Hwang Y S, Brinton B G, Leonard R B, Blue S R, Woods M L, Carroll K C
Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City 84132, USA.
J Investig Med. 1998 Dec;46(9):435-43.
Until 1995, there were no cases of vancomycin resistant enterococcus (VRE) identified at our university hospital. From May 1995 to August 1996, we investigated a cluster of 10 cases of phenotypic class Van B Enterococcus faecium.
Patients were matched with controls who were on the same unit for at least 7 days prior to the case developing VRE. Control patients were age and sex matched if possible, and had duration of hospitalization at least as long as the number of days it took the patient to become VRE positive. We analyzed 16 independent risk factors using Epi-info version 6. Environmental cultures were obtained in the MICU where 5 of the patients were located. All 10 patient isolates and environmental isolates were analyzed by pulsed field gel electrophoresis (PFGE).
PFGE confirmed the genetic relatedness of all 10 patient isolates and environmental isolates. The VRE-positive group was more likely to be immunosuppressed and to have exposure to 3 physicians. In the MICU, significant, P < 0.05) risk factors for VRE were higher Apache scores, location adjacent to a VRE case, duration