耐万古霉素肠球菌医院感染流行特征与危险因素分析

Prevalence of vancomycin-resistant Enterococci causing nosocomial infections and its risk factors

目的对耐万古霉素肠球菌（VRE）医院感染现状、流行特征及相关危险因素进行分析,为制定VRE医院感染预防控制策略提供科学依据。方法收集医院2010年1月-2014年9月23例VRE医院感染患者的临床及流行病学资料,采用1∶1成组设计病例对照研究,运用单因素及多因素logistic回归分析,探索VRE医院感染发生的危险因素。结果 4年共纳入2 887例住院患者,23例发生VRE医院感染,4年感染率波动较大,为0.20%~1.90%;尿路感染是VRE医院感染最常见的感染类型,占73.91%;科室分布以老年病房最高,占26.09%;8例VRE患者发生混合感染;死亡8例,病死率34.78%;多因素logistic回归分析结果显示,高龄、患有基础疾病、感染前使用过碳青霉烯类抗菌药物是VRE医院感染的独立危险因素。结论老年患者、患有基础疾病、使用碳青霉烯类抗菌药物是VRE医院感染的危险因素,VRE与真菌混合感染提示不良临床结局,临床应严格掌握广谱抗菌药物使用指征,预防VRE的发生和传播。

OBJECTIVE To determine the current status,prevalence and risk factors of vancomycin-resistant Enterococci（VRE）causing nosocomial infections in the hospital so as to provide scientific reference for formulating strategies for prevention and control of nosocomial VRE infections.METHODS Clinical and epidemic data of the patients that were diagnosed with nosocomial VRE infection from Jan.2010 to Sep.2014 were collected,and then a 1∶1case-control study was performed.Single-factor and multi-factor logistic regression analyses were applied to analyze the risk factors.RESULTS Totally 2887 patients during the 4years were enrolled,of which,23 were infected with VRE.The annual incidence of VRE infection fluctuated greatly,ranging from 0.20%to 1.90%.Urinary tract infection was the most common type of nosocomial VRE infections,accounting for 73.91%.The geriatric ward was the predominant affected department,accounting for 26.09%.Co-infections occurred in 8VRE patients,and 8cases died,with the mortality rate of 34.78%.Multiple logistic regression analysis showed that old age,suffering from underlying diseases and usage of carbapenem agents before infections were independent risk factors for acquisition of VRE.CONCLUSIONOld age,suffering from underlying diseases and usage of carbapenem agents are risk factors for nosocomial VRE infections.The co-infections of VRE with fungi may suggest a bad clinical ending.The determined VRE prevalence and risk factors of VRE acquisition are expected to be useful in establishing guidelines for preventing occurrence and spread of VRE infections.