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HASTANEDE YATAN HASTALARDAN ALINAN REKTAL SÜRÜNTÜ ÖRNEKLERİNDE VANKOMİSİNE DİRENÇLİ ENTEROKOK TARANMASI: STRATEJİK DEĞERLENDİRME

Yıl 2021, Cilt: 35 Sayı: 3, 70 - 76, 29.12.2021
https://doi.org/10.54962/ankemderg.1048456

Öz

Vankomisine dirençli enterokoklar (VRE), hastaneye yatış süresini uzatmakta, ve özellikle immünsüpresif hastalarda enfeksiyon gelişme riskini arttırabilmektedir. VRE taşıyıcılığı ve gelişebilen enfeksiyonların yayılmasını önlemek için tarama ve temas izolasyonları önerilmektedir. Kolonizasyon tarama politikası sağlık kuruluşlarının hastane enfeksiyon komitelerince uygulanan yönerge/kılavuzlarına göre gerçekleştirilmektedir. Bu retrospektif çalışmada, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesinde yatırılarak izlenen hastalardan alınan rektal sürüntü örneklerindeki VRE oranlarının belirlenmesi, tarama yapılan hastalarda gelişen VRE enfeksiyonlarıyla ilişkisinin değerlendirilmesi ve maliyet analizi yapılarak rektal sürüntü örneklerinin taranmasında klinik ve maliyet etkinliğin belirlenmesi amaçlanmıştır.
1 Ocak- 31 Aralık 2019 tarihleri arasında tüm birimlerde yatan hastalardan hastanemiz Hastane Sürveyans Politikası’na göre alınan rektal sürüntü örnekleri taşıma besiyerinde (Citotest, China) laboratuvara gönderilmiştir. ChromID VRE (bioMérieux, Fransa) besiyerine ekimi yapılan ve inkübasyon sonrasında menekşe rengi üreyen koloniler vankomisin dirençli (VR) Enterococcus faecium, yeşil renkte üreyen koloniler VR Enterococcus faecalis olarak ön tanı almıştır. Tanımlama matriks aracılı lazer dezorpsiyon iyonizasyon-uçuş zamanlı kütle spektrometresi (MALDI-TOF MS) cihazı (bioMérieux, Fransa) ile doğrulanmıştır.
Çalışma sürecinde 771 hastadan 1710 örnek alınmıştır. Erişkin örneklerinin % 7,9’unda (68/1362) , pediatri örneklerinin % 8,3’ünde (29/348), tüm örneklerin toplam % 8,1’inde (137/1710) VRE pozitifliği saptanmıştır. Her iki grupta da en yüksek pozitiflik oranı yoğun bakım hastalarındadır. Kemik iliği ve solid organ transplantasyon ünitelerinden gönderilen örneklerdeki pozitiflik oranları pediatri hastalarında % 8,82 iken, erişkin hastalarda %3,0 olarak saptanmıştır . Izole edilen toplam 137 VRE kökeninin % 77,4‘ü VR E. faecium’dur. VRE kolonizasyonu saptanan 108 erişkin hastanın üçünde kan, biyopsi ve idrar örneklerinde VRE saptanmış; tarama pozitifliği, klinik örnek pozitifliğinden önce belirlenmiştir. VRE kolonizasyonu saptanan 29 pediatri hastasının birinde idrar örneğinde VRE saptanmış ancak tarama pozitifliği klinik örnek pozitifliğinden 17 gün sonra ortaya çıkmıştır. Sadece sarf malzemeler dikkate alındığında örnek başına maliyet; VRE üremesi saptanmayan hastalar için ₺9,18 (1,62$), VRE üremesi saptanan hastalar için ₺35,38 (6,26$) olarak hesaplanmıştır.
Verilerimiz hastane enfeksiyon kontrol komitesine sunulmuş ve mali kaynakların, harcanan emeğin ve zamanın daha etkin kullanılması için 2020 yılı itibariyle hastanemizde VRE taraması sadece pediatrik hematoloji, onkoloji ve kemik iliği nakil hastalarında rutin olarak yapılmaya başlanmıştır.

