Chou Yen-Yi, Lin Te-Yu, Lin Jung-Chung, Wang Ning-Chi, Peng Ming-Yieh, Chang Feng-Yee
Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2 Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
J Microbiol Immunol Infect. 2008 Apr;41(2):124-9.
Vancomycin-resistant enterococci (VRE) have emerged as important nosocomial pathogens. This study was conducted to clarify the clinical features and outcome of patients with vancomycin-resistant enterococcal bacteremia.
Patients with vancomycin-resistant enterococcal bacteremia treated at a medical center in northern Taiwan between November 1998 and July 2006 were reviewed. Clinical and bacteriological characteristics of Enterococcus faecium and Enterococcus faecalis were compared.
Twelve patients (6 males and 6 females) were included for analyses. The mean age was 69.3 years (range, 40 to 86 years), and 8 cases (66.7%) were older than 65 years. All patients had underlying disease. Two patients received total hip replacement before development of VRE bacteremia. Twelve patients had prior exposure to broad-spectrum antimicrobial therapy. Ten patients had prior intensive care unit stay and prior mechanical ventilation before VRE bacteremia. All of the patients (n = 12) had an intravascular catheter in place. Bacteremia was caused by E. faecalis in 4 patients and by E. faecium in eight. The portals of entry included urinary tract (8.3%), skin, soft tissue and bone (41.7%) and unknown sources (50.0%). E. faecium showed a higher rate of resistance to ampicillin and teicoplanin than E. faecalis (87.5% vs 0.0%, p=0.01). The 60-day mortality rate was higher in patients with E. faecium bacteremia than E. faecalis bacteremia (62.5% vs 0.0%), although statistical significance was not obtained (p=0.08).
VRE bacteremia may have an impact on the mortality and morbidity of hospitalized patients. Patients with bacteremia caused by vancomycin-resistant E. faecium had a grave prognosis, especially immunosuppressed patients. The prudent use of antibiotics and strict enforcement of infection control may prevent further emergence and spread of VRE.
耐万古霉素肠球菌（VRE）已成为重要的医院感染病原菌。本研究旨在阐明耐万古霉素肠球菌菌血症患者的临床特征及转归。
回顾1998年11月至2006年7月在台湾北部一家医疗中心接受治疗的耐万古霉素肠球菌菌血症患者。比较粪肠球菌和屎肠球菌的临床及细菌学特征。
纳入12例患者（6例男性和6例女性）进行分析。平均年龄为69.3岁（范围40至86岁），8例（66.7%）年龄大于65岁。所有患者均有基础疾病。2例患者在发生VRE菌血症前接受了全髋关节置换术。12例患者既往均接受过广谱抗菌治疗。10例患者在发生VRE菌血症前曾入住重症监护病房并接受过机械通气。所有患者（n = 12）均留置血管内导管。4例患者的菌血症由粪肠球菌引起，8例由屎肠球菌引起。感染途径包括尿路（8.3%）、皮肤、软组织和骨（41.7%）以及不明来源（50.0%）。屎肠球菌对氨苄西林和替考拉宁的耐药率高于粪肠球菌（87.5%对0.0%，p = 0.01）。屎肠球菌菌血症患者的60天死亡率高于粪肠球菌菌血症患者（62.5%对0.0%），尽管未达到统计学显著性（p = 0.08）。
VRE菌血症可能影响住院患者的死亡率和发病率。耐万古霉素屎肠球菌引起菌血症的患者预后严重，尤其是免疫抑制患者。谨慎使用抗生素和严格执行感染控制措施可预防VRE的进一步出现和传播。
