Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene.
Dtsch Arztebl Int. 2013 Oct;110(43):725-31. doi: 10.3238/arztebl.2013.0725. Epub 2013 Oct 25.
The spread of vancomycin-resistant enterococci (VRE), particularly E. faecium, in hospitals leads to many cases of colonization, but only sporadic infections. Detailed and valid risk assessment is needed so that patients at risk can be protected from VRE infection. The principal aims of risk assessment must include not only lowering VRE-associated morbidity and mortality in patients at risk, but also refraining from unnecessary anti-infective measures among those who are not at risk.
We selectively searched the PubMed database for pertinent articles on the epidemiology and clinical relevance of VRE in order to derive a uniform and practical hygiene strategy from the available scientific evidence.
Only low-level evidence is available for the interventions studied to date, and most of the recommendations that have been issued can be characterized as expert opinion. As a rule, VRE are not highly pathogenic; they tend to have high rates of colonization, but low rates of infection. The risk factors for colonization with VRE include (among others) the administration of antibiotics and immunosuppressants, prior hospitalization, diarrhea, intubation, and other invasive treatments. The areas of highest risk are hematology/oncology wards, liver transplantation wards, dialysis units, and neonatology wards.
The chain of infection can be broken by improved and consistently applied standard hygienic measures (hand and surface disinfection). Some patients are nonetheless at elevated risk of VRE infection. In specific clinical situations, the optimal protection of these patients against VRE infection demands the obligatory enforcement of stricter hygienic measures (contact isolation).
万古霉素耐药肠球菌（VRE），尤其是屎肠球菌，在医院中的传播导致了许多定植病例，但仅有散发病例感染。需要进行详细和有效的风险评估，以便使处于风险中的患者免受 VRE 感染。风险评估的主要目的不仅必须包括降低处于风险中的患者的 VRE 相关发病率和死亡率，而且还必须避免对无风险的患者进行不必要的抗感染措施。
我们有选择地在 PubMed 数据库中搜索了有关 VRE 的流行病学和临床相关性的相关文章，以便从现有科学证据中得出统一且实用的卫生策略。
迄今为止，对所研究的干预措施仅存在低水平的证据，并且大多数已发布的建议可以被描述为专家意见。通常，VRE 的致病性不高；它们往往具有较高的定植率，但感染率较低。VRE 定植的危险因素包括（除其他外）使用抗生素和免疫抑制剂、先前住院、腹泻、插管和其他侵入性治疗。高风险区域包括血液科/肿瘤科病房、肝移植病房、透析病房和新生儿科病房。
通过改进和一致应用标准卫生措施（手部和表面消毒）可以打破感染链。但是，某些患者仍然存在 VRE 感染的风险增加。在特定的临床情况下，为了保护这些患者免受 VRE 感染，需要强制性实施更严格的卫生措施（接触隔离）。
