Goetz A M, Rihs J D, Wagener M M, Muder R R
Veterans Affairs Medical Center, Pittsburgh, PA, USA.
Am J Infect Control. 1998 Dec;26(6):558-62. doi: 10.1053/ic.1998.v26.a86286.
After our first known patient with vancomycin-resistant enterococci (VRE) infection was admitted in 1993, we observed a gradual increase in infections and colonization caused by this organism. Thus we initiated a prospective study to quantitate the incidence of VRE infection versus colonization, to identify risk factors for VRE, and to define the natural history of VRE colonization among our patients.
Stool/rectal cultures were performed for patients admitted to the intensive care units at the time of admission and weekly thereafter. Patients found to be carrying VRE were followed with cultures every 2 weeks, and this protocol was continued after transfer to the medical-surgical wards. A surveillance form was initiated on each VRE patient and included demographics, underlying diseases, and risk factors. Environmental cultures in the intensive care units were randomly performed. Patients with positive cultures were isolated.
During a 27-month period, 210 patients were found to be colonized or infected with VRE. Ages ranged from 35 to 97 years; the mean age was 65 years. Fourteen percent (29 of 210) of the patients were VRE positive on admission. Nosocomial colonization or infection occurred at an average of 28 days after admission. Seventeen percent (25 of 216) of patients cleared VRE during their hospital stay; 19% (40 of 210) developed 47 infections. One third of infections involved the urinary tract. Liver transplantation, chemotherapy, and total parenteral nutrition were each associated with infection.
Routine measures as advocated by the Centers for Disease Control and Prevention were not effective in controlling VRE in our patient population.
1993年我们收治了首例已知的耐万古霉素肠球菌（VRE）感染患者，此后我们观察到该病原体引起的感染和定植呈逐渐上升趋势。因此，我们开展了一项前瞻性研究，以量化VRE感染与定植的发生率，确定VRE的危险因素，并明确患者中VRE定植的自然病程。
对入住重症监护病房的患者在入院时及之后每周进行粪便/直肠培养。发现携带VRE的患者每2周进行一次培养随访，转至内科/外科病房后仍继续该方案。为每位VRE患者填写一份监测表，内容包括人口统计学信息、基础疾病和危险因素。对重症监护病房进行环境随机培养。培养结果阳性的患者进行隔离。
在27个月期间，发现210例患者被VRE定植或感染。年龄范围为35至97岁；平均年龄为65岁。14%（210例中的29例）的患者入院时VRE呈阳性。医院获得性定植或感染平均发生在入院后28天。17%（216例中的25例）的患者在住院期间清除了VRE；19%（210例中的40例）发生了47次感染。三分之一的感染累及泌尿系统。肝移植、化疗和全胃肠外营养均与感染有关。
美国疾病控制与预防中心倡导的常规措施在控制我们患者群体中的VRE方面无效。
