Chiew Y F
Department of Laboratory Medicine, National University Hospital, Singapore.
Ann Acad Med Singap. 1997 Nov;26(6):808-14.
Vancomycin-resistant enterococci (VRE) are gaining much attention in the West, chiefly because of the lack of available antimicrobial therapy for VRE infections as most VRE are also resistant to drugs previously used to treat such diseases (e.g. aminoglycosides and ampicillin), the possibility that the vancomycin-resistant genes present in VRE can be transferred to methicillin-resistant Staphylococcus aureus (MRSA), and increasing reports of VRE and the trend towards endemicity in North America. There are three case reports and a study showing stool carriage of more than 10% from Singapore. One of the case reports is notable as the VRE isolated from the urinary tract is community-acquired. In Europe, there is a strong association between the use of avoparcin (a glycopeptide) in animal feeds and the emergence of VRE. Clonal dissemination resulting in nosocomial transmission is also demonstrated. Prior vancomycin use is a risk factor for the subsequent development of VRE bacteraemia. The laboratory plays an important role, namely, a) detection of VRE, and b) determination of susceptibilities of antimicrobials whereby possible therapeutic options may be instituted when antimicrobial intervention is indicated. There is a need to evaluate existing infection control measures against VRE to prevent it from becoming endemic in Singapore as had happened in North America.
耐万古霉素肠球菌（VRE）在西方正备受关注，主要原因如下：对于VRE感染缺乏有效的抗菌治疗方法，因为大多数VRE对以前用于治疗此类疾病的药物（如氨基糖苷类和氨苄西林）也具有耐药性；VRE中存在的耐万古霉素基因有可能转移至耐甲氧西林金黄色葡萄球菌（MRSA）；以及北美地区VRE报告病例不断增加且有呈地方流行之势。有三例病例报告以及一项研究表明，新加坡粪便携带率超过10%。其中一例病例报告值得注意，因为从泌尿道分离出的VRE是社区获得性的。在欧洲，动物饲料中使用阿伏帕星（一种糖肽）与VRE的出现之间存在密切关联。也证实了克隆传播导致医院内传播。先前使用万古霉素是随后发生VRE菌血症的一个危险因素。实验室发挥着重要作用，即：a）检测VRE；b）确定抗菌药物敏感性，以便在需要进行抗菌干预时能够制定可能的治疗方案。有必要评估现有的针对VRE的感染控制措施，以防止其在新加坡像在北美那样成为地方流行病。
