Dembry L M, Uzokwe K, Zervos M J
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Infect Control Hosp Epidemiol. 1996 May;17(5):286-92. doi: 10.1086/647297.
To evaluate the epidemiology of, and control measures for, vancomycin-resistant Enterococcus (VRE) in a renal unit.
A 3-month, prospective, prevalence culture survey of patients on a 24-bed renal unit.
A 975-bed community teaching hospital.
Patients admitted to the renal unit over a 3-month period. Patients identified with VRE were each matched with four patients without VRE isolated over the study period. INTERVENTIONS/CONTROL MEASURES: Resistant-organism barrier precautions. To eradicate carriage of VRE, two patients with VRE stool colonization were treated with 5 days of oral doxycycline (100 mg twice per day) and rifampin (300 mg/day).
Seven patients with VRE (8 isolates) were identified. Five isolates were Enterococcus faecium (vancomycin MIC = 16 to 256 micrograms/mL), two were Enterococcus faecalis (MICs = 16 and 124 micrograms/mL), and one was Enterococcus gallinarum (MIC = 8.0 micrograms/mL). Eradication of carriage with VRE was accomplished in two patients treated with doxycycline and rifampin. In the final 30 days of the culture survey and at 9 months, there were no further patients with VRE identified.
Resistant-organism precautions and elimination of patient carriage may be useful measures for controlling the spread of low-prevalence endemic vancomycin-resistant Enterococcus.
评估肾内科耐万古霉素肠球菌（VRE）的流行病学情况及控制措施。
对拥有24张床位的肾内科患者进行为期3个月的前瞻性患病率培养调查。
一家拥有975张床位的社区教学医院。
在3个月期间入住肾内科的患者。在研究期间，每例确诊为VRE的患者与4例未分离出VRE的患者进行匹配。干预措施/控制措施：耐药菌隔离预防措施。为根除VRE定植，2例VRE粪便定植患者接受了为期5天的口服强力霉素（每日2次，每次100mg）和利福平（300mg/天）治疗。
共识别出7例VRE患者（8株分离菌）。5株为粪肠球菌（万古霉素最低抑菌浓度[MIC]=16至256μg/mL），2株为屎肠球菌（MIC分别为16和124μg/mL），1株为鹑鸡肠球菌（MIC=8.0μg/mL）。接受强力霉素和利福平治疗的2例患者实现了VRE定植的根除。在培养调查的最后30天及9个月时，未再发现VRE患者。
耐药菌预防措施及消除患者定植可能是控制低流行率地方性耐万古霉素肠球菌传播的有效措施。
