Atalay Sabri, Ece Gülfem, Samlıoğlu Pınar, Maraş Gül, Köse Işıl, Köse Sükran
Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey.
Mikrobiyol Bul. 2012 Oct;46(4):553-9.
Vancomycin-resistant enterocococci (VRE) are common pathogens that may lead to infection in intensive care units. VRE strains that colonize the hospital environment can stay alive for a long time on fomites and can easily be spread by the hands of hospital staff and by the instruments. The aim of this study was to evaluate the epidemic and sporadic VRE cases, following an epidemic at anesthesiology intensive care unit (ICU). The records of the patients hospitalized at anesthesiology ICU between October 2010-June 2011 were evaluated retrospectively. The hospitalized patients with VRE positive culture reports were included in this study. Rectal swab samples of the patients and environmental surveillance cultures were inoculated on sheep blood agar and enterococcosel agar media and incubated for 24-48 hours. The isolated strains were identified by conventional methods and automatized Vitek 2.0 system (BioMérieux, France). The molecular detection of VRE was performed by real-time polymerase chain reaction (Cepheid GeneXpert System, USA). A total of 19 VRE colonised or infected cases (11 male, 8 female; age range: 18-96 years, mean age: 60 years) that were detected sporadically or during the epidemic, were included in this study. Ten (52.6%) cases were evaluated as colonization (seven rectal, two urinary and one both urinary and rectal colonisation). Nine patients were considered as infected (five bacteremia, three catheter infections and one urinary tract infection). Five of the nine patients directly progressed to infection. Four of the nine patients progressed to infection after rectal colonization. Eight of the infected cases were treated with daptomycin and one case with linezolid. Five of the infected and treated cases died and the rate of mortality was determined as 55.6%. PCR was applied to the samples of eight cases and vanA was detected in seven of these. VRE were not grown in two of the PCR positive samples and one PCR positive sample did not yield VRE growth in culture. VRE were detected from the samples obtained from patients' monitors, infusion sets, bedside, bedstands and walls and the origin of VRE was thought to be environmental contamination. It was concluded that adherence to infection control guidelines and continuous education of the health-care personel were prerequisites for effective control of VRE colonization and infection in the health-care setting.
耐万古霉素肠球菌（VRE）是常见病原体，可能导致重症监护病房发生感染。定植于医院环境中的VRE菌株可在污染物表面长期存活，且很容易通过医院工作人员的手和器械传播。本研究旨在评估麻醉重症监护病房（ICU）发生疫情后，VRE的流行病例和散发病例情况。对2010年10月至2011年6月期间在麻醉ICU住院患者的记录进行回顾性评估。本研究纳入了VRE培养报告呈阳性的住院患者。将患者的直肠拭子样本和环境监测培养物接种于羊血琼脂和肠球菌琼脂培养基上，培养24 - 48小时。通过传统方法和自动化Vitek 2.0系统（法国生物梅里埃公司）对分离出的菌株进行鉴定。采用实时聚合酶链反应（美国赛沛GeneXpert系统）对VRE进行分子检测。本研究共纳入19例VRE定植或感染病例（男性11例，女性8例；年龄范围：18 - 96岁，平均年龄：60岁），这些病例为散发病例或在疫情期间发现。10例（52.6%）病例被评估为定植（7例直肠定植，2例尿道定植，1例尿道和直肠均定植）。9例患者被视为感染（5例菌血症，3例导管感染，1例尿路感染）。9例感染患者中有5例直接进展为感染。9例患者中有4例在直肠定植后进展为感染。8例感染病例接受了达托霉素治疗，1例接受利奈唑胺治疗。5例接受治疗的感染病例死亡，死亡率为55.6%。对8例病例的样本进行了PCR检测，其中7例检测到vanA。在2份PCR阳性样本中未培养出VRE，1份PCR阳性样本在培养中未产生VRE生长。从患者的监护仪、输液器集、床边、床架和墙壁获取的样本中检测到VRE，认为VRE的来源是环境污染。得出的结论是，遵守感染控制指南以及对医护人员进行持续教育是在医疗环境中有效控制VRE定植和感染的先决条件。
