Sažetak
Uvod/Cilj. Enterococcus spp. rezistentan na vankomicin (VRE) jedan je od najznačajnih bolničkih patogena. Cilj rada bio je da se utvrde stope rektalne kolonizacije VRE kod bolesnika lečenih u Odeljenju za hematološku intenzivnu negu, i da se sagledaju faktori rizika od kolonizacije. Metode. Prospektivnom kohortnom studijom obuhvaćeno je 70 bolesnika lečenih u periodu od tri meseca u Klinici za hematologiju Kliničkog centra Srbije u Beogradu. Podaci o demografskim karatkteristikama bolesnika, upotrebi antibiotika i drugim faktorima rizika od VRE kolonizacije tokom sadašnje i prethodnih hospitalizacija (tokom 6 meseci) prikupljani su za svakog bolesnika uz pomoć upitnika. Bolesnicima je uzmana koprokultura ili rektalni bris na prijemu, a prilikom otpusta onim bolesnicima kod kojih na prijemu nije izolovan VRE. Osetljivost izolata proverena je disk-difuzionim testom sa diskovima vankomicina 30 μg/mL (BBL) u skladu sa Clinical and Laboratory Standards Institute (CLSI) standardima. Rezultati. Na prijemu je bilo 7% VRE kolonizovnaih bolesnika. Stopa VRE kolonizacije tokom tekuće hospitalizacije iznosila je 41,5%. Univarijantna logistička regresija pokazala je statistički značajne razlike u pogledu dijagnoze, dužine sadašnje hospitalizacije, primeni aminoglikozida i piperacilin/tazobaktama u sadašnjoj hospitalizaciji, dužini primene karbapenema i piperacilin /tazobaktama u sadašnjoj hospitalizaciji između bolesnika kolonizovanih VRE i nekolonizovanih bolesnika. Multivarijantnom logističkom regresijom ustanovljeno je da su akutna mijeloidna leukemija (AML), primena karbapenema u prethodnoj hospitalizaciji i dužina primene piperacilin/tazobactama u sadašnjoj hospitalizaciji bili nezavisni faktori rizika od kolonizacije bolesnika VRE. Zaključak. Zabeležena je visoka stopa kolonizacije pacijenata VRE. Racionalna upotreba antibiotika i aktivni nadzor mogu biti korisne mere prevencije nastanka rezistencije bakterija na antibiotike.
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Reference
Willems RJ, Bonten MJ. Glycopeptide-resistant enterococci: de-ciphering virulence, resistance and epidemicity. Curr Opin In-fect Dis 2007; 20(4): 384−90.
Sujatha S, Praharaj I. Glycopeptide resistance in gram-positive cocci: a review. Interdiscip Perspect Infect Dis 2012; 2012: 781679.
Surveillance report. Antimicrobial resistance surveillance in Europe, 2009. Available from: www.ecdc.europa.eu/en/.../1011_SUR_annual_EARS_Net_2009
Arias C, Murray B. The rise of the Enterococcus: beyond van-comycin resistance. Nat Rev Microbiol 2012; 10(4): 266−78.
Low DE, Keller N, Barth A, Jones RN. Clinical prevalence, anti-microbial susceptibility, and geographic resistance patterns of enterococci: results from the SENTRY Antimicrobial Surveil-lance Program, 1997-1999. Clin Infect Dis 2001; 32 Suppl 2: S133−45.
Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, et al. Emergence and spread of vancomycin resis-tance among enterococci in Europe. Euro Surveill 2008; 13(47). pii: 19046.
ECDC. Antimicrobial resistance surveillance in Europe 2010. Annual report of the European Antimicrobial Resistance Sur-veillance Network (EARS-Net). Available from: http://repositorio.insa.pt/handle/10400.18/702
National Nosocomial Infections Surveillance (NNIS) System Report data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32(8): 470−85.
Achenbach C, Flores E, Farerrell P, Pitrak D,Weber G. Prevalence of risk factors for colonization with vancomicyn-resistant enterococcus among human immunodeficiency virus positive outpatients. Infect Control Hosp Epidemiol 2006; 27(1): 102−4.
Sakka V, Tsiodras S, Galani L, Antoniadou A, Souli M, Galani I, et al. Risk-factors and predictors of mortality in patients colo-nised with vancomycin-resistant enterococci. Clin Microbiol Infect 2008; 14(1): 14−21.
Tacconelli E, Cataldo MA. Vancomycin-resistant enterococci (VRE): transmission and control. Int J Antimicrob Agents 2008; 31: 99−106.
Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus spp. Infect Control Hosp Epidemiol 2003; 24(5); 362−86.
Yoon YK, Lee SE, Lee J, Kim HJ, Kim JY, Park DW, et al. Risk factors for prolonged carriage of vancomycin-resistant Ente-rococcus faecium among patients in intensive care units: a case-control study. J Antimicrob Chemother 2011; 66(8): 1831−8.
