Green M, Barbadora K, Michaels M
Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pennsylvania 15213.
J Clin Microbiol. 1991 Nov;29(11):2503-6. doi: 10.1128/jcm.29.11.2503-2506.1991.
Between November 1988 and October 1989, 49 first-time pediatric liver transplant recipients at the Children's Hospital of Pittsburgh were prospectively monitored for the presence of stool colonization and the development of disease caused by vancomycin-resistant gram-positive cocci (VRGPC). Quantitative stool culturing was done on a weekly basis, and cultures were planted onto a selective medium for VRGPC. Isolates for which the MIC was greater than or equal to 8 were considered resistant to vancomycin. Patients were monitored clinically for the development of infection, and their charts were systematically reviewed for the use of antibiotics. Eighty-six isolates were recovered from 36 of the 49 patients. Enterococcal species were isolated from 31 patients and included Enterococcus gallinarum (n = 28), E. casseliflavus (n = 14), E. faecium (n = 9), E. faecalis (n = 2), E. mundtii (n = 2), and E. durans (n = 1). Stool colonization with vancomycin-resistant enterococci was noted to increase steadily during the first month after transplantation. Only 9 of 31 patients demonstrated clearance of these organisms in serial repeat cultures. Additional isolates of VRGPC included Lactobacillus confusus (n = 13), Lactobacillus spp. (n = 12), and Pediococcus pentosaceus (n = 4). Infection due to VRGPC developed in three patients: a urinary tract infection in two and peritonitis in one. E. faecium was the pathogen in each of these cases. The ranges of MICs of vancomycin were 8 to 32 micrograms/ml for all enterococcal isolates and greater than 128 micrograms/ml for Lactobacillus and Pediococcus isolates. All Lactobacillus and Pediococcus isolates were resistant to teicoplanin, although they were susceptible to daptomycin. All other isolates were susceptible to both teicoplanin and daptomycin. This study demonstrates that stool colonization with VRGPC may be a common and early finding among pediatric liver transplant recipients. However, infection appears to be uncommon.
1988年11月至1989年10月期间，匹兹堡儿童医院对49例首次接受小儿肝移植的受者进行了前瞻性监测，以观察耐万古霉素革兰氏阳性球菌（VRGPC）在粪便中的定植情况及由此引发疾病的情况。每周进行一次粪便定量培养，并将培养物接种到VRGPC的选择性培养基上。对万古霉素的最低抑菌浓度（MIC）大于或等于8的分离株被视为对万古霉素耐药。对患者进行临床感染监测，并系统查阅其病历以了解抗生素的使用情况。从49例患者中的36例分离出86株菌株。从31例患者中分离出肠球菌属，包括鹑鸡肠球菌（n = 28）、格氏肠球菌（n = 14）、屎肠球菌（n = 9）、粪肠球菌（n = 2）、蒙氏肠球菌（n = 2）和耐久肠球菌（n = 1）。耐万古霉素肠球菌在粪便中的定植在移植后的第一个月内稳步增加。31例患者中只有9例在连续重复培养中显示这些菌被清除。VRGPC的其他分离株包括混淆乳杆菌（n = 13）、乳杆菌属（n = 12）和戊糖片球菌（n = 4）。3例患者发生了VRGPC感染：2例为尿路感染，1例为腹膜炎。这3例病例的病原体均为屎肠球菌。所有肠球菌分离株的万古霉素MIC范围为8至32微克/毫升，乳杆菌和片球菌分离株的MIC大于128微克/毫升。所有乳杆菌和片球菌分离株对替考拉宁耐药，尽管它们对达托霉素敏感。所有其他分离株对替考拉宁和达托霉素均敏感。这项研究表明，VRGPC在粪便中的定植在小儿肝移植受者中可能是一个常见且早期出现的现象。然而，感染似乎并不常见。
