Oh Hyang Soon, Kim Eui Chong, Oh Myoung Don, Choe Kang Won
Infection Control Service, Seoul National University Hospital, Seoul, South Korea.
Scand J Infect Dis. 2004;36(11-12):790-4. doi: 10.1080/00365540410021117.
A vancomycin-resistant Enterococcus (VRE) outbreak occurred at a hematology/oncology (HO) service in a tertiary acute care hospital, 1 January to 30 April 2002. This study was undertaken to identify risk factors, and to establish relations between seasonal factors and this VRE outbreak. Every patient (n = 82) and health care worker (HCW) (n = 31) at the HO unit was screened by rectal swab and stool culture during the VRE outbreak. Environmental surface culture (n = 35) and pulsed-field gel electrophoresis (PFGE) of VRE isolates were preformed. Among a total of 82 patients, 17 had VRE. All VRE isolates were E. faecium, the 6 studied further were Van A with identical PFGE patterns. Cultures of surfaces and HCWs were negative for VRE. Prolonged hospital stay (p = 0.02), male gender (p = 0.02), and care in a 6-bed room (p < 0.01) were risk factors for acquisition of VRE. An association with the VRE outbreak period was found again for long hospital stay, but also for the antibiotic usage pattern, frequent surgery and a high proportion of new inexperienced staff (52% vs 4% before the outbreak (p < 0.01, Fisher's exact test). Sudden personnel turnover in high-risk units should be avoided.
2002年1月1日至4月30日期间，一家三级急症医院的血液学/肿瘤学（HO）科室发生了耐万古霉素肠球菌（VRE）暴发。本研究旨在确定危险因素，并建立季节因素与此次VRE暴发之间的关系。在VRE暴发期间，对HO科室的每一位患者（n = 82）和医护人员（HCW）（n = 31）进行直肠拭子和粪便培养筛查。对VRE分离株进行环境表面培养（n = 35）和脉冲场凝胶电泳（PFGE）。在总共82名患者中，17名感染了VRE。所有VRE分离株均为粪肠球菌，进一步研究的6株为Van A型，PFGE图谱相同。表面和医护人员的培养物VRE检测均为阴性。住院时间延长（p = 0.02）、男性（p = 0.02）以及在6人间接受护理（p < 0.01）是感染VRE的危险因素。再次发现住院时间长与VRE暴发期有关，抗生素使用模式、频繁手术以及新入职无经验工作人员比例高也与之有关（暴发前为4%，暴发时为52%，p < 0.01，Fisher精确检验）。应避免高风险科室人员的突然更替。
