降低VRE感染的发生。
Objective: To investigate the epidemiological characteristics and risk factors of vancomycin resistant enterococcus(VRE) infection in intensive care unit(ICU) of department of neurosurgery, and to provide reference for clinical prevention and control.Methods: A total of 420 patients, who underwent surgery in the ICU of department of neurosurgery in Taizhou Hospital of Traditional Chinese Medicine from January 2014 to January 2016, were chosen as subjects. The application of antibiotics before infection in the patients with VRE infection was compared, and univariate and multivariate Logistic regression analysis were used to analyze the risk factors of VRE infection to propose the prevention and control measures. Results: Among the 420 inpatients in ICU, there were 58 cases of VRE infection, accounted for 13.81%. The most common antibiotics used before VRE infection was three generation cephalosporin, accounted for 37.93%, and four generation cephalosporin was least, accounted for 6.90%. Single factor and Logistic regression analysis showed that the ICU hospitalization time≥14 d, indwelling catheter≥14 d, Glasgow Coma Scale(GCS) score<8 and patients infected by VRE nearby were the risk factors of VRE infection(P<0.05). Conclusion: The most common antibiotics used before VRE infection is three generation cephalosporin. ICU hospitalization time ≥14 d, indwelling catheter ≥14 d, GCS score<8 and patients infected by VRE nearby are the risk factors of VRE infection. Rational use of antibiotics and taking corresponding prevention and control measures are necessary in the clinical practice to reduce the incidence of VRE infection.
Objective: To investigate the epidemiological characteristics and risk factors of vancomycin resistant enterococcus(VRE) infection in intensive care unit(ICU) of department of neurosurgery, and to provide reference for clinical prevention and control.Methods: A total of 420 patients, who underwent surgery in the ICU of department of neurosurgery in Taizhou Hospital of Traditional Chinese Medicine from January 2014 to January 2016, were chosen as subjects. The application of antibiotics before infection in the patients with VRE infection was compared, and univariate and multivariate Logistic regression analysis were used to analyze the risk factors of VRE infection to propose the prevention and control measures. Results: Among the 420 inpatients in ICU, there were 58 cases of VRE infection, accounted for 13.81%. The most common antibiotics used before VRE infection was three generation cephalosporin, accounted for 37.93%, and four generation cephalosporin was least, accounted for 6.90%. Single factor and Logistic regression analysis showed that the ICU hospitalization time≥14 d, indwelling catheter≥14 d, Glasgow Coma Scale(GCS) score<8 and patients infected by VRE nearby were the risk factors of VRE infection(P<0.05). Conclusion: The most common antibiotics used before VRE infection is three generation cephalosporin. ICU hospitalization time ≥14 d, indwelling catheter ≥14 d, GCS score<8 and patients infected by VRE nearby are the risk factors of VRE infection. Rational use of antibiotics and taking corresponding prevention and control measures are necessary in the clinical practice to reduce the incidence of VRE infection.
引文
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[10]Toner L,Papa N,Aliyu SH,et al.Vancomycin resistant enterococci in urine cultures:Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom[J].Investig Clin Urol,2016,57(2):129-134
[11]Mohammad H,Younis W,Chen L,et al.Phenylthiazole Antibacterial Agents Targeting Cell Wall Synthesis Exhibit Potent Activity in Vitro and in Vivo against Vancomycin-Resistant Enterococci[J].J Med Chem,2017,60(6):2425-2438
