Low D E, Willey B M, McGeer A J
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Am J Surg. 1995 May;169(5A Suppl):8S-12S.
The enterococcus has become an important nosocomial pathogen, reported by the National Nosocomial Infections Surveillance System as the third most common pathogen associated with blood-stream infections and the second most commonly isolated pathogen overall. It is now more frequently recognized as a cause of superinfection in the surgical patient, as the possible result of the frequent use of ineffective antimicrobials for prophylaxis and treatment. Both of these findings are due, in part, to the intrinsic antimicrobial resistance of the enterococci. Of greater concern is the ready ability of this organism to acquire resistance traits. During the past 5 years, the appearance and rapid dissemination of strains with high-level resistance to vancomycin, ampicillin, gentamicin, and streptomycin have been reported; in some cases, no effective antimicrobial therapy was available to patients infected with these strains. Enterococci, in addition to their intrinsic and acquired tolerance to beta-lactams, have acquired the ability to inactivate penicillin and ampicillin via beta-lactamase production. Prompt recognition of such multiresistant enterococci, the implementation of effective infection control precautions, and rational use of antimicrobials may limit or even prevent the spread of such strains in the hospital setting.
肠球菌已成为一种重要的医院感染病原体，据国家医院感染监测系统报告，它是与血流感染相关的第三大常见病原体，也是总体上第二大最常分离出的病原体。现在它更常被认为是外科手术患者发生二重感染的原因，这可能是频繁使用无效抗菌药物进行预防和治疗的结果。这两个发现部分归因于肠球菌固有的抗菌耐药性。更令人担忧的是这种微生物容易获得耐药特性。在过去5年中，已报告了对万古霉素、氨苄西林、庆大霉素和链霉素具有高水平耐药性的菌株的出现和迅速传播；在某些情况下，感染这些菌株的患者没有有效的抗菌治疗方法。肠球菌除了对β-内酰胺类药物具有固有的和获得性耐受性外，还通过产生β-内酰胺酶获得了使青霉素和氨苄西林失活的能力。及时识别此类多重耐药肠球菌、实施有效的感染控制预防措施以及合理使用抗菌药物，可能会限制甚至防止此类菌株在医院环境中的传播。
