Nürnberger Laura, Schmidt Dirk, Szumlanski Tobias, Kirchhoff Lisa, Ross Birgit, Steinmann Jörg, Rath Peter-Michael
Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Institute for Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Nuremberg Hospital, Nuremberg, Germany.
GMS Hyg Infect Control. 2021 Mar 17;16:Doc13. doi: 10.3205/dgkh000384. eCollection 2021.
: Vancomycin-resistant accounts for around 10-23% of nosocomial enterococcal infections and constitutes a relevant therapeutic problem due to its limited susceptibility to antibiotics. The resistance towards glycopeptide antibiotics is mediated by the so-called van genes. Currently, the most common resistance type in Germany is the -type. Little data are available on the molecular epidemiology in Germany. Therefore, an epidemiological typing of isolates with vanB-type resistance from two German hospitals in Essen and Nuremberg was performed. Two outbreaks and 104 sporadic cases were investigated. All 128 isolates with -type resistance were collected between 2011-2012 and 2017-2018. They were characterized using multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). ST 117 was the most common sequence type (ST) in both hospitals, especially since 2017. PFGE divided the isolates of this study into 68 PFGE types and showed a broad genetic diversity. Two epidemiologically assumed in-hospital outbreaks were genetically confirmed. Apart from that, in-hospital transmissions were rare events. The results obtained by MLST confirmed the previously described allocation of STs in Germany. PFGE showed a broad genetic diversity of VRE between the two hospitals and also within each hospital. In-hospital transmissions were rare, but outbreaks did occur. Our data supports the strategy to screen and isolate patients in transmission events in order to detect monoclonality indicating a common source or hygiene mismanagement.
耐万古霉素肠球菌占医院内肠球菌感染的10%-23%左右，由于其对抗生素的敏感性有限，构成了一个相关的治疗难题。对糖肽类抗生素的耐药性由所谓的van基因介导。目前，德国最常见的耐药类型是vanB型。德国关于分子流行病学的数据很少。因此，对来自埃森和纽伦堡两家德国医院的具有vanB型耐药性的肠球菌分离株进行了流行病学分型。调查了两起暴发和104例散发病例。所有128株具有vanB型耐药性的分离株均在2011 - 2012年和2017 - 2018年期间收集。使用多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）对它们进行了特征分析。ST117是两家医院中最常见的序列类型（ST），尤其是自2017年以来。PFGE将本研究中的分离株分为68种PFGE类型，显示出广泛的遗传多样性。两起流行病学上推测的医院内暴发在基因上得到了证实。除此之外，医院内传播是罕见事件。MLST获得的结果证实了德国先前描述的ST分配情况。PFGE显示两家医院之间以及每家医院内部的耐万古霉素肠球菌都具有广泛的遗传多样性。医院内传播很少见，但确实发生了暴发。我们的数据支持在传播事件中对患者进行筛查和隔离的策略，以便检测表明有共同来源或卫生管理不当的单克隆性。
