Stosor V, Kruszynski J, Suriano T, Noskin G A, Peterson L R
Department of Pathology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Infect Control Hosp Epidemiol. 1999 Oct;20(10):653-9. doi: 10.1086/501560.
To determine the molecular epidemiology of vancomycin-resistant enterococci (VRE) at our medical center in order to identify the extent of strain clonality and possible transmission patterns of this pathogen.
An important facet of our infection control program includes molecular typing of all clinical and surveillance isolates of VRE to determine transmission patterns in the hospital. Molecular strain typing is performed by restriction endonuclease analysis (REA) of genomic DNA. REA patterns are visually compared to categorize VRE strains into type and subtype designations.
A 588-bed, university-affiliated, tertiary-care hospital and a neighboring 155-bed rehabilitation facility.
From January 1995 through December 1996, 379 VRE isolates were collected from 197 patients. Thirty-three genotypes were determined by REA typing; 15 genotypes were implicated in 29 instances of potential nosocomial transmission. Three major clusters of VRE involving patients on multiple nursing units and two adjacent hospitals were identified. The remaining instances of nosocomial transmission occurred in small patient clusters.
In conclusion, the VRE epidemic at this medical center is polyclonal. VRE transmission patterns are complex, and, while large clusters do occur, the usual pattern of nosocomial acquisition of this pathogen occurs in the setting of "mini-clusters".
确定我院医疗中心耐万古霉素肠球菌（VRE）的分子流行病学特征，以明确菌株克隆性程度及该病原体可能的传播模式。
我们感染控制计划的一个重要方面包括对所有VRE临床和监测分离株进行分子分型，以确定医院内的传播模式。通过对基因组DNA进行限制性内切酶分析（REA）来进行分子菌株分型。直观比较REA图谱，将VRE菌株分类为型和亚型。
一家拥有588张床位的大学附属医院和一家相邻的拥有155张床位的康复机构。
1995年1月至1996年12月，从197例患者中收集到379株VRE分离株。通过REA分型确定了33种基因型；15种基因型涉及29例潜在的医院内传播。确定了涉及多个护理单元患者和两家相邻医院的三个主要VRE簇。其余医院内传播病例发生在小患者群中。
总之，该医疗中心的VRE流行是多克隆性的。VRE传播模式复杂，虽然确实会出现大的簇，但该病原体医院内获得的常见模式发生在“小簇”环境中。
