背景:一些单中心研究表明,在地方性或非暴发环境下,消除对万古霉素耐药肠球菌(VRE)的隔离控制,对感染率没有影响。我们对停止隔离的影响进行了系统评价和荟萃分析。
方法:我们搜索了PubMed,Embase,截至2024年4月10日,Cochrane图书馆和WebofScience用于评估VRE隔离停止的研究。亚组分析评估了异质性的来源。
结果:9项研究纳入最终综述。四个报告了医院获得性VRE(HA-VRE)感染的发生率,五个报告了医院获得性VRE血流感染(HA-VREBSI)的发生率。停止分离前后HA-VRE感染率无显著差异(RR,0.93;95%CI,0.68-1.26;P=0.62),以及HA-VREBSI的发生率没有显着差异(RR,0.68;95%CI,0.44-1.07,P=0.09)。此外,我们进行了两项亚组分析:一项根据研究是否在COVID-19期间进行分层,另一项根据临床医生是否继续使用个人防护设备分层.两项分析均显示,亚组之间HA-VREBSI的发生率和隔离终止没有显着差异。
结论:在地方性或非暴发环境中,VRE患者停止隔离治疗与HA-VRE感染率升高无关.
BACKGROUND: Several single-center studies have suggested that eliminating isolation for vancomycin-resistant enterococci (VRE) control in the context of endemic or nonoutbreak settings, has no impact on infection rates. We performed a systematic review and meta-analysis on the impact of discontinuing isolation.
METHODS: We searched PubMed, Embase, the Cochrane Library, and Web of Science through April 10, 2024 for studies evaluating discontinuation of isolation for VRE. Subgroup analyses assessed sources of heterogeneity.
RESULTS: Nine studies were included in the final review. Four reported the incidence of hospital-acquired VRE (HA-VRE) infections and 5 reported the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). No significant difference between the rates of HA-VRE infection before and after stopping isolation was observed (risk ratios, 0.93; 95% confidence interval, 0.68-1.26; P = .62), as well as no significant difference on the incidence of HA-VRE BSI (risk ratios, 0.68; 95% confidence interval, 0.44-1.07, P = .09). Furthermore, we conducted 2 subgroup analyses: one stratified by whether the studies were conducted during Coronavirus Disease 19 (COVID-19), and the other stratified by whether clinicians continued to use personal protective equipment. Both analyses revealed no significant differences in the incidence of HA-VRE BSI and termination of isolation between the subgroups.
CONCLUSIONS: In the context of endemic or nonoutbreak settings, discontinuation of isolation for VRE patients has not been associated with an increased rate of HA-VRE infections.