Gardam MA, Conly JM
Infection Prevention and Control Unit, University Health Network, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario M5G 2C4, Canada.
Curr Infect Dis Rep. 1999 Oct;1(4):319-327. doi: 10.1007/s11908-999-0037-z.
Glycopeptide resistance may be either constitutive or transferable (on plasmids or as a transposon), and four phenotypes (van A, B, C, D) have been described to date. Recent data suggest solid media screening protocols appear to be insensitive at detecting low levels of carriage, and up to 40% of colonized patients may be falsely glycopeptide-resistant enterococci (GRE) negative. Managing GRE-colonized or -infected patients using contact precautions appears to be useful in controlling clonal outbreaks, but may be of limited utility once GRE is endemic. Alternate strategies to manage GRE-colonized patients with prolonged carriage and in outpatient or home health settings include using risk-based transmission assessment to limit the logistic and psychosocial difficulties associated with the use of continuous contact precautions. The therapeutic options for treating GRE infection remain limited. Attempts to decolonize GRE-colonized patients with bacitracin appear to be of limited utility.
糖肽耐药性可能是组成型的，也可能是可转移的（通过质粒或转座子），迄今为止已描述了四种表型（Van A、B、C、D）。近期数据表明，固体培养基筛查方案在检测低水平携带时似乎不敏感，高达40%的定植患者可能被误判为糖肽耐药肠球菌（GRE）阴性。对GRE定植或感染患者采取接触预防措施进行管理，在控制克隆暴发方面似乎是有效的，但一旦GRE成为地方病，其作用可能有限。对于长期携带GRE的患者以及门诊或家庭健康环境中的GRE定植患者，其他管理策略包括使用基于风险的传播评估，以限制与持续接触预防措施使用相关的后勤和社会心理困难。治疗GRE感染的治疗选择仍然有限。使用杆菌肽使GRE定植患者去定植的尝试似乎效果有限。