[12]Kaveh M,Bazargani A,Ramzi M,et al.Colonization Rate and Risk Factors of Vancomycin-Resistant Enterococci among Patients Received Hematopoietic Stem Cell Transplantation in Shiraz,Southern Iran[J].Int J Organ Transplant Med,2016,7(4):197-205
[13]李金明,郑国昌.输尿管结石术后厌氧菌感染的多重耐药菌分布及抗菌药物治疗[J].中国医药导刊,2015,17(9):937-938Li Jin-ming,Zheng Guo-chang.Distribution of Multi-drug Resistant Bacteria and Antimicrobial Agents in the Treatment of Postoperative Anaerobic Bacteria Infection in Patients with Ureteral Calculi[J].Chinese Journal of Medical Guide,2015,17(9):937-938
[14]李倩,武元星,唐明忠,等.神经外科重症监护病房细菌流行及耐药性的20年监测[J].临床神经外科杂志,2016,13(1):49-55,59Li Qian,Wu Yuan-xing,Tang Ming-zhong,et al.Distribution and antimicrobial-resistance of bacteria isolated in nosocomial infection in NSICU within 20 years[J].Journal of Clinical Neurosurgery,2016,13(1):49-55,59
[15]Herc ES,Kauffman CA,Marini BL,et al.Daptomycin nonsusceptible vancomycin resistant Enterococcus bloodstream infections in patients with hematological malignancies:risk factors and outcomes[J].Leuk Lymphoma,2017,58(12):2852-2858
[16]?zsoy S,lki A.Detection of vancomycin-resistant enterococci(VRE)in stool specimens submitted for Clostridium difficile toxin testing[J].Braz J Microbiol,2017,48(3):489-492
[17]Szczypta A,Talaga K,Bulanda M.Nursing care for patients infected or colonized with vancomycin-resistant enterococci(VRE)[J].Folia Med Cracov,2016,56(4):13-20
[18]Biswas PP,Dey S,Adhikari L,et al.Virulence markers of vancomycin resistant enterococci isolated from infected and colonized patients[J].J Glob Infect Dis,2014,6(4):157-63
[19]张瑞敏,周海燕,谭颜华,等.ICU患者导管相关性感染的目标性监测分析[J].中华医院感染学杂志,2015,25(20):4694-4695,4727Zhang Rui-min,Zhou Hai-yan,Tan Yan-hua,et al.Targeted monitoring of catheter-related infections in general ICU ward[J].Chinese Journal of Nosocomiology,2015,25(20):4694-4695,4727
[20]李六亿,陈美恋,吴安华,等.耐万古霉素肠球菌感染流行病学多中心研究[J].中国感染控制杂志,2015,14(8):518-523Li Liu-yi,Chen Mei-lian,Wu An-hua,et al.A multicenter study on epidemiology of vancomycin-resistant Enterococcus infection[J].Chinese Journal of Infection Control,2015,14(8):518-523
[21]白耀霞,余佳佳,徐杰,等.肠球菌万古霉素耐药基因和毒力基因的研究进展[J].甘肃医药,2017,36(6):433,444Bai Yao-xia,Yu Jia-jia,Xu Jie,et al.Research progress of enterococcus vancomycin resistant genes and virulence genes[J].Gansu Medical Journal,2017,36(6):433,444
[22]Chen XX,Lo YC,Su LH,et al.Investigation of the case numbers of catheter-related bloodstream infection overestimated by the central line-associated bloodstream infection surveillance definition[J].J Microbiol Immunol Infect,2015,48(6):625-631
[23]Chuang YC,Lin HY,Chen PY,et al.Effect of Daptomycin Dose on the Outcome of Vancomycin-Resistant,Daptomycin-Susceptible Enterococcus faecium Bacteremia[J].Clin Infect Dis,2017,64(8)1026-1034
[24]Adrie C,Lugosi M,Sonneville R,et al.Persistent lymphopenia is a risk factor for ICU-acquired infections and for death in ICU patients with sustained hypotension at admission[J].Ann Intensive Care2017,7(1):30
[25]Alevizakos M,Gaitanidis A,Nasioudis D,et al.Colonization with Vancomycin-Resistant Enterococci and Risk for Bloodstream Infection Among Patients With Malignancy:A Systematic Review and Meta-Analysis[J].Open Forum Infect Dis,2016,4(1):ofw246
[26]Garg S,Mohan B,Taneja N.Biofilm formation capability of enterococcal strains causing urinary tract infection vis-a-vis colonisation and correlation with enterococcal surface protein gene[J].Indian JMed Microbiol,2017,35(1):48-52
[27]Li M,Lee K,Hsu M,et al.Lactobacillus-derived extracellular vesicles enhance host immune responses against vancomycin-resistant enterococci[J].BMC Microbiol,2017,17(1):66