Kaynakça

  • Antimicrobial resistance in the EU/EEA (EARS-Net) Annual Epidemiological Report for 2019 https://www.ecdc.europa.eu/sites/default/files/documents/surveillance-antimicrobial-resistance-Europe-2019.pdf . Erişim tarihi:15.08.2021.
  • Avcıoğlu F, Altınöz Aytar A, Öztürk E, Şahin İ, Çalışkan E. Düzce Üniversitesi Araştırma ve Uygulama Hastanesinde vankomisine dirençli enterokok kolonizasyonunun değerlendirilmesi. Düzce Tıp Fakültesi Derg. 2016;18(1):8-11.
  • Bryce E, Grand J, Scharf S, et al. Horizontal infection prevention measures and a risk-managed approach to vancomycin-resistant enterococci: an evaluation. Am Journal of Infect Control. 2015;43(11);1238-43.
  • Bulut A, Şengül H, Kaşıkcı ÖM. Vankomisine dirençli enterokok sürveyans çalışması: bir devlet hastanesi örneği. JAREN. 2018;4(1):21-7.
  • CDC “Management of Multidrug-Resistant Organisms In Healthcare Settings https://www.cdc.gov/infectioncontrol/guidelines/mdro Erişim tarihi:15.08.2021
  • Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 1995;44(12):6-7. https://www.cdc.gov/mmwr/preview/mmwrhtml/00039349.htm Erişim tarihi:15.08.2021
  • Central Asian and Eastern European Surveillance of Antimicrobial Resistance. Annual report 2017 (2018). https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/publications/2017/central-asian-and-eastern-european-surveillance-of-antimicrobial-resistance.-annual-report-2017-2018 Erişim tarihi:12.12.2021
  • De Lisle S, Perl TM. Vancomycin-resistant enterococci: a road map on how to prevent the emergence and transmission of antimicrobial resistance. Chest. 2003;123(5):504-18.
  • Hendrix CW, Hammond JM, Swoboda SM, et al. Surveilance strategies and impact of vancomycin-resistant enterococcal colonization and infection in critically ill patients. Ann Surg. 2001;233(2):259-65.
  • Johnstone J, Chen C, Rosella L, et al. Ontario, Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada. Am J Infect Control. 2018;46(11):1266-71.
  • Kirişçi Ö. ve Çalışkan A. Rektal tarama örnekleri ile klinik örneklerde üreyen vankomisine dirençli enterokokların irdelenmesi:yedi yıllık sürveyans, retrospektif kesitsel bir çalışma. ANKEM Derg. 2020;34(3):105-11.
  • Mundy LM, Sahm DF, Gilmore M. Relationships between enterococcal virulence and antimicrobial resistance, Clin Microbiol Rev. 2000;13(4):513-22.
  • Mutters NT, Gunther F, Frank U, et al. Costs and possible benefits of a two-tier infection control management strategy consisting of active screening for multidrug-resistant organisms and tailored control measures. J Hospital Infection. 2016;(93):191-6.
  • Patel R. Clinical impact of vancomycin-resistant enterococci. J Antimicrob Chemother. 2003;51(S3):13-21.
  • Shepard BD, Gilmore MS. Antibiotic resistant enterococci: the mechanisms and dveroynamics of drug introduction and resistance. Microbes Infect. 2002;4(2):215-24.
  • Sohn KM, Peck KR, Joo EJ, et al. Duration of colonization and risk factors for prolonged carriage of vancomycin-resistant enterococci after discharge from the hospital. Int J Infect Dis. 2013;17(4):240-60.
  • Uttley AH, Collins CH, Naidoo J, et al. Vancomycin resistant enterococci. Lancet. 1988;1(8575-6):57-8.
  • Vehreschild MJGT, Haverkamp M, Biehl LM, et al. Vancomycin-resistant enterococci (VRE): a reason to isolate?. Infection. 2019;47(1):7-11.
  • Wenzel RP, Edmond MB. Infection control: the case for horizontal rather than vertical interventional programs. Int J Infect Dis. 2010;14(Suppl 4):S3-5.
  • Weterings V, Oosten AV, Nieuwkoo E, et al. Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014–2017: successful control using a restrictive screening strategy. Antimicrob Resist Infect Control. 2021;10(1):38.
  • Woodford N, Johnson AP, Morrison D et al.Current perspectives on glycopeptide resistance. Clin Microbiol Rev. 1995;8(4):585-615.
  • Zhou W, Sun HZY, Gao S, et al. Characterization of clinical enterococci isolates, focusing on the vancomycinresistant enterococci in a tertiary hospital in China: based on the data from 2013 to 2018 Zhou et al. BMC Infect Dis. 2020;20:356-364.

