The rectal carriage of glycopeptide-resistant Enterococcus spp. (GRE) had been established at approximately 50% in a series of prevalence studies on a busy haematological malignancy unit.
The aim of this study was to reduce the chance of patients acquiring GRE.
A prospective three-phase sequential study was performed.
In Phase 1, the acquisition rate of GRE detectable by rectal swab was measured without any intervention for a period of 4 months.
For the following 8 months (Phase 2), the first-line treatment for febrile neutropenic episodes was changed from monotherapy with ceftazidime to piperacillin/tazobactam.
In addition, an intense education programme was introduced to improve hygiene to reduce the risk of case-to-case spread.
In the final 4 months (Phase 3), ceftazidime was again used as the first-line antimicrobial, while continuing the same level of training in relation to hygiene.
The carriage of GRE was measured from rectal swabs done weekly.
During the initial 4 months, at any time, 40-50% of patients in the unit were colonized with GRE, and 43 of 75 (57%) new patients initially negative for GRE acquired it within 6 weeks of their admission.
In Phase 2,25 patients out of 129 (19%) acquired GRE, with the acquisition rate falling progressively so that in the last 3 months, only one new patient acquired GRE (logrank comparison of probabilities for cohort 1 vs cohort 2b : P<0.0001). (...)
Mots-clés Pascal : Infection nosocomiale, Glycopeptide, Antibiotique, Antibactérien, Résistance, Souche hospitalière, Enterococcus, Streptococcaceae, Micrococcales, Bactérie, Service hospitalier, Contamination biologique, Prévention, Programme sanitaire, Evaluation, Homme, Prescription médicale
Mots-clés Pascal anglais : Nosocomial infection, Glycopeptide, Antibiotic, Antibacterial agent, Resistance, Hospital strain, Enterococcus, Streptococcaceae, Micrococcales, Bacteria, Hospital ward, Biological contamination, Prevention, Sanitary program, Evaluation, Human, Medical prescription
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0168803
Code Inist : 002B30A03B. Création : 16/11/1999.