Ali Murat ÇELİK, Sami KINIKLI, Ali Pekcan DEMİRÖZ, Selcan ARSLAN, Zeliha Koçak TUFAN, Ferah ERGİN, Hasan IRMAK, Salih CESUR, Cemal BULUT

Absence of vancomycin-resistant enterococci (VRE) despite the presence of risk factors: A survey of rectal carriage of VRE

Amaç: Dirençli mikororganizmalar, hastalığa sebep olmadan önce, hastaların ve sağlık çalışanlarının ilk olarak gastrointestinal sisteminde kolonize olurlar. Bu çalışmada hastanede yatan hastalarda ve sağlık çalışanlarında vankomisine dirençli enterokok (VRE) kolonizasyonu ve taşıyıcılık için risk faktörlerinin bulunup bulunmadığının araştırılması amaçlanmıştır.Yöntem ve gereç: Çalışma 600 yataklı bir eğitim ve araştırma hastanesinde yapıldı. Özellikle yoğun bakımda yatan hastalar olmak üzere 508 yataklı hasta ve sağlık çalışanı çalışmaya dahil edildi. Antibiyotik kullanım geçmişi, katater varlığı, eşlik eden hastalık varlığı gibi risk faktörleri sorgulandı. VRE kolonizasyonu araştırılmak üzere rektal sürüntü kültürleri alındı.Bulgular:Hem hasta grubunda hem de sağlık çalışanlarında VRE kolonizasyonu için daha önceki çalışmalarda belirtilmiş olan risk faktörleri yüksek oranda saptandı. VRE kolonizasyonu başka bir hastaneden transfer edilen bir hasta hariç saptanmadı. Sonuç: Risk faktörlerinin varlığına rağmen kolonizasyonun olmaması: hastane içi transferin az olması, sağlık çalışanlarında sıkı tarama yapılması ve VRE bulunmayışı (hastalara geçiş ihtimali daha az olacaktır), sıkı takip edilen enfeksiyon kontrol stratejisi, VRE kolonizasyonu olan hastaların izole edilmesi, damar içi kataterlerin endikasyonsuz kullanılmaması ve erken çekilmesine, malignite ve eşlik eden hastalık varlığının az olmasına bağlandı.

Risk faktörlerinin bulunmasına rağmen vankomisin dirençli enterokokun (VRE) bulunmaması: Bir VRE rektal taşıyıcılık surveyansı

Aim: The resistant organisms from patients and healthcare workers (HCWs) first colonized the gastrointestinal tract before causing infections in patients. In this study, presence of risk factors for vancomycin-resistant enterococci (VRE) colonization and the prevalence of rectal carriage of VRE among HCWs and hospitalized patients in the absence of an outbreak were investigated. Design: Cross-sectional study. Setting: A 600-bed training and research hospital.Materials and methods: A total of 508 intensive-care unit (ICU) patients and HCWs in these units were included. Risk factors such as previous antibiotic use, especially vancomycin and cephalosporin, the presence of invasive devices like catheters, and co-morbid diseases were investigated. Rectal smear cultures were obtained from each participant to detect VRE colonization.Results: Risk factors for VRE colonization were identified among both patients and HCWs with a significant ratio. Except for one patient, who had been transferred from another hospital, no VRE colonization was detected in patients or HCWs.Conclusion: The result was attributed to factors such as low inter-institutional transfer, HCWs’ being free of VRE colonization (transmission is less likely), strict infection control strategy of the hospital, isolation of newly transferred patients suspected of having VRE colonization, isolation of VRE colonization identified patients, use of indwelling catheters only when indicated and their early removal, and low prevalence of predisposing co-morbid diseases and malignity. We want to underline that a strict hospital infection control program can prevent colonization, even in the presence of risk factors.

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