Screening Vancomycin Resistant Enterococci in Rectal Swab Specimens of Hospitalised Patients: A Strategical Assessment

Yıl 2021, Cilt: 35 Sayı: 3, 70 - 76, 29.12.2021
https://doi.org/10.54962/ankemderg.1048456

Öz

Vancomycin-resistant enterococci (VRE) may lead to prolonged hospitalization stay and increase the risk of infections especially in immunosuppressed patients. Rectal swab screening and contact isolation are advised to prevent the spread of VRE colonisation and infection among patients. Colonisation screening policy is carried out according to the guidelines applied by the hospital infection committees. In this retrospective study, it was aimed to determine the rate of vancomycin-resistant enterococci (VRE) in rectal swab samples and to evaluate the relationship with VRE colonization and infection taken from hospitalized patients in Marmara University Pendik Training and Research Hospital and to determine the clinical efficacy and cost-effectiveness of rectal swab screening.
Rectal swab samples taken from hospitalized patients in all units between 1 January and 31 December 2019, according to our hospital's "Hospital Surveillance Policy", were sent to the laboratory in transport medium (Citotest, China) and incubated in ChromID VRE (bioMérieux, France) medium. Violet colored colonies were preidentified as vancomycin resistant (VR) Enterococcus faecium, and green colored colonies as VR Enterococcus faecalis. Identification was confirmed with a matrix mediated laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) device (bioMérieux, France).
During the study period, 1710 samples were taken from 771 patients. VRE positivity was detected in 7.9 % (68/1362) of adult samples, 8.3 % (29/348) of pediatric samples, and 8.1 % (137/1710) of all hospitalized patients. In both groups, the highest positivity rate was detected in intensive care patients. The positivity rate in the samples sent from the bone marrow transplantation and transplantation units was found to be 8.82 % in pediatric patients and 3.0 % in adult patients. Of the total 137 VRE strains isolated, 77.4 % were VR E. faecium. VRE was detected only three in 108 adult patients from the blood, biopsy and urine samples, and before the positivity of the clinical samples. VRE was detected in the urine sample of a pediatric patient in whom VRE was isolated in the rectal swab sample, but the screening positivity occurred 17 days after the clinical sample positivity. Screening cost per sample was calculated as ₺9,18 (1,62$) for VRE negative sample and ₺35,38 (6,26$) for VRE positive sample, excluding personnel cost. Our data was presented to the hospital infection control committee and since the beginning of 2020, VRE routine screening was restricted only to pediatric hematology, oncology and bone marrow transplant patients in order to use the financial sources, effort and time more effectively.