[28]刘畅,廖莎莎,朱立勤,等.万古霉素和利奈唑胺治疗革兰阳性球菌感染给药方案优化[J].天津医药,2016,44(8):1040-1042Liu Chang,Liao Sha-sha,Zhu Li-qin,et al.Optimization of vancomycin and linezolid dosage regimen for treatment of Gram-positive cocci infections[J].Tianjin Medical Journal,2016,44(8):1040-1042
[29]薄天慧,郝银松,王德琴,等.主动筛查重症监护病房耐万古霉素肠球菌和防控措施[J].中国消毒学杂志,2016,33(5):411-412,415Bo Tian-hui,Hao Yin-song,Wang De-qin,et al.Active surveillance on vancomycin resistant enterococcus in intensive care unit and control measures[J].Chinese Journal of Disinfection,2016,33(5):411-412,415
[30]梁蓓蓓,倪文涛,王瑾,等.替考拉宁与万古霉素治疗革兰氏阳性菌感染的临床疗效和安全性对比的Meta分析[J].中国临床药理学杂志,2017,33(2):176-180Liang Bei-bei,Ni Wen-tao,Wang Jin,et al.Effectiveness and safety of teicoplanin versus vancomycin for the treatment of gram-positive bacterial infections:Meta-analysis of randomised controlled trials[J].Chinese Journal of Clinical Pharmacology,2017,33(2):176-180
[2]Munigala S,Mc Mullen KM,Russo AJ,et al.Reinstatement of Reflex Testing of Stool Samples for Vancomycin-Resistant Enterococc(VRE)Resulted in Decreased Incidence of Hospital-Associated VRE[J].Infect Control Hosp Epidemiol,2017,38(5):619-621
[3]Amberpet R,Sistla S,Parija SC,et al.Screening for Intestinal Colonization with Vancomycin Resistant Enterococci and Associated Risk Factors among Patients Admitted to an Adult Intensive Care Unit of a Large Teaching Hospital[J].J Clin Diagn Res,2016,10(9)DC06-DC09
[4]Isenman H,Fisher D.Advances in prevention and treatment of vancomycin-resistant Enterococcus infection[J].Curr Opin Infect Dis2016,29(6):577-582
[5]Sutcu M,Akturk H,Acar M,et al.Impact of vancomycin-resistant enterococci colonization in critically ill pediatric patients[J].Am J Infect Control,2016,44(5):515-519
[6]徐雪梅,吴思颖,谢轶,等.耐万古霉素肠球菌血流感染的危险因素分析[J].中国感染与化疗杂志,2015,15(5):447-451Xu Xue-mei,Wu Si-ying,Xie Yi,et al.Risk factors of bloodstream infections caused by vancomycin-resistant Enterococcus[J].Chinese Journal of Infection and Chemotherapy,2015,15(5):447-451
[7]王娜,谭然,刘琳,等.磷霉素联合常规抗菌药物对耐万古霉素肠球菌的体外抗菌活性影响[J].中华医院感染学杂志,2016,26(12)2664-2666Wang Na,Tan Ran,Liu Lin,et al.Effects of fosfomycin combined conventional antibacterial agents on in vitro antibacterial activity of vancomycin-resistant Enterococci[J].Chinese Journal of Nosocomiology,2016,26(12):2664-2666
[8]Caballero S,Kim S,Carter RA,et al.Cooperating Commensals Restore Colonization Resistance to Vancomycin-Resistant Enterococcus faecium[J].Cell Host Microbe,2017,21(5):592-602
[9]Fonville JM,Van Herk CMC,Das PHAC,et al.A Single Negative Result for van Quantitative PCR on Enrichment Broth Can Replace Five Rectal Swab Cultures in Screening for Vancomycin-Resistant Enterococci[J].J Clin Microbiol,2017,55(7):2261-2267
[10]Toner L,Papa N,Aliyu SH,et al.Vancomycin resistant enterococci in urine cultures:Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom[J].Investig Clin Urol,2016,57(2):129-134
[11]Mohammad H,Younis W,Chen L,et al.Phenylthiazole Antibacterial Agents Targeting Cell Wall Synthesis Exhibit Potent Activity in Vitro and in Vivo against Vancomycin-Resistant Enterococci[J].J Med Chem,2017,60(6):2425-2438
[12]Kaveh M,Bazargani A,Ramzi M,et al.Colonization Rate and Risk Factors of Vancomycin-Resistant Enterococci among Patients Received Hematopoietic Stem Cell Transplantation in Shiraz,Southern Iran[J].Int J Organ Transplant Med,2016,7(4):197-205
[13]李金明,郑国昌.输尿管结石术后厌氧菌感染的多重耐药菌分布及抗菌药物治疗[J].中国医药导刊,2015,17(9):937-938Li Jin-ming,Zheng Guo-chang.Distribution of Multi-drug Resistant Bacteria and Antimicrobial Agents in the Treatment of Postoperative Anaerobic Bacteria Infection in Patients with Ureteral Calculi[J].Chinese Journal of Medical Guide,2015,17(9):937-938
[14]李倩,武元星,唐明忠,等.神经外科重症监护病房细菌流行及耐药性的20年监测[J].临床神经外科杂志,2016,13(1):49-55,59Li Qian,Wu Yuan-xing,Tang Ming-zhong,et al.Distribution and antimicrobial-resistance of bacteria isolated in nosocomial infection in NSICU within 20 years[J].Journal of Clinical Neurosurgery,2016,13(1):49-55,59
