Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany.
Am J Infect Control. 2013 Sep;41(9):778-81. doi: 10.1016/j.ajic.2012.11.019. Epub 2013 Feb 28.
Vancomycin-resistant enterococci (VRE) are primarily opportunistic pathogens with incalculable clinical significance. In addition, the effectiveness of isolation in VRE is often not easily assessed. The goals of this study were to estimate the transmissibility of VRE of patients with VRE bacteraemia to other hospitalized patients and to document reliable epidemiologic data on all VRE cases in a large health care center.
A prospective survey on in-patients colonized and/or systemically infected with VRE was conducted at a 2,000-bed tertiary care university hospital in Germany. All roommates of VRE bacteraemia patients were analyzed. Pulsed-field gel electrophoresis was performed to assess clonal relatedness.
16,507 Screening tests were performed on 9,258 patients, of which 560 tested positive for VRE (6.1%). Nineteen patients also suffered from VRE bacteraemia, an incidence of 3.4%. This cohort was multimorbid and had high rates of exposure to external risk factors (eg, previous hospital stay prior to admission, 78.9%). The transmission rate to contacts was low (3.5%). Contact time of negative contacts was significantly lower than that of VRE-positive contacts (19.3 hours vs 72.0 hours, respectively, P < .006).
VRE bacteraemia was found exclusively in multimorbid patients, transmission occurred seldom, and average contact time of positive contacts was very high. The risk of transmission of VRE from bacteraemic patients to hospitalized contacts is low.
耐万古霉素肠球菌（VRE）主要是机会性病原体，具有不可估量的临床意义。此外，评估 VRE 隔离的效果往往并不容易。本研究的目的是估计 VRE 菌血症患者 VRE 对其他住院患者的传染性，并记录大型医疗中心所有 VRE 病例的可靠流行病学数据。
在德国一家拥有 2000 张床位的三级保健大学医院对定植和/或全身感染 VRE 的住院患者进行了前瞻性调查。分析了所有 VRE 菌血症患者的同室病友。采用脉冲场凝胶电泳评估克隆相关性。
对 9258 名患者进行了 16507 次筛查检测，其中 560 次检测出 VRE（6.1%）。19 名患者还患有 VRE 菌血症，发病率为 3.4%。该队列患者多病共存，且有较高的外部风险因素暴露率（如入院前的先前住院史，占 78.9%）。接触者的传播率较低（3.5%）。阴性接触者的接触时间明显短于 VRE 阳性接触者（分别为 19.3 小时和 72.0 小时，P<0.006）。
VRE 菌血症仅见于多病共存患者，传播很少发生，阳性接触者的平均接触时间非常高。菌血症患者向住院接触者传播 VRE 的风险较低。
