Control of Vancomycin-Resistant Enterococcus in Health Care Facilities in a Region

作者：Belinda E. Ostrowsky, William E. Trick, Annette H. Sohn, Stephen B. Quirk, Stacey C. Holt, Loretta A. Carson, Bertha C. Hill, Matthew J. Arduino, Matthew J. Kuehnert, William Robert Jarvis · 发表于：New England Journal of Medicine · 年份：2001 · DOI：10.1056/nejm200105103441903 · 被引用次数：309 · 研究领域：Antimicrobial Resistance in Staphylococcus、Surgical site infection prevention、Bacterial Identification and Susceptibility Testing

BACKGROUND: In late 1996, vancomycin-resistant enterococci were first detected in the Siouxland region of Iowa, Nebraska, and South Dakota. A task force was created, and in 1997 the assistance of the Centers for Disease Control and Prevention was sought in assessing the prevalence of vancomycin-resistant enterococci in the region's facilities and implementing recommendations for screening, infection control, and education at all 32 health care facilities in the region. METHODS: The infection-control intervention was evaluated in October 1998 and October 1999. We performed point-prevalence surveys, conducted a case-control study of gastrointestinal colonization with vancomycin-resistant enterococci, and compared infection-control practices and screening policies for vancomycin-resistant enterococci at the acute care and long-term care facilities in the Siouxland region. RESULTS: Perianal-swab samples were obtained from 1954 of 2196 eligible patients (89 percent) in 1998 and 1820 of 2049 eligible patients (89 percent) in 1999. The overall prevalence of vancomycin-resistant enterococci at 30 facilities that participated in all three years of the study decreased from 2.2 percent in 1997 to 1.4 percent in 1998 and to 0.5 percent in 1999 (P<0.001 by chi-square test for trend). The number of facilities that had had at least one patient with vancomycin-resistant enterococci declined from 15 in 1997 to 10 in 1998 to only 5 in 1999. At both acute care and long-term care facilities, the...