Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100191, China.
Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100191, China.
J Microbiol Immunol Infect. 2023 Apr;56(2):351-357. doi: 10.1016/j.jmii.2022.07.001. Epub 2022 Jul 13.
Vancomycin-resistant Enterococcus (VRE) can be carried in the gut for a long period and its carriage status is associated with subsequent infections. This study aimed to investigate the frequency of intestinal VRE carriage in intensive care patients in Beijing.
A multicenter, retrospective cross-sectional study was conducted at six hospitals in Beijing, China. All patients admitted to intensive care units (ICUs) between April 2 and May 1, 2017, were enrolled, and their clinical data were gathered by reviewing electronic medical records. Rectal swabs collected from patients were stored at -80 °C in the Institute of Clinical Pharmacology, Peking University First Hospital, and they were selectively cultured for VRE, then the identified strains were analyzed by polymerase chain reaction (PCR) to detect the glycopeptide resistance gene and were characterized by multilocus sequence typing (MLST).
Of 148 patients recruited, 46 (31.1%) carried VRE, with the majority (n = 42) being Enterococcus faecium. In total, 78.3% of the VRE were vanA positive and 15.2% vanM positive, while 6.5% undetected glycopeptide resistance gene. The predominant ST was ST78 (47.6%) followed by ST192 (14.3%), ST555 (9.5%), and ST789 (9.5%). Multivariate analysis showed that factors associated VRE carriage were patients aged >65 years (odds ratio [OR], 3.786; 95% confidence interval [CI], 1.402-10.222) and recent third-generation cephalosporins use (OR, 6.360; 95% CI, 1.873-21.601).
The overall proportion of VRE carriage in patients admitted to ICUs was markedly high in Beijing, China. The vanM gene has been spread widely but vanA gene was the dominant resistance determinant in VRE in Beijing.
耐万古霉素肠球菌（VRE）可在肠道内携带很长时间，其携带状态与后续感染有关。本研究旨在调查北京重症监护病房（ICU）患者肠道 VRE 携带率。
在中国北京的六家医院进行了一项多中心、回顾性、横断面研究。纳入 2017 年 4 月 2 日至 5 月 1 日期间入住 ICU 的所有患者，并通过查阅电子病历收集其临床数据。从患者采集的直肠拭子在北京大学第一医院临床药理研究所储存在-80°C，选择性培养 VRE，然后通过聚合酶链反应（PCR）检测鉴定的菌株中糖肽耐药基因，并通过多位点序列分型（MLST）进行特征分析。
共纳入 148 例患者，46 例（31.1%）携带 VRE，其中大多数（n=42）为屎肠球菌。总共，78.3%的 VRE 为 vanA 阳性，15.2%为 vanM 阳性，6.5%未检测到糖肽耐药基因。主要 ST 为 ST78（47.6%），其次为 ST192（14.3%）、ST555（9.5%）和 ST789（9.5%）。多变量分析表明，与 VRE 携带相关的因素是年龄>65 岁的患者（比值比[OR]，3.786；95%置信区间[CI]，1.402-10.222）和近期使用第三代头孢菌素（OR，6.360；95%CI，1.873-21.601）。
中国北京 ICU 患者中 VRE 携带率总体较高。vanM 基因已广泛传播，但 vanA 基因是北京 VRE 中的主要耐药决定因素。
