Bonten Marc J M, Willems Rob J
Universitair Medisch Centrum Utrecht, afd. Medische Microbiologie, Utrecht, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(38):A5233.
There have recently been 12 outbreaks of infection caused by vancomycin-resistant enterococci (VRE) in Dutch hospitals. Although the first VRE outbreaks were reported almost 12 years ago, such outbreaks remained uncommon and the question is why they are occurring now. Based on molecular epidemiological studies we have learned that a subpopulation of Enterococcus faecium, resistant to amoxicillin but susceptible to vancomycin, has become highly endemic in Dutch hospitals in the past 12 years. Initial analyses suggest that several transposons containing vancomycin-resistance genes have been introduced into this population, followed by nosocomial spread. We recommend that hospitals without detected VRE outbreaks screen high-risk patients for the presence of VRE. If transmission has already occurred in many hospitals, it will be extremely difficult (and costly) to eradicate VRE.
最近荷兰医院发生了12起由耐万古霉素肠球菌（VRE）引起的感染暴发。尽管首次VRE暴发报告于近12年前，但此类暴发仍不常见，问题是为何现在会发生。基于分子流行病学研究，我们了解到在过去12年中，对阿莫西林耐药但对万古霉素敏感的粪肠球菌亚群在荷兰医院中已高度流行。初步分析表明，几个含有万古霉素耐药基因的转座子已被引入该菌群，随后在医院内传播。我们建议未检测到VRE暴发的医院对高危患者进行VRE筛查。如果许多医院已经发生了传播，根除VRE将极其困难（且成本高昂）。