Kaynakça

  • Antimicrobial resistance in the EU/EEA (EARS-Net) Annual Epidemiological Report for 2019 https://www.ecdc.europa.eu/sites/default/files/documents/surveillance-antimicrobial-resistance-Europe-2019.pdf . Erişim tarihi:15.08.2021.
  • Avcıoğlu F, Altınöz Aytar A, Öztürk E, Şahin İ, Çalışkan E. Düzce Üniversitesi Araştırma ve Uygulama Hastanesinde vankomisine dirençli enterokok kolonizasyonunun değerlendirilmesi. Düzce Tıp Fakültesi Derg. 2016;18(1):8-11.
  • Bryce E, Grand J, Scharf S, et al. Horizontal infection prevention measures and a risk-managed approach to vancomycin-resistant enterococci: an evaluation. Am Journal of Infect Control. 2015;43(11);1238-43.
  • Bulut A, Şengül H, Kaşıkcı ÖM. Vankomisine dirençli enterokok sürveyans çalışması: bir devlet hastanesi örneği. JAREN. 2018;4(1):21-7.
  • CDC “Management of Multidrug-Resistant Organisms In Healthcare Settings https://www.cdc.gov/infectioncontrol/guidelines/mdro Erişim tarihi:15.08.2021
  • Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 1995;44(12):6-7. https://www.cdc.gov/mmwr/preview/mmwrhtml/00039349.htm Erişim tarihi:15.08.2021
  • Central Asian and Eastern European Surveillance of Antimicrobial Resistance. Annual report 2017 (2018). https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/publications/2017/central-asian-and-eastern-european-surveillance-of-antimicrobial-resistance.-annual-report-2017-2018 Erişim tarihi:12.12.2021
  • De Lisle S, Perl TM. Vancomycin-resistant enterococci: a road map on how to prevent the emergence and transmission of antimicrobial resistance. Chest. 2003;123(5):504-18.
  • Hendrix CW, Hammond JM, Swoboda SM, et al. Surveilance strategies and impact of vancomycin-resistant enterococcal colonization and infection in critically ill patients. Ann Surg. 2001;233(2):259-65.
  • Johnstone J, Chen C, Rosella L, et al. Ontario, Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada. Am J Infect Control. 2018;46(11):1266-71.
  • Kirişçi Ö. ve Çalışkan A. Rektal tarama örnekleri ile klinik örneklerde üreyen vankomisine dirençli enterokokların irdelenmesi:yedi yıllık sürveyans, retrospektif kesitsel bir çalışma. ANKEM Derg. 2020;34(3):105-11.
  • Mundy LM, Sahm DF, Gilmore M. Relationships between enterococcal virulence and antimicrobial resistance, Clin Microbiol Rev. 2000;13(4):513-22.
  • Mutters NT, Gunther F, Frank U, et al. Costs and possible benefits of a two-tier infection control management strategy consisting of active screening for multidrug-resistant organisms and tailored control measures. J Hospital Infection. 2016;(93):191-6.
  • Patel R. Clinical impact of vancomycin-resistant enterococci. J Antimicrob Chemother. 2003;51(S3):13-21.
  • Shepard BD, Gilmore MS. Antibiotic resistant enterococci: the mechanisms and dveroynamics of drug introduction and resistance. Microbes Infect. 2002;4(2):215-24.
  • Sohn KM, Peck KR, Joo EJ, et al. Duration of colonization and risk factors for prolonged carriage of vancomycin-resistant enterococci after discharge from the hospital. Int J Infect Dis. 2013;17(4):240-60.
  • Uttley AH, Collins CH, Naidoo J, et al. Vancomycin resistant enterococci. Lancet. 1988;1(8575-6):57-8.
  • Vehreschild MJGT, Haverkamp M, Biehl LM, et al. Vancomycin-resistant enterococci (VRE): a reason to isolate?. Infection. 2019;47(1):7-11.
  • Wenzel RP, Edmond MB. Infection control: the case for horizontal rather than vertical interventional programs. Int J Infect Dis. 2010;14(Suppl 4):S3-5.
  • Weterings V, Oosten AV, Nieuwkoo E, et al. Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014–2017: successful control using a restrictive screening strategy. Antimicrob Resist Infect Control. 2021;10(1):38.
  • Woodford N, Johnson AP, Morrison D et al.Current perspectives on glycopeptide resistance. Clin Microbiol Rev. 1995;8(4):585-615.
  • Zhou W, Sun HZY, Gao S, et al. Characterization of clinical enterococci isolates, focusing on the vancomycinresistant enterococci in a tertiary hospital in China: based on the data from 2013 to 2018 Zhou et al. BMC Infect Dis. 2020;20:356-364.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Tıbbi Mikrobiyoloji
Bölüm Araştırma Makaleleri
Yazarlar

Gamze Alçi 0000-0003-2987-2489

Deniz Güneşer Bu kişi benim 0000-0002-7967-5451

Ayfer Güner Bu kişi benim 0000-0002-5930-0708

Ayşegül Karahasan Bu kişi benim 0000-0002-1560-2624

Yayımlanma Tarihi 29 Aralık 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 35 Sayı: 3

Kaynak Göster

Vancouver Alçi G, Güneşer D, Güner A, Karahasan A. HASTANEDE YATAN HASTALARDAN ALINAN REKTAL SÜRÜNTÜ ÖRNEKLERİNDE VANKOMİSİNE DİRENÇLİ ENTEROKOK TARANMASI: STRATEJİK DEĞERLENDİRME. ANKEM Derg. 2021;35(3):70-6.