Infectious Disease Unit, Shaare Zedek Medical Centre and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Translational Genomics Laboratory, Medical Genetics Institute, Shaare Zedek Medical Centre and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
J Hosp Infect. 2022 Mar;121:105-113. doi: 10.1016/j.jhin.2021.11.021. Epub 2021 Dec 9.
Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens with increasing prevalence worldwide. Hospitals in Jerusalem, Israel are known to have high rates of VRE carriage. However, the clonicity of this pathogen in endemic areas remains unclear.
The medical files of patients with VRE bacteraemia (N=182) hospitalized in the three major hospitals in Jerusalem between 2009 and 2020 were reviewed. These were compared with 100 patients with vancomycin-susceptible enterococcus (VSE) bacteraemia during the same period, and their clinical and demographic characters were analysed. Whole-genome sequencing (WGS) of the VRE isolates was performed, and the results were analysed considering the demographic, epidemiologic and clinical outcome data.
Patients with VRE bacteraemia had higher rates of central line use, haematologic malignancy and immunosuppression compared with patients with VSE bacteraemia (63% vs 27%, P<0.001; 25% vs 13%, P=0.02; 24% vs 13%, P=0.04, respectively). Patients with VRE bacteraemia had significantly higher 7- and 30-day in-hospital mortality rates (31% vs 18%, P= 0.02; 57% vs 34%, P<0.001, respectively) and a longer mean hospital stay (39 vs 24 days, P=0.005) than patients with VSE bacteraemia. The WGS results of VRE isolates showed diversity rather than endemicity of a single clone. No clones were associated with specific ethnicity, geographical distribution or worse prognosis.
WGS revealed the occurrence of small unrelated outbreaks rather than the expansion of large clusters in Jerusalem. VRE bacteraemia was found in sicker patients, and was associated with higher mortality and longer hospitalization compared with VSE bacteraemia.
耐万古霉素肠球菌（VRE）是一种重要的医院获得性病原体，其在全球的流行率不断上升。以色列耶路撒冷的医院已知具有较高的 VRE 携带率。然而，该病原体在流行地区的克隆性尚不清楚。
对 2009 年至 2020 年间在耶路撒冷三家主要医院住院的 182 例 VRE 菌血症患者的病历进行了回顾。将这些患者与同期 100 例万古霉素敏感肠球菌（VSE）菌血症患者进行了比较，并分析了他们的临床和人口统计学特征。对 VRE 分离株进行了全基因组测序（WGS），并根据人口统计学、流行病学和临床结局数据对结果进行了分析。
与 VSE 菌血症患者相比，VRE 菌血症患者中心静脉置管使用率、血液系统恶性肿瘤和免疫抑制发生率更高（63% vs 27%，P<0.001；25% vs 13%，P=0.02；24% vs 13%，P=0.04）。VRE 菌血症患者的 7 天和 30 天院内死亡率明显更高（31% vs 18%，P=0.02；57% vs 34%，P<0.001），住院时间也更长（39 天 vs 24 天，P=0.005）。VRE 分离株的 WGS 结果显示存在多样性而非单一克隆的地方性。没有发现特定的克隆与特定的种族、地理位置或较差的预后相关。
WGS 显示，在耶路撒冷发生的是较小的不相关暴发，而不是大型集群的扩张。与 VSE 菌血症相比，VRE 菌血症患者病情更重，死亡率更高，住院时间更长。
