投稿分類 其他

主委發表種類: 壁報

投稿標題(中): 萬古黴素抗藥性屎腸球菌於血液腫瘤科造成之群突發

投稿標題(英): Outbreaks caused by vancomycin-resistant Enterococcus faecium in hematology and oncology units

投稿摘要: Background:
Vancomycin-resistance in Enterococcus faecium (VR E. faecium) poses a major threat in health care settings. Infection rate at intense care units in Taiwan caused by VR E. faecium from 2005 to 2014 raised in Medical Centers from 13.4% to 50.7%, and in regional hospitals from 8.8% to 50.4%. It is well known that patients in hematology and oncology departments are especially at risk of HAI VRE acquisition. We herein apply EBM methods to search meta-analyzed evidence to assess pooled data on the main sources, transmission modes and potential risk factors for VR E. faecium acquisition as well as appropriate infection control measures in order to terminate such HAI outbreaks.
Methods:
The terms: Vancomycin-resistance Enterococcus faecium, outbreak, hematology, oncology were used as keywords to search from the Outbreak Database and PubMed. A 2017 published SR (systematic review) was acquired out of 4 searching results afterward for critical appraisal.
Results and Discussions:
The SR included 35 VR E. faecium outbreaks describing 757 affected patients and 77 deaths. The most frequent site of pathogen detection were stool samples or rectal swabs (57% of all isolation sites), followed by blood cultures (30%). The most common outbreak source was an index patient. The main modes of transmission were (1) hands of health care workers, (2) contact to a contaminated environment and (3) patient-to-patient contact. The most common risk factor for VR E. faecium positivity was prior antibiotic treatment. The most common infection control measures performed were screening and isolating or cohorting of patients.
Conclusions:
A rational use of antibiotics in hematology and oncology units is recommended in order to reduce selection pressure on resistant pathogens such as VR E. faecium In addition the importance of hand hygiene should be stressed to all staff whenever possible.

稿件檔: