McDonald L C, Kuehnert M J, Tenover F C, Jarvis W R
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Emerg Infect Dis. 1997 Jul-Sep;3(3):311-7. doi: 10.3201/eid0303.970307.
Although nosocomial acquisition and subsequent colonization of vancomycin-resistant enterococci (VRE), an emerging international threat to public health, has been emphasized in the United States, colonization among nonhospitalized persons has been infrequently documented. In contrast, in Europe, colonization appears to occur frequently in persons outside the health-care setting. An important factor associated with VRE in the community in Europe has been avoparcin, a glycopeptide antimicrobial drug used for years in many European nations at subtherapeutic doses as a growth promoter in food-producing animals. In Europe, evidence suggests that foodborne VRE may cause human colonization. Although avoparcin has never been approved for use in the United States, undetected community VRE transmission may be occurring at low levels. Further studies of community transmission of VRE in the United States are urgently needed. If transmission with VRE from unrecognized community sources can be identified and controlled, increased incidence of colonization and infection among hospitalized patients may be prevented.
虽然耐万古霉素肠球菌（VRE）的医院内获得及随后的定植已成为对公共卫生的一个新的国际威胁，在美国已受到重视，但非住院患者中的定植情况鲜有记录。相比之下，在欧洲，医疗保健机构以外的人群中似乎经常发生定植。欧洲社区中与VRE相关的一个重要因素是阿伏帕星，多年来在许多欧洲国家，它作为食品生产动物的生长促进剂，以低于治疗剂量使用。在欧洲，有证据表明食源性VRE可能导致人类定植。虽然阿伏帕星从未被批准在美国使用，但美国可能正在发生未被察觉的社区VRE低水平传播。迫切需要对美国VRE的社区传播进行进一步研究。如果能够识别并控制来自未被认识的社区来源的VRE传播，住院患者中定植和感染的发生率增加或许可以得到预防。
