Skip to main content
main-content

01.12.2017 | Research | Ausgabe 1/2017 Open Access

Antimicrobial Resistance & Infection Control 1/2017

The effect of antibiotic use on prevalence of nosocomial vancomycin-resistant enterococci- an ecologic study

Zeitschrift:
Antimicrobial Resistance & Infection Control > Ausgabe 1/2017
Autoren:
Cornelius Remschmidt, Michael Behnke, Axel Kola, Luis A. Peña Diaz, Anna M. Rohde, Petra Gastmeier, Frank Schwab

Abstract

Background

Vancomycin-resistant enterococci (VRE) are among the most common antimicrobial-resistant pathogens causing nosocomial infections. Although antibiotic use has been identified as a risk factor for VRE, it remains unclear which antimicrobial agents particularly facilitate VRE selection. Here, we assessed whether use of specific antimicrobial agents is independently associated with healthcare-associated (HA) VRE rates in a university hospital setting in Berlin, Germany.

Methods

We conducted the study between January 2014 and December 2015 at the Charité-university hospital of Berlin, Germany. From the hospital pharmacy, we extracted data for all antibacterials for systemic use (anatomical therapeutic chemical (ATC)-classification J01) and calculated ward specific antibiotic consumption in defined daily doses (DDDs) per 100 patient-days (PD). We used the microbiology laboratory database to identify all patients with isolation of invasive or non-invasive VRE and calculated HA-VRE incidence as nosocomial VRE-cases per 100 patients and HA-VRE incidence density as nosocomial VRE-cases per 1000 PD. We defined VRE isolates as hospital-acquired if they were identified three days or later after hospital admission and otherwise as community-acquired (CA-VRE). We performed univariable and multivariable regression analyses to estimate the association of the frequency of HA-VRE per month with antibiotic use and other parameters such as length of stay, type of ward or presence of at least one CA-VRE on ward. In a second analysis, we considered only patients with VRE infections.

Results

We included data from 204,054 patients with 948,380 PD from 61 wards. Overall, 1430 VRE-cases were identified of which 409 (28.6%) were considered hospital-acquired (HA). We found that carbapenem use in the current month and prior-month use of glycopeptides increased the risk for HA-VRE by 1% per 1 DDD/100 PD and 3% per 1 DDD/100 PD, respectively. However, when only VRE from clinical samples were considered, only glycopeptide use showed a statistically significant association. In both models, detection of at least one patient with CA-VRE on a ward in the current month significantly increased the risk of HA-VRE, thereby indicating nosocomial spread of VRE.

Conclusions

Our findings suggest that the risk of HA-VRE is associated with specific antimicrobial agents. Prudent use of these antimicrobial agents might reduce nosocomial VRE rates. That appearance of at least one CA-VRE case on the ward increased the risk of HA-VRE detection highlights the importance of strict hand hygiene practices to interrupt person-to-person transmission of VRE.
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2017

Antimicrobial Resistance & Infection Control 1/2017 Zur Ausgabe

Neu im Fachgebiet Innere Medizin

05.03.2021 | Riechstörungen | Podcast | Nachrichten

Riechstörungen – über vielfältige Ursachen und neue Therapien

Mit Prof. Thomas Hummel, Leiter des Zentrums für Riechen und Schmecken, Uniklinik Dresden

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Innere Medizin und bleiben Sie gut informiert – ganz bequem per eMail.

© Springer Medizin 

Bildnachweise