Venkatachalam I, Aung M K, Lai D C M, Foo M Z Q, Sim J X Y, Arora S, Oo A M, Fong Y T, Tan K Y, Lee L C, Ling M L
Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
J Hosp Infect. 2025 Aug;162:253-262. doi: 10.1016/j.jhin.2025.02.017. Epub 2025 Mar 8.
In alignment with national and international recommendations, vancomycin-resistant enterococcus (VRE) surveillance in Singapore General Hospital (SGH) was scaled down and limited to immunocompromised patients from August 2020.
To describe the evolving epidemiology and risk associations of VRE between 2018 and 2023 in a tertiary hospital in Singapore.
Inpatients admitted between January 2018 and December 2023 were included. VRE surveillance criteria changed in August 2020 and November 2022. Incidence of any VRE (VRE (all)), VRE from surveillance (VRE (surveillance)), clinical VRE isolates (VRE (clinical)), healthcare-associated VRE infections (HA-VRE (infections)) and bacteraemia (VRE (bacteraemia)) were reviewed. Three case-control studies were conducted. Environmental screening was performed.
Over the six-year study period there were 5173 patients with VRE, of whom 3141 (60.7%) had HA-VRE, 5157 (99.7%) had E. faecium and 4336 (84%) carried vanA.121 (2.2%) patients had VRE bacteraemia with mortality 50.4%. There were significant changes in incidence of VRE (all), VRE (surveillance) and VRE (clinical) but HA-VRE (infections) and VRE (bacteraemia) remained stable. VRE acquisition was associated with presence of concurrent MRSA (odds ratio: 9.4; 95% confidence interval: 1.3-66.8; P < 0.02), CPE (7.2; 2.0-26.0; P < 0.001), intensive care unit (ICU) admission (6.1; 2.8-13.2; P < 0.001), haemodialysis (4.6; 1.8-12.0; P < 0.001), surgery (3.7; 1.6-8.3; P < 0.001), vancomycin use (28.2; 5.4-146.5; P < 0.001), and metronidazole use (4.4; 1.0-19.0; P = 0.04) in the preceding three months. VRE infection had similar risk associations. In all, 12.5% of environmental samples were VRE positive.
VRE endemic state in SGH is associated with significant patient and environmental VRE burden. VRE acquisition and infection have been associated with co-carriage of MRSA or CPE, vancomycin and metronidazole use, ICU admission and prior surgery. Targeted infection prevention and antimicrobial stewardship programmes may reduce VRE (infections).
根据国家和国际建议，新加坡总医院（SGH）自2020年8月起缩减了耐万古霉素肠球菌（VRE）监测规模，并将监测对象限制为免疫功能低下患者。
描述2018年至2023年期间新加坡一家三级医院VRE的流行病学变化及风险关联。
纳入2018年1月至2023年12月期间住院的患者。2020年8月和2022年11月，VRE监测标准发生了变化。回顾了任何VRE（VRE（所有））、监测发现的VRE（VRE（监测））、临床VRE分离株（VRE（临床））、医疗保健相关VRE感染（HA-VRE（感染））和菌血症（VRE（菌血症））的发生率。进行了三项病例对照研究。开展了环境筛查。
在六年的研究期间，共有5173例VRE患者，其中3141例（60.7%）为HA-VRE，5157例（99.7%）为粪肠球菌，4336例（84%）携带vanA。121例（2.2%）患者发生VRE菌血症，死亡率为50.4%。VRE（所有）、VRE（监测）和VRE（临床）的发生率有显著变化，但HA-VRE（感染）和VRE（菌血症）保持稳定。VRE感染的获得与同时存在耐甲氧西林金黄色葡萄球菌（MRSA）（比值比：9.4；95%置信区间：1.3-66.8；P<0.02）、耐碳青霉烯类肠杆菌科细菌（CPE）（7.2；2.0-26.0；P<0.001）、入住重症监护病房（ICU）（6.1；2.8-13.2；P<0.001）、血液透析（4.6；1.8-12.0；P<0.001）、手术（3.7；1.6-8.3；P<0.001）、前三个月使用万古霉素（28.2；5.4-146.5；P<0.001）以及使用甲硝唑（4.4；1.0-19.0；P=0.04）有关。VRE感染有类似的风险关联。总体而言，12.5%的环境样本VRE呈阳性。
SGH的VRE地方流行状态与患者和环境中显著的VRE负担相关。VRE感染的获得和感染与MRSA或CPE的共同携带、万古霉素和甲硝唑的使用、入住ICU以及既往手术有关。有针对性的感染预防和抗菌药物管理计划可能会减少VRE（感染）。
