Indumathi Venkatachalam, May Kyawt Aung, Deborah Chooi Mun Lai, Mabel Zhi Qi Foo, Jean Xiang Ying Sim, Shalvi Arora, Aung Myat Oo, Yuke Tien Fong, Kwee Yuen Tan, Lai Chee Lee, Moi Lin Ling
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引用次数: 0
Abstract
Objective: To describe the evolving epidemiology and risk associations of vancomycin-resistant Enterococcus (VRE) between 2018 and 2023 in a tertiary hospital in Singapore.
Methods: Inpatients in Singapore General Hospital (SGH) between January 2018 and December 2023 were included. VRE surveillance criteria changed in August 2020 and November 2022. Incidence of any VRE (VRE (all)), VRE from surveillance (VRE (surveillance)), clinical VRE isolates (VRE (clinical)), healthcare-associated VRE infections (HA-VRE (infections)) and bacteremia (VRE (bacteremia)) were reviewed. Three case-control studies were conducted. Environmental screening was performed.
Results: Over the six-year study period there were 5,173 patients with VRE, of whom 3,141 (60.7%) had HA-VRE, 5157 (99.7%) had E.faecium and 4,336 (84%) carried vanA.121 (2.2%) patients had VRE bacteraemia with mortality 50.4%. There were significant changes in incidence of VRE (all), VRE (surveillance) and VRE (clinical) but HA-VRE (infections) and VRE (bacteremia) remained stable. VRE acquisition was associated with presence of concurrent MRSA (OR 9.4, 95% CI 1.3-66.8, p-value < 0.02), CPE (OR 7.2, 95% CI 2.0-26.0, p-value <0.001), ICU admission (OR 6.1, 95% CI 2.8-13.2, p<0.001), hemodialysis (OR 4.6, 95% CI 1.8-12.0, p<0.001), surgery (OR 3.7, 95% CI 1.6-8.3, p<0.001), vancomycin use (OR 28.2, 95% CI 5.4-146.5, p<0.001) and metronidazole use (OR 4.4, 95% CI 1.0-19.0, p-value 0.04) in the preceding three-months. VRE infection had similar risk associations. 12.5% of environmental samples were VRE positive.
Conclusion: VRE endemic state in SGH is associated with significant patient and environmental VRE burden. VRE acquisition and infection have been associated with co-carriage of MRSA or CPE, vancomycin and metronidazole use, ICU admission and prior surgery. Targeted infection prevention and antimicrobial-stewardship programs may reduce VRE (infections).
期刊介绍：
The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.
The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that:
provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings;
provide new insight into cleaning, disinfection and decontamination;
provide new insight into the design of healthcare premises;
describe novel aspects of outbreaks of infection;
throw light on techniques for effective antimicrobial stewardship;
describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control;
improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change;
improve understanding of the use of IT systems in infection surveillance and prevention and control.
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