[15]Herc ES,Kauffman CA,Marini BL,et al.Daptomycin nonsusceptible vancomycin resistant Enterococcus bloodstream infections in patients with hematological malignancies:risk factors and outcomes[J].Leuk Lymphoma,2017,58(12):2852-2858
[16]?zsoy S,lki A.Detection of vancomycin-resistant enterococci(VRE)in stool specimens submitted for Clostridium difficile toxin testing[J].Braz J Microbiol,2017,48(3):489-492
[17]Szczypta A,Talaga K,Bulanda M.Nursing care for patients infected or colonized with vancomycin-resistant enterococci(VRE)[J].Folia Med Cracov,2016,56(4):13-20
[18]Biswas PP,Dey S,Adhikari L,et al.Virulence markers of vancomycin resistant enterococci isolated from infected and colonized patients[J].J Glob Infect Dis,2014,6(4):157-63
[19]张瑞敏,周海燕,谭颜华,等.ICU患者导管相关性感染的目标性监测分析[J].中华医院感染学杂志,2015,25(20):4694-4695,4727Zhang Rui-min,Zhou Hai-yan,Tan Yan-hua,et al.Targeted monitoring of catheter-related infections in general ICU ward[J].Chinese Journal of Nosocomiology,2015,25(20):4694-4695,4727
[20]李六亿,陈美恋,吴安华,等.耐万古霉素肠球菌感染流行病学多中心研究[J].中国感染控制杂志,2015,14(8):518-523Li Liu-yi,Chen Mei-lian,Wu An-hua,et al.A multicenter study on epidemiology of vancomycin-resistant Enterococcus infection[J].Chinese Journal of Infection Control,2015,14(8):518-523
[21]白耀霞,余佳佳,徐杰,等.肠球菌万古霉素耐药基因和毒力基因的研究进展[J].甘肃医药,2017,36(6):433,444Bai Yao-xia,Yu Jia-jia,Xu Jie,et al.Research progress of enterococcus vancomycin resistant genes and virulence genes[J].Gansu Medical Journal,2017,36(6):433,444
[22]Chen XX,Lo YC,Su LH,et al.Investigation of the case numbers of catheter-related bloodstream infection overestimated by the central line-associated bloodstream infection surveillance definition[J].J Microbiol Immunol Infect,2015,48(6):625-631
[23]Chuang YC,Lin HY,Chen PY,et al.Effect of Daptomycin Dose on the Outcome of Vancomycin-Resistant,Daptomycin-Susceptible Enterococcus faecium Bacteremia[J].Clin Infect Dis,2017,64(8)1026-1034
[24]Adrie C,Lugosi M,Sonneville R,et al.Persistent lymphopenia is a risk factor for ICU-acquired infections and for death in ICU patients with sustained hypotension at admission[J].Ann Intensive Care2017,7(1):30
[25]Alevizakos M,Gaitanidis A,Nasioudis D,et al.Colonization with Vancomycin-Resistant Enterococci and Risk for Bloodstream Infection Among Patients With Malignancy:A Systematic Review and Meta-Analysis[J].Open Forum Infect Dis,2016,4(1):ofw246
[26]Garg S,Mohan B,Taneja N.Biofilm formation capability of enterococcal strains causing urinary tract infection vis-a-vis colonisation and correlation with enterococcal surface protein gene[J].Indian JMed Microbiol,2017,35(1):48-52
[27]Li M,Lee K,Hsu M,et al.Lactobacillus-derived extracellular vesicles enhance host immune responses against vancomycin-resistant enterococci[J].BMC Microbiol,2017,17(1):66
[28]刘畅,廖莎莎,朱立勤,等.万古霉素和利奈唑胺治疗革兰阳性球菌感染给药方案优化[J].天津医药,2016,44(8):1040-1042Liu Chang,Liao Sha-sha,Zhu Li-qin,et al.Optimization of vancomycin and linezolid dosage regimen for treatment of Gram-positive cocci infections[J].Tianjin Medical Journal,2016,44(8):1040-1042
[29]薄天慧,郝银松,王德琴,等.主动筛查重症监护病房耐万古霉素肠球菌和防控措施[J].中国消毒学杂志,2016,33(5):411-412,415Bo Tian-hui,Hao Yin-song,Wang De-qin,et al.Active surveillance on vancomycin resistant enterococcus in intensive care unit and control measures[J].Chinese Journal of Disinfection,2016,33(5):411-412,415
[30]梁蓓蓓,倪文涛,王瑾,等.替考拉宁与万古霉素治疗革兰氏阳性菌感染的临床疗效和安全性对比的Meta分析[J].中国临床药理学杂志,2017,33(2):176-180Liang Bei-bei,Ni Wen-tao,Wang Jin,et al.Effectiveness and safety of teicoplanin versus vancomycin for the treatment of gram-positive bacterial infections:Meta-analysis of randomised controlled trials[J].Chinese Journal of Clinical Pharmacology,2017,33(2):176-180