Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany.
Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Antimicrob Resist Infect Control. 2023 Aug 12;12(1):78. doi: 10.1186/s13756-023-01278-0.
The rising prevalence of vancomycin-resistant enterococci (VRE) is a matter of concern in hospital settings across Europe without a distinct geographical pattern. In this scoping review, we compared the epidemiology of vancomycin-resistant Enterococcus spp. in hospitals in the Netherlands and Germany, between 1991 and 2022. We searched PubMed and summarized the national antibiotic resistance surveillance data of the two countries. We included 46 studies and summarized national surveillance data from the NethMap in the Netherlands, the National Antimicrobial Resistance Surveillance database in Germany, and the EARS-Net data. In total, 12 studies were conducted in hospitals in the Netherlands, 32 were conducted in German hospitals, and an additional two studies were conducted in a cross-border setting. The most significant difference between the two countries was that studies in Germany showed an increasing trend in the prevalence of VRE in hospitals, and no such trend was observed in studies in the Netherlands. Furthermore, in both Dutch and German hospitals, it has been revealed that the molecular epidemiology of VREfm has shifted from a predominance of vanA towards vanB over the years. According to national surveillance reports, vancomycin resistance in Enterococcus faecium clinical isolates fluctuates below 1% in Dutch hospitals, whereas it follows an increasing trend in German hospitals (above 20%), as supported by individual studies. This review demonstrates that VRE is more frequently encountered in German than in Dutch hospitals and discusses the underlying factors for the difference in VRE occurrence in these two neighboring countries by comparing differences in healthcare systems, infection prevention control (IPC) guidelines, and antibiotic use in the Netherlands and Germany.
耐万古霉素肠球菌（VRE）的流行率不断上升，这在欧洲各地的医院环境中都是一个令人关注的问题，且没有明显的地理模式。在本次范围界定综述中，我们比较了 1991 年至 2022 年间荷兰和德国医院中肠球菌属耐万古霉素菌株的流行病学。我们检索了 PubMed 并总结了这两个国家的国家抗生素耐药性监测数据。我们纳入了 46 项研究，并总结了荷兰 NethMap、德国国家抗生素耐药性监测数据库和 EARS-Net 数据的国家监测数据。总共，12 项研究在荷兰的医院进行，32 项研究在德国的医院进行，另外两项研究在跨境环境中进行。这两个国家之间最显著的差异是，德国的研究表明医院中 VRE 的流行率呈上升趋势，而荷兰的研究则没有观察到这种趋势。此外，在荷兰和德国的医院中均发现，VREfm 的分子流行病学多年来已从以 vanA 为主转变为以 vanB 为主。根据国家监测报告，荷兰医院中肠球菌属粪肠球菌临床分离株的万古霉素耐药率波动在 1%以下，而德国医院的耐药率呈上升趋势（高于 20%），这得到了个别研究的支持。本综述表明，德国医院中 VRE 的检出率高于荷兰医院，并通过比较荷兰和德国在医疗保健系统、感染预防与控制（IPC）指南以及抗生素使用方面的差异，讨论了这两个邻国 VRE 发生差异的潜在因素。
