Camins Bernard C, Farley Monica M, Jernigan John J, Ray Susan M, Steinberg James P, Blumberg Henry M
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA.
Infect Control Hosp Epidemiol. 2007 Aug;28(8):983-91. doi: 10.1086/518971. Epub 2007 Jun 29.
Vancomycin-resistant Enterococcus organisms (VRE) have emerged as common nosocomial pathogens, but few population-based data are available on the impact of invasive VRE infections.
We assessed the incidence of invasive VRE infections and predictors of mortality among patients identified during prospective, population-based surveillance performed in the metropolitan statistical area (MSA) of Atlanta, Georgia.
From July 1997 through June 2000, a total of 192 patients who resided in the Atlanta MSA developed an invasive VRE infection, for a rate of 1.57 cases per 100,000 person-years. The incidence of invasive VRE disease significantly increased from 0.91 cases per 100,000 person-years during the first year of the study to 1.73 cases per 100,000 person-years during the third year of the study (P<.001). Rates of invasive VRE infection were significantly higher among African American patients than white patients (2.59 vs 0.70 cases per 100,000 person-years; P<.001). Blood was the most common sterile site from which VRE was recovered (161 [83%] of 193 isolates), followed by deep surgical sites (17 [9%]), peritoneal fluid (10 [5%]), pleural fluid (3 [2%]), and cerebrospinal fluid (1 [0.5%]). In multivariate analysis, a Charlson comorbidity index of 5 or greater, previous receipt of antibiotic therapy, having 2 or more sets of blood cultures positive for VRE, and receipt of central parenteral nutrition were independent predictors of mortality, whereas receipt of an antibiotic with in vitro activity against the VRE isolate was associated with a decreased risk of mortality. Molecular typing revealed 38 different pulsed-field gel electrophoresis patterns, but the 2 most common pulsed-field gel electrophoresis types were found at 3 Emory University-affiliated hospitals.
The incidence of invasive VRE infection significantly increased in the Atlanta MSA during the 3-year study period, with significant racial disparities detected. Receipt of an antimicrobial agent with in vitro activity against VRE was associated with a lower mortality rate. Molecular typing results demonstrated polyclonal emergence of VRE in Atlanta.
耐万古霉素肠球菌（VRE）已成为常见的医院病原体，但关于侵袭性VRE感染影响的基于人群的数据很少。
我们评估了在佐治亚州亚特兰大大都市区（MSA）进行的前瞻性人群监测中确定的患者中侵袭性VRE感染的发生率和死亡率预测因素。
从1997年7月到2000年6月，共有192名居住在亚特兰大MSA的患者发生了侵袭性VRE感染，发病率为每10万人年1.57例。侵袭性VRE疾病的发病率从研究第一年的每10万人年0.91例显著增加到研究第三年的每10万人年1.73例（P<0.001）。非裔美国患者的侵袭性VRE感染率显著高于白人患者（每10万人年2.59例对0.70例；P<0.001）。血液是分离出VRE最常见的无菌部位（193株分离株中的161株[83%]），其次是深部手术部位（17株[9%]）、腹腔液（10株[5%]）、胸腔液（3株[2%]）和脑脊液（1株[0.5%]）。在多变量分析中，Charlson合并症指数为5或更高、先前接受过抗生素治疗、有2套或更多套血培养VRE阳性以及接受中心肠外营养是死亡的独立预测因素，而接受对VRE分离株有体外活性的抗生素与死亡风险降低相关。分子分型显示有38种不同的脉冲场凝胶电泳图谱，但2种最常见的脉冲场凝胶电泳类型出现在3家埃默里大学附属医院。
在3年研究期间，亚特兰大MSA的侵袭性VRE感染发病率显著增加，发现了显著的种族差异。接受对VRE有体外活性的抗菌药物与较低的死亡率相关。分子分型结果表明亚特兰大的VRE是多克隆出现的。