CLSI. Performance Standards for Antimicrobial Disk Suscep-tibility Testing; Seventeenth Informational Supplement M100-S17. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.
CLSI. Performance Standards for Antimicrobial Disk Suscep-tibility Tests; M02-A10. Approved Standard − Tenthth edi-tion. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.
Gambarotto K, Ploy MC, Turlure P, Grélaud C, Martin C, Bordes-soule D, et al. Prevalence of vancomycin-resistant enterococci in fecal samples from hospitalized patients and nonhospita-lized controls in a cattle-rearing area of France. J Clin Micro-biol 2000; 38(2): 620−4.
van den Braak N, Ott A, van Belkum A, Kluytmans JA, Koeleman JG, Spanjaard L, et al. Prevalence and determinants of fecal colonization with vancomycin-resistant Enterococcus in hospitalized patients in The Netherlands. Infect Control Hosp Epidemiol 2000; 21(8): 520−4.
Almyroudis NG, Lesse AJ, Hahn T, Samonis G, Hazamy PA, Wongkittiroch K, et al. Molecular epidemiology and risk factors for colonization by vancomycin-resistant Enterococcus in pa-tients with hematologic malignancies. Infect Control Hosp Epidemiol 2011; 32(5): 490−6.
Liss BJ, Vehreschild JJ, Cornely OA, Hallek M, Fätkenheuer G, Wisplinghoff H, et al. Intestinal colonisation and blood stream infections due to vancomycin-resistantentero-cocci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection 2012; 40(6): 613−9.
Matar MJ, Tarrand J, Raad I, Rolston KV. Colonization and in-fection with vancomycin-resistant Enterococcus among pa-tients with cancer. Am J Infect Control 2006; 34(8): 534−6.
Suntharam N, Lankford MG, Trick WE, Peterson LR, Noskin GA. Risk factors for acquisition of vancomycin-resistant enterococci among hematology-oncology patients. Diagn Microbiol Infect Dis 2002; 43(3): 183−8.
Mirović V, Tomanović B, Konstantinović S. The frequency of resis-tance to antibiotics of most frequently isolated bacteria from blood cultures during the period 1997-2002. Vojnosanit Pregl 2004; 61(4): 391−7. (Serbian)
Cheong HJ, Song JY, Eom JS, Kim WJ, Choi SJ, Choi JH, et al. Colonization rate, risk factor for acquisition, and genetic sensity of vancomicyn-resistant enterococci (VRE) isolated from culture of patients in intensive care unit from Korea. Korean J Infect Dis 2002; 34: 276−84.
Metallidis S, Chatzidimitriou M, Tsona A, Bisiklis A, Lazaraki G, Koumentaki E, et al. Vancomicyn-Resistant Enterococci, Colonizing the Intenstinal Tract of Patients in a University Hospital in Greece. Braz J Infect Dis 2006; 10(3): 179−84.
Song JY, Cheong HJ, Jo YM, Choi WS, Noh JY, Heo JY, et al. Vancomicyn-Resistant Enterococci colonization before admi-sion to the intensive care unit: A clinico-epidemiological analysis. Am J Infect Control 2009; 37(9): 734−40.
Padiglione AA, Wolfe R, Grabsch EA, Olden D, Pearson S, Franklin C, et al. Risk Factors for New Detection of Van-comycin-Resistant Enterococci in Acute-Care Hospitals That Employ Strict Infection Control Procedures. Antimocrob Agents Chemother 2003; 47(8): 2492–8.
Carmely Y, Samore MH, Huskins C. The association between antecedent vancomicyn teatment and hospital-acquired vancomicyn-resistent eneterococci; a meta analysis. Arch Intern Med 1999; 159(20): 2461−8.
Ostrovsky BE, Venkataraman L, D'Agata EM, Gold HS, De Girolami, Samore MH. Vancomicyn-resistant enterococci intensive care units: high freguency of stool carrige during a non outbreak period. Arch Intern Med 1999; 159(13): 1467−72.
de Bruin MA, Riley LW. Does vancomycin prescribing intervention affect vancomycin-resistant enterococcus infection and colonization in hospitals? A systematic review. BMC Infect Dis 2007; 7: 24−35.
Stiefel U, Paterson DL, Pultz NJ, Gordon SM, Aron DC, Donskey CJ. Effect of the increasing use of piperacillin/tazobactam on the incidence of vancomycin-resistant enterococci in four aca-demic medical centers. Infect Control Hosp Epidemiol 2004; 25(5): 380−3.
Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, at al. NHSN annual update: antimicrobial-resistant pa-thogens associated with healthcare-associated infections: an-nual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Pre-vention, 2006-2007. Infect Control Hosp Epidemiol 2008; 29(11): 996−1011.