医院内耐万古霉素肠球菌定植、感染风险因素调查与控制

Investigation and intervention of risk factors for colonization and infection of nosocomial vancomycin resistant enterococcus

目的调查医院内耐万古霉素肠球菌(vancomycin resistantenterococcus,VRE)定植、感染状况,对感染控制措施进行评价。方法对2005年1月至2009年12月在北京协和医院住院患者的VRE定植、感染进行前瞻性调查,对危险因素进行分析;对感染控制措施进行评价。结果共发现VRE阳性检出者34例,阳性检出者涉及全院17个病区,加强医疗及老年病区相对集中(24/34,70.6%),65岁以上者占73.5%(25/34),全部患者具备1项以上VRE感染风险因素。初次检出标本主要来源依次为尿液(14/34,11例来自尿管留置者)、血液(7/34,4例来自中央静脉留置者)、直肠拭子(6/34)、手术部位(5/34)。34例VRE阳性检出病例中,6例为定植,其余28例为临床感染并进行治疗;VanA型耐药菌株有24例;屎肠球菌28例。阳性检出菌株体外药敏对糖肽类全部耐药,对利奈唑胺敏感性为100%;28例感染者给予利奈唑胺治疗,有效率75.0%(21/28)。34例患者死亡11例(病死率32.4%,归因病死率23.5%)。未发生VRE院内水平传播。结论 VRE定植、感染者的病死率高;老年人、入院前半年内曾使用抗菌药物、留置导管等可能是VRE定植、感染的主要危险因素;VRE对全部糖肽类抗菌药物耐药;应加强抗菌药物应用的管理,强化医院感染控制措施(特别是接触隔离)在加强医疗部门的实施和监督。

Objective To evaluate the colonization and infection of vancomycin resistant enterococcus（VRE） in hospital and the intervention effect.Methods Data were collected from patients with colonization or infection of VRE from January 2005 to December 2009.The prospective study was conducted,and the risk factors were analyzed.Besides,the intervention effect was evaluated.Results Overall 34 patients with VRE were diagnosed.They were distributed over 17 wards,especially in ICU and geriatric wards（24/34,70.6%）.Among the patients with VRE,25 cases were more than 65 years old,and all the patients got at least one risk factor for colonization and infection of VRE.The main sources of VRE were urine（14/34）,blood（7/34）,rectal swab（6/34） and surgical site（5/34）.Among the patients,28 cases were diagnosed as VRE infection and 6 cases as colonization.Drug-resistant strains with phenotype VanA and Enterococcus faecium were found in 24 cases and 28 cases,respectively.All the VRE strains were resistant to glycopeptides but sensitive to linezolid（100%）.The 28 patients with VRE infection were treated with linezolid,with an effective treatment rate of 75.0%（21/28）.The mortality and attributable mortality of the 34 patients were 32.4% and 23.5%,respectively.No horizontal transmission of VRE was found in hospital.Conclusion Colonization and infection of VRE are both related to high mortality.Being elderly,administration of antibiotics within 6 months before admission,indwelling ureter,central venous catheter,etc.may be the main risk factors for colonization and infection of VRE.All the VRE strains are resistant to glycopeptides but sensitive to linezolid.Infection control measures,especially contact isolation,must be put into practice and supervised.