鉴定耐万古霉素肠球菌克隆株及台湾某医院感染爆发期间的医院间传播。
Identification of vancomycin-resistant enterococci clones and inter-hospital spread during an outbreak in Taiwan.
机构信息
Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, Chang Gung University, 222, Mai Chin Road, Kwei-Shan, Tao-Yuan, Taiwan.
出版信息
BMC Infect Dis. 2013 Apr 4;13:163. doi: 10.1186/1471-2334-13-163.
BACKGROUND
In 2003, nosocomial infections caused by vancomycin-resistant enterococci (VRE) occurred rarely in Taiwan. Between 2003 and 2010, however, the average prevalence of vancomycin resistance among enterococci spp. increased from 2% to 16% in community hospitals and from 3% to 21% in medical centers of Taiwan. We used molecular methods to investigate the epidemiology of VRE in a tertiary teaching hospital in Taiwan.
METHODS
Between February 2009 and February 2011, rectal samples and infection site specimens were collected from all inpatients in the nephrology ward after patient consent was obtained. VRE strain types were determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).
RESULTS
A total of 59 vanA gene-containing VRE isolates (1 per patient) were obtained; 24 originated from rectal sample surveillance of patients who exhibited no symptoms (22 Enterococcus faecium and 2 Enterococcus faecalis), and 35 had developed infections over 3 days after admission (32 E. faecium, 2 E. faecalis, and 1 Enterococcus durans). The 59 VRE isolates demonstrated vancomycin minimum inhibitory concentrations (MICs) of ≥256 μg/m. The MIC range for linezolid, tigecycline, and daptomycin was 0.25-1.5 μg/mL, 0.032-0.25 and 1-4 μg/mL, respectively. For 56 isolates, the MIC for teicoplanin was >8 μg/mL. The predominant types in the nephrology ward were MLST types 414, 78, and18 as well as PFGE types A, C, and D.
CONCLUSION
VREs are endemic in nephrology wards. MLST 414 is the most predominant strain. The increase VRE prevalence is due to cross-transmission of VRE clones ST 414,78,18 by undetected VRE carriers. Because similar VRE STs had been reported in a different hospital of Taiwan, this finding may indicate inter-hospital VRE spread in Taiwan. Active surveillance and effective infection control policies are important controlling the spread of VRE in high risk hospital zones. All endemic VRE strains are resistant to teicoplanin but are sensitive to daptomycin, linezolid, and tigecycline.
背景
2003 年，台湾的万古霉素耐药肠球菌（VRE）医院感染罕见。然而，2003 年至 2010 年间，肠球菌属万古霉素耐药率在社区医院从 2%增加至 16%，在医学中心从 3%增加至 21%。我们使用分子方法调查了台湾一家教学医院的 VRE 流行病学。
方法
2009 年 2 月至 2011 年 2 月，在获得患者同意后，从肾病病房的所有住院患者中采集直肠样本和感染部位标本。通过脉冲场凝胶电泳（PFGE）和多位点序列分型（MLST）确定 VRE 菌株类型。
结果
共获得 59 株含 vanA 基因的 VRE 分离株（每位患者 1 株）；24 株来自无症状患者的直肠样本监测（22 株粪肠球菌和 2 株屎肠球菌），35 株在入院后 3 天内发生感染（32 株粪肠球菌、2 株屎肠球菌和 1 株耐久肠球菌）。59 株 VRE 分离株的万古霉素最低抑菌浓度（MIC）≥256 μg/ml。利奈唑胺、替加环素和达托霉素的 MIC 范围分别为 0.25-1.5 μg/ml、0.032-0.25 μg/ml 和 1-4 μg/ml。对于 56 株分离株，替考拉宁的 MIC＞8 μg/ml。肾病病房的主要类型为 MLST 414、78 和 18 以及 PFGE A、C 和 D 型。
结论
VRE 在肾病病房中流行。MLST 414 是最主要的菌株。VRE 流行率的增加是由于未检出的 VRE 携带者传播了 VRE 克隆 ST414、78、18。由于在台湾的另一家医院也报告了类似的 VRE ST，这一发现可能表明台湾医院间 VRE 的传播。主动监测和有效的感染控制政策对于控制高危医院区域 VRE 的传播非常重要。所有流行的 VRE 菌株均对替考拉宁耐药，但对达托霉素、利奈唑胺和替加环素敏感。
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