The Worth of Surveillance for Vancomycin-Resistant Enterococci in the Hematology-Oncology Unit
Notice bibliographique
Résumé
Abstract Background: Vancomycin-resistant enterococcus (VRE) has become a nosocomial pathogen of increasing importance. First identified in Europe in 1988, it has since been identified in multiple sites in the United States and Canada, as well as in Latin America. A 20-fold increase in the percentage of enterococci associated with nosocomial infections that were resistant to vancomycin, from 0.4% in 1989 to 7.9% in 1993, has been reported by the Centers for Disease Control and Prevention. VRE outbreak has been identified on February 2012 in hematology-oncology unit. It has since implemented some outbreak measures in order to control this outbreak, and as part of the control program during this outbreak of VRE infection in oncology-hematology unit of our tertiary care hospital, swab anal cultures have been performed weekly for inpatients as well as at the moment of their hospitalization. Objectives: To assess the incidence of colonization and infection by VRE of admitted patients in oncology-hematology unit and to evaluate the role of neutropenia and central line as well as their impact on blood stream infection (BSI) by VRE in previous colonized patients. Methods: All patients admitted to hematology-oncology unit in Instituto do Câncer do Estado de São Paulo São Paulo (ICESP) were undertaken to surveillance for VRE by Hospital Infection Control Committee from March 1, 2012 to May 31, 2014. It is important to highlight that ICESP has not promoted bone marrow transplantation. Neutropenia was defined as a neutrophil count ≤0.5 x 109/L. Feces (in patients with neutropenia) or rectal swab for those with a neutrophil count >0.5 x 109/L were collected for research VRE on admission and weekly for those that persist with negative results. Enterococci were isolated by standard microbiological methods. It was considered patients with colonized VRE when a bacterium is present, without any signs or symptoms of infection. BSI by VRE was defined in patients with positive blood culture for VRE. Results: A total of 1,666 patients had been screening for VRE colonization. One hundred sixty-one cases of VRE colonization were detected among them. The rate of VRE colonization during hospitalization was 9.7%. The incidence rate of VRE colonization was 9.4 cases per 1,000 inpatient-days. Twenty (12.4%) out of 161 VRE colonized patients developed BSI by VRE. The incidence of BSI by VRE was 1.2 cases per 1,000 inpatient-days. Eleven (55%) patients with BSI by VRE presented Acute Leukemia. A hundred percent of patients with BSI by VRE presented neutropenia and 14 (70%) out of 20 had central venous catheter inserted as well. Conclusions: We conclude that it is important to perform surveillance for VRE due to our incidence of patients colonized by VRE such as BSI by VRE. We believe these data may justify surveillance attendance and contact precautions. It was observed the importance of neutropenia to BSI by VRE in patients previously colonized. Thus, this fact could suggest that others studies are necessary in order to evaluate the role of antibiotic as linezolid for febrile neutropenia treatment in patients colonized by VRE. Disclosures No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».