National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Germany.
National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Germany.
Drug Resist Updat. 2020 Dec;53:100732. doi: 10.1016/j.drup.2020.100732. Epub 2020 Oct 27.
Enterococci are commensals of the intestinal tract of many animals and humans. Of the various known and still unnamed new enterococcal species, only isolates of Enterococcus faecium and Enterococcus faecalis have received increased medical and public health attention. According to textbook knowledge, the majority of infections are caused by E. faecalis. In recent decades, the number of enterococcal infections has increased, with the increase being exclusively associated with a rising number of nosocomial E. faecium infections. This increase has been accompanied by the dissemination of certain hospital-acquired strain variants and an alarming progress in the development of antibiotic resistance namely vancomycin resistance. With this review we focus on a description of the specific situation of vancomycin resistance among clinical E. faecium isolates in Germany over the past 30 years. The present review describes three VRE episodes in Germany, each of which is framed by the beginning and end of the respective decade. The first episode is specified by the first appearance of VRE in 1990 and a country-wide spread of specific vanA-type VRE strains (ST117/CT24) until the late 1990s. The second decade was initially marked by regional clusters and VRE outbreaks in hospitals in South-Western Germany in 2004 and 2005, mainly caused by vanA-type VRE of ST203. Against the background of a certain "basic level" of VRE prevalence throughout Germany, an early shift from the vanA genotype to the vanB genotype in clinical isolates already occurred at the end of the 2000s without much notice. With the beginning of the third decade in 2010, VRE rates in Germany have permanently increased, first in some federal states and soon after country-wide. Besides an increase in VRE prevalence, this decade was marked by a sharp increase in vanB-type resistance and a dominance of a few, novel strain variants like ST192 and later on ST117 (CT71, CT469) and ST80 (CT1065). The largest VRE outbreak, which involved about 2,900 patients and lasted over three years, was caused by a novel and until that time, unknown strain type of ST80/CT1013 (vanB). Across all periods, VRE outbreaks were mainly oligoclonal and strain types varied over space (hospital wards) and time. The spread of VRE strains obviously respects political borders; for instance, both vancomycin-variable enterococci which were highly prevalent in Denmark and ST796 VRE which successfully disseminated in Australia and Switzerland, were still completely absent among German hospital patients, until to date.
肠球菌是许多动物和人类肠道的共生菌。在各种已知和仍未命名的新肠球菌物种中，只有屎肠球菌和粪肠球菌的分离株受到了更多的医学和公共卫生关注。根据教科书知识，大多数感染是由粪肠球菌引起的。近几十年来，肠球菌感染的数量有所增加，这种增加仅与医院获得性屎肠球菌感染数量的增加有关。这种增加伴随着某些医院获得性菌株变异体的传播和抗生素耐药性的惊人进展，即万古霉素耐药性。通过本次综述，我们重点介绍了过去 30 年德国临床屎肠球菌分离株中万古霉素耐药性的具体情况。本综述描述了德国发生的三次 VRE 事件，每一次都以各自十年的开始和结束为框架。第一个事件由 1990 年首次出现 VRE 和特定 vanA 型 VRE 菌株（ST117/CT24）在全国范围内传播来定义，直到 90 年代末。第二个十年的特点是 2004 年和 2005 年德国西南部医院的地区性聚集和 VRE 爆发，主要由 ST203 引起的 vanA 型 VRE 引起。在德国 VRE 流行率存在一定“基础水平”的背景下，21 世纪末临床分离株的 vanA 基因型向 vanB 基因型的早期转变并没有引起太多关注。2010 年第三个十年开始时，德国 VRE 率持续上升，首先在一些联邦州，随后在全国范围内上升。除了 VRE 流行率的增加外，这十年的特点是 vanB 型耐药性急剧增加，少数新型菌株变异体如 ST192 以及后来的 ST117（CT71、CT469）和 ST80（CT1065）的优势地位。最大的 VRE 爆发涉及约 2900 名患者，持续了三年多，由一种新型且此前未知的 ST80/CT1013（vanB）菌株引起。在所有时期，VRE 爆发主要是寡克隆的，菌株类型在空间（医院病房）和时间上都有所不同。VRE 菌株的传播显然尊重政治边界；例如，在丹麦高度流行的万古霉素可变肠球菌和在澳大利亚和瑞士成功传播的 ST796 VRE 菌株，直到今天，在德国医院患者中仍然完全不存在。
