Lack of Increased Colonization with Vancomycin-Resistant Enterococci during Preferential Use of Vancomycin for Treatment during an Outbreak of Healthcare-Associated Clostridium difficile Infection
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作者:
Miller, Mark
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McGill Univ, Jewish Gen Hosp, Montreal, PQ H3T 1E2, CanadaCornerstone Res Grp, Burlington, ON L7N 3H8, Canada
Miller, Mark
[2
]
Bernard, Lisa
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Cornerstone Res Grp, Burlington, ON L7N 3H8, CanadaCornerstone Res Grp, Burlington, ON L7N 3H8, Canada
Bernard, Lisa
[1
]
Thompson, Melissa
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Cornerstone Res Grp, Burlington, ON L7N 3H8, CanadaCornerstone Res Grp, Burlington, ON L7N 3H8, Canada
Thompson, Melissa
[1
]
Grima, Daniel
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Cornerstone Res Grp, Burlington, ON L7N 3H8, CanadaCornerstone Res Grp, Burlington, ON L7N 3H8, Canada
Grima, Daniel
[1
]
Pepin, Jocelyne
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McGill Univ, Jewish Gen Hosp, Montreal, PQ H3T 1E2, CanadaCornerstone Res Grp, Burlington, ON L7N 3H8, Canada
Pepin, Jocelyne
[2
]
机构:
[1] Cornerstone Res Grp, Burlington, ON L7N 3H8, Canada
OBJECTIVE. To assess whether use of oral vancomycin for treatment during an outbreak of Clostridium difficile infection (CDI) was associated with increased rates of colonization with vancomycin-resistant enterococci (VRE).. DESIGN. A retrospective analysis of hospital databases. SETTING. The Jewish General Hospital in Montreal, Quebec, Canada. METHODS. We collected data regarding VRE colonization and CDI from November 1, 2000, through September 30, 2007, during which policies of preferential oral metronidazole or vancomycin treatment were implemented to control an outbreak of CDI. Four periods were considered: period 1, the preoutbreak period when metronidazole was used; period 2, the CDI outbreak period when metronidazole was used; period 3, the postoutbreak period when vancomycin was used; and period 4, the postoutbreak period when metronidazole was used. RESULTS. A total of 2,412 cases of CDI and 425 cases of VRE colonization were identified. The rate of CDI increased significantly during period 2 and decreased to preoutbreak levels during period 3. The rate of VRE also increased during period 2 and decreased during the first 18 months of period 3. A clonal outbreak of cases of VRE (VanA) colonization was observed toward the end of period 3 and into period 4. Excluding the period of the clonal outbreak, there was a strong correlation between the number of cases of CDI and VRE colonization (r = 0.736; P = .001) and a negative association between VRE colonization and vancomycin use (r = -0.765; P = .04). CONCLUSIONS. Increased vancomycin use was not associated with an increase in VRE colonization over a 2-year period. Restriction of vancomycin use during CDI outbreaks because of the fear of increasing VRE colonization may not be warranted. Infect Control Hosp Epidemiol 2010; 31(7):710-715
机构:
Pusan Natl Univ, Sch Med, Med Res Inst, Dept Internal Med,Div Infect Dis, Pusan, South KoreaPusan Natl Univ, Sch Med, Med Res Inst, Dept Internal Med,Div Infect Dis, Pusan, South Korea
Choi, Hee Kyoung
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Kim, Kye Hyung
Lee, Sun Hee
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Pusan Natl Univ, Sch Med, Med Res Inst, Dept Internal Med,Div Infect Dis, Pusan, South KoreaPusan Natl Univ, Sch Med, Med Res Inst, Dept Internal Med,Div Infect Dis, Pusan, South Korea
机构:
VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Stevens, Vanessa W.
Khader, Karim
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VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Khader, Karim
Echevarria, Kelly
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US Dept Vet Affairs, Antimicrobial Stewardship Task Force, Pharm Benefits Management Program, Hines, IL USA
South Texas Vet Affairs Hlth Care Syst, San Antonio, TX USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Echevarria, Kelly
Nelson, Richard E.
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VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Nelson, Richard E.
Zhang, Yue
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VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Zhang, Yue
Jones, Makoto
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VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Jones, Makoto
Timbrook, Tristan T.
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VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USA
Univ Utah Hlth, Salt Lake City, UT USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Timbrook, Tristan T.
Samore, Matthew H.
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VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Samore, Matthew H.
Rubin, Michael A.
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VA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
Univ Utah, Dept Internal Med, Div Epidemiol, Sch Med, Salt Lake City, UT 84148 USAVA Salt Lake City Hlth Care Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
机构:
Case Western Reserve Univ, Sch Med, Dept Infect Dis, Univ Hosp Cleveland, Cleveland, OH USALouis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USA
Al-Nassir, Wafa N.
Sethi, Ajay K.
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Case Western Reserve Univ, Sch Med, Dept Epidemiol & Biostat, Cleveland, OH 44106 USALouis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USA
Sethi, Ajay K.
Li, Yuejin
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Louis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USALouis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USA
Li, Yuejin
Pultz, Michael J.
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Louis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USALouis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USA
Pultz, Michael J.
Riggs, Michelle M.
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Louis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USALouis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USA
Riggs, Michelle M.
Donskey, Curtis J.
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Louis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USALouis Stokes Cleveland VA Med Ctr, Res Serv, Cleveland, OH 44106 USA
机构:
St Marianna Univ Hosp, Dept Emergency & Crit Care Med, Miyamae Ku, Kanagawa, Japan
Cedars Sinai Med Ctr, Div Infect Dis, Los Angeles, CA 90048 USASt Marianna Univ Hosp, Dept Emergency & Crit Care Med, Miyamae Ku, Kanagawa, Japan
Fujitani, Shigeki
George, W. Lance
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VA Greater Los Angeles Healthcare Syst, Infect Dis Sect, Los Angeles, CA USASt Marianna Univ Hosp, Dept Emergency & Crit Care Med, Miyamae Ku, Kanagawa, Japan
George, W. Lance
Morgan, Margie A.
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Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USASt Marianna Univ Hosp, Dept Emergency & Crit Care Med, Miyamae Ku, Kanagawa, Japan
Morgan, Margie A.
Nichols, Stephen
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Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USASt Marianna Univ Hosp, Dept Emergency & Crit Care Med, Miyamae Ku, Kanagawa, Japan
Nichols, Stephen
Murthy, A. Rekha
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机构:
Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USA
Cedars Sinai Med Ctr, Dept Hosp Epidemiol, Los Angeles, CA 90048 USASt Marianna Univ Hosp, Dept Emergency & Crit Care Med, Miyamae Ku, Kanagawa, Japan
机构:
Columbia Univ, Med Ctr, Mailman Sch Publ Hlth, New York, NY USAColumbia Univ, Med Ctr, Mailman Sch Publ Hlth, New York, NY USA
Monteserin, N.
Larson, E.
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Columbia Univ, Med Ctr, Mailman Sch Publ Hlth, New York, NY USA
Columbia Univ, Med Ctr, Sch Nursing, New York, NY USAColumbia Univ, Med Ctr, Mailman Sch Publ Hlth, New York, NY USA