Peking Union Medical College Graduate School, Chinese Academy of Medical Sciences, Beijing, China.
Chin Med J (Engl). 2011 Feb;124(4):498-503.
The incidence of vancomycin-resistant enterococci (VRE) appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since March 2008 to March 2009. The objective of this study was to analyze the molecular features of the isolates and the control measures used to eradicate a VRE outbreak in a tertiary institution in China.
We characterized VRE isolates from 21 infected and 11 colonized inpatients from a single hospital by pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST), the analysis of Tn1546-like elements and virulence genes detection. Infection control measures, including more environmental disinfection, screening for VRE colonization, contact precautions, education and strict antibiotic restriction, were implemented to control the outbreak.
During the outbreak, a total of 32 VRE strains were obtained. There were 21 strains found in Emergency Intensive Care Unit (EICU), 9 isolates from Geriatric Ward, and two from other units. All the isolates harbored the vanA gene, however, four of them exhibited the VanB phenotype. Meanwhile, MLST analysis revealed that all isolates belonged to clonal complex (CC) 17. With the infection-control measures, the epidemic was constrained in two units (EICU and Geriatric Ward). After March 2009, no further case infected with VRE was detected in the following one-year period.
The outbreak was controlled by continuous implementation of the infection control programme, and more rigorous infection control policy is needed.
万古霉素耐药肠球菌（VRE）在中国的发病率似乎呈上升趋势，但很少有医院感染爆发的报道。我院自 2008 年 3 月至 2009 年 3 月发生了 VRE 爆发。本研究旨在分析分离株的分子特征及采用的控制措施，以消除中国一家三级医院的 VRE 爆发。
对来自一家医院的 21 例感染和 11 例定植患者的 VRE 分离株进行脉冲场凝胶电泳（PFGE）、多位点序列分型（MLST）、Tn1546 样元件分析和毒力基因检测。采取了包括加强环境消毒、筛查 VRE 定植、接触预防、教育和严格抗生素限制等感染控制措施来控制疫情。
疫情期间共获得 32 株 VRE 株。其中 21 株来自急诊重症监护病房（EICU），9 株来自老年病房，2 株来自其他病房。所有分离株均携带 vanA 基因，但其中 4 株表现为 VanB 表型。同时，MLST 分析显示所有分离株均属于克隆群（CC）17。通过感染控制措施，疫情得到了限制，仅在 EICU 和老年病房两个病房中发生。2009 年 3 月之后，在接下来的一年中没有再发现 VRE 感染病例。
通过持续实施感染控制计划，疫情得到了控制，需要采取更严格的感染控制政策。
