Kim J M, Song Y G
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 1998 Dec;39(6):562-8. doi: 10.3349/ymj.1998.39.6.562.
Enterococci recently became the second-to-third most commonly isolated organism from nosocomial infections. Enterococci are intrinsically more resistant to many antimicrobial agents and often show acquired resistance to many antimicrobial agents including high-level aminoglycosides. With the increased use of vancomycin, vancomycin-resistant enterococci (VRE) has become an important nosocomial pathogen. In Korea, the proportion of VRE among all enterococcal of VRE is no longer low in some settings and recent observations of a sudden increase of VRE isolation in several hospitals in Korea suggests that VRE infection may become a serious problem in the near future. The most important considerations are that vancomycin-resistant genes may spread to other highly virulent genera, such as MRSA, and that there are no approved and convincingly effective antibiotics for the treatment of VRE. Therefore, current efforts have concentrated on limiting the spread of these organisms within the hospital environment. Prudent use of antimicrobial agents and strict adherence to preventive measures such as aggressive communication, education, and infection control practices are essential to control the spread of this organism. However, hospital infection control protocols and the laboratory support they require are costly in terms of space and supplies, as well as in personnel resources. These factors add further pressure to already stretched hospital budgets. Nevertheless, policies or programs defining and managing VRE infection or colonization should be established and now is the time to enforce an overall management strategy against VRE.
肠球菌最近成为医院感染中第二至第三常见的分离菌。肠球菌对许多抗菌药物具有内在的更高耐药性，并且常常对包括高水平氨基糖苷类在内的许多抗菌药物表现出获得性耐药。随着万古霉素使用的增加，耐万古霉素肠球菌（VRE）已成为一种重要的医院病原体。在韩国，VRE在所有肠球菌中的比例在某些情况下已不再低，并且最近韩国几家医院中VRE分离突然增加的观察结果表明，VRE感染在不久的将来可能会成为一个严重问题。最重要的考虑因素是耐万古霉素基因可能传播到其他高毒力菌属，如耐甲氧西林金黄色葡萄球菌（MRSA），并且目前没有经批准且有令人信服的疗效的抗生素用于治疗VRE。因此，目前的努力集中在限制这些微生物在医院环境中的传播。谨慎使用抗菌药物并严格遵守预防措施，如积极的沟通、教育和感染控制措施，对于控制这种微生物的传播至关重要。然而，医院感染控制方案及其所需的实验室支持在空间、物资以及人力资源方面成本高昂。这些因素给本已紧张的医院预算增加了进一步的压力。尽管如此，仍应制定界定和管理VRE感染或定植的政策或方案，现在是实施针对VRE的全面管理策略的时候了。
