The Role of "Colonization Pressure" in the Spread of Vancomycin-Resistant Enterococci

作者：Marc J. M. Bonten, Sarah Slaughter, Anton W. Ambergen, Mary K. Hayden, Jean van Voorhis, Catherine Nathan, Robert A. Weinstein · 发表于：Archives of Internal Medicine · 年份：1998 · DOI：10.1001/archinte.158.10.1127 · 被引用次数：441 · 研究领域：Infection Control in Healthcare、Antimicrobial Resistance in Staphylococcus、Nosocomial Infections in ICU

OBJECTIVE: The spread of nosocomial multiresistant microorganisms is affected by compliance with infection control measures and antibiotic use. We hypothesized that "colonization pressure" (ie, the proportion of other patients colonized) also is an important variable. We studied the effect of colonization pressure, compliance with infection control measures, antibiotic use, and other previously identified risk factors on acquisition of colonization with vancomycin-resistant enterococci (VRE). METHODS: Rectal colonization was studied daily for 19 weeks in 181 consecutive patients who were admitted to a single medical intensive care unit. A statistical model was created using a Cox proportional hazards regression model including length of stay in the medical intensive care unit until acquisition of VRE, colonization pressure, personnel compliance with infection control measures (hand washing and glove use), APACHE (Acute Physiology and Chronic Health Evaluation) 11 scores, and the proportion of days that a patient received vancomycin or third-generation cephalosporins, sucralfate, and enteral feeding. RESULTS: With survival until colonization with VRE as the end point, colonization pressure was the most important variable affecting acquisition of VRE (hazard ratio [HR], 1.032; 95% confidence interval [C1], 1.012-1.052; P=.002). In addition, enteral feeding was associated with acquisition of VRE (HR, 1.009; 95% CI, 1.000-1.017; P=.05), and there was a trend toward association of...