Bonilla H F, Zervos M A, Lyons M J, Bradley S F, Hedderwick S A, Ramsey M A, Paul L K, Kauffman C A
Division of Infectious Diseases, Veterans' Affairs Medical Center, Ann Arbor, MI 48105, USA.
Infect Control Hosp Epidemiol. 1997 May;18(5):333-9. doi: 10.1086/647621.
To compare the epidemiology of vancomycin-resistant Enterococcus faecium (VRE) in a long-term-care unit and an acute-care hospital.
Point-prevalence surveys for VRE rectal colonization of patients were carried out over a 21-month period in patients in a long-term-care unit and an acute-care hospital (medical ward and intensive-care units). The environment and hands of healthcare workers also were sampled for VRE. Contour-clamped homogeneous electric field (CHEF) electrophoresis was used to evaluate possible transmission among roommates and the relatedness of patient strains to those in the environment and on the hands of healthcare workers.
A 200-bed Veterans Affairs Medical Center with an attached 90-bed long-term-care unit.
From December 1994 to January 1996, rectal VRE colonization of patients in the long-term-care unit increased significantly from 9% to 22%. In contrast, patients on the medical ward rarely were colonized after the first survey in December 1994, and only two intensive-care-unit patients were found to be colonized during the four surveys. The environment was contaminated persistently in the long-term-care unit. In the four surveys, carriage of VRE on hands of healthcare workers varied from 13% to 41%; 65% of healthcare workers with VRE found on their hands worked in the long-term-care unit. Seven different strains were identified by CHEF typing. Although the initial survey found only vanA strains, subsequent surveys showed vanB strains also were present.
Residents of a long-term-care unit frequently were colonized with VRE, but infections were uncommon in this population. The environment of the long-term-care unit was contaminated with VRE, and VRE was found frequently on the hands of healthcare workers in this unit. Both vanA and vanB genotypes were found in this setting.
比较长期护理机构和急症护理医院中耐万古霉素屎肠球菌（VRE）的流行病学情况。
在21个月期间，对长期护理机构和急症护理医院（内科病房和重症监护病房）的患者进行VRE直肠定植的现患率调查。同时对医护人员的手部及环境进行VRE采样。采用轮廓夹钳均匀电场（CHEF）电泳评估室友之间可能的传播情况以及患者菌株与环境及医护人员手部菌株的相关性。
一家拥有200张床位的退伍军人事务医疗中心及附属的90张床位的长期护理机构。
1994年12月至1996年1月，长期护理机构中患者的直肠VRE定植率从9%显著增至22%。相比之下，内科病房的患者在1994年12月首次调查后很少被定植，在四次调查中重症监护病房仅发现两名患者被定植。长期护理机构的环境持续受到污染。在四次调查中，医护人员手部VRE携带率在13%至41%之间；手部检出VRE的医护人员中有65%在长期护理机构工作。通过CHEF分型鉴定出七种不同菌株。虽然初次调查仅发现vanA菌株，但后续调查显示也存在vanB菌株。
长期护理机构的居民经常被VRE定植，但该人群感染并不常见。长期护理机构的环境被VRE污染，且该机构医护人员的手部经常检出VRE。在此环境中发现了vanA和vanB两种基因型。
