Salgado Cassandra D
Medical University of South Carolina, Charleston, SC, USA.
Am J Infect Control. 2008 Dec;36(10):S175.e5-8. doi: 10.1016/j.ajic.2008.10.010.
Between 2 to 4 million patients each year develop health care-acquired infections in the United States. Infection resulting from vancomycin-resistant Enterococcus (VRE) is now the second to third most common cause of nosocomial infections in the United States. VRE is most often transmitted by the contaminated hands, clothing, and equipment of health care workers. Patients with VRE bloodstream infections (BSIs) have increased rates of recurrent BSI (16.9% vs 3.7%, respectively, P < .0001), increased crude case fatality rates (relative risk [RR], 2.57; 95% confidence interval [CI]: 2.27-2.91), increased mortality because of bacteremia (RR, 1.79; 95% CI: 1.28-2.50), and increased hospital costs of $27,000 per episode of BSI (P = .04) compared with those with vancomycin-susceptible BSI. Additionally, transfer of the gene responsible for vancomycin resistance to S aureus has been demonstrated in vitro, and reports of clinical infections because of vancomycin-resistant Staphylococcus aureus have been reported from many areas of the world, including the United States. Risk factors for VRE colonization and infection include prolonged length of hospital stay, use of broad-spectrum antibiotics, having an indwelling invasive device, and close proximity to another VRE-colonized or -infected patient; however, risk factors for developing VRE BSI among colonized patients have not been fully described.
Infection control measures for VRE include antibiotic-usage control, reducing contamination of the environment with proper cleaning and disinfection, and reducing contamination of health care workers by use of contact precautions. Health care-acquired BSIs can also be effectively controlled by closely following central venous line prevention guidelines and complying with the central venous line bundle. Control and prevention of VRE colonization and thus infection would be expected to reduce morbidity, reduce health care costs, and save lives.
在美国，每年有200万至400万患者发生医疗保健相关感染。耐万古霉素肠球菌（VRE）引起的感染目前是美国医院感染的第二至第三大常见原因。VRE最常通过医护人员被污染的手、衣物和设备传播。患有VRE血流感染（BSI）的患者复发性BSI发生率增加（分别为16.9%和3.7%，P <.0001），粗病死率增加（相对风险[RR]，2.57；95%置信区间[CI]：2.27 - 2.91），因菌血症导致的死亡率增加（RR，1.79；95% CI：1.28 - 2.50），与耐万古霉素BSI患者相比，每例BSI的住院费用增加27,000美元（P =.04）。此外，负责万古霉素耐药性的基因已在体外被证明可转移至金黄色葡萄球菌，并且世界许多地区，包括美国，都报告了耐万古霉素金黄色葡萄球菌引起临床感染的病例。VRE定植和感染的风险因素包括住院时间延长、使用广谱抗生素、留置侵入性装置以及与另一名VRE定植或感染患者密切接触；然而，定植患者中发生VRE BSI的风险因素尚未完全明确。
VRE的感染控制措施包括抗生素使用控制、通过适当清洁和消毒减少环境污染以及通过采取接触预防措施减少医护人员污染。遵循中心静脉导管预防指南并遵守中心静脉导管集束措施，也可有效控制医疗保健相关BSI。控制和预防VRE定植从而预防感染有望降低发病率、降低医疗保健成本并挽救生命。
