Orsi G B, Ciorba V
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
Ann Ig. 2013 Nov-Dec;25(6):485-92. doi: 10.7416/ai.2013.1948.
Vancomycin-resistant enterococci (VRE) are among the most common healthcare associated multidrug-resistant organisms. Purpose of the article was to review recent data regarding the epidemiology, clinical issues and infection control of this organisms.
A PubMed-MEDLINE search was carried out.
The European Antimicrobial Resistance Surveillance System (EARSS) highlights a large variability between the various european countries, with VRE ranging from <2% (Finland, Holland) to >20% (Ireland, Greece, Portugal). Italy shows a low rate level (4.2%). In USA according to the National Healthcare Safety Network (NHSN) in 2006-2007 overall 33% of enterococci were resistant to vancomycin, whereas in Canada VRE prevalence showed to be much lower <10%. Although with some methodological limits, several studies showed that infections caused by VRE are more serious and associated to a higher mortality rate and economic burden compared to those caused by vancomycin susceptible enterococci (VSE). The average increased associated mortality was over two-fold. Resistance to newer antimicrobial agents as daptomycin and linezolid has been described, complicating treatment options for infections caused by these organisms.
Control measures aimed at reducing the incidence of VRE colonization and infection in healthcare settings should include: hand washing with an antiseptic or a waterless antiseptic agent, routine screening for vancomycin resistance among clinical isolates, rectal surveillance cultures, contact isolation for patients with VRE and antimicrobial stewardship.
耐万古霉素肠球菌（VRE）是最常见的与医疗保健相关的多重耐药菌之一。本文的目的是综述有关该菌的流行病学、临床问题及感染控制的最新数据。
进行了PubMed-MEDLINE检索。
欧洲抗菌药物耐药监测系统（EARSS）突显了欧洲各国之间的巨大差异，VRE比例从＜2%（芬兰、荷兰）到＞20%（爱尔兰、希腊、葡萄牙）不等。意大利显示出较低的发生率水平（4.2%）。在美国，根据国家医疗安全网络（NHSN）的数据，2006 - 2007年总体上33%的肠球菌对万古霉素耐药，而在加拿大，VRE的流行率则低得多，＜10%。尽管存在一些方法学上的局限性，但多项研究表明，与万古霉素敏感肠球菌（VSE）引起的感染相比，VRE引起的感染更严重，且与更高的死亡率和经济负担相关。平均增加的相关死亡率超过两倍。已有对达托霉素和利奈唑胺等新型抗菌药物耐药的报道，这使得这些菌引起的感染的治疗选择变得复杂。
旨在降低医疗机构中VRE定植和感染发生率的控制措施应包括：用消毒剂或无水消毒剂洗手、对临床分离株进行万古霉素耐药性常规筛查、直肠监测培养、对VRE患者进行接触隔离以及抗菌药物管理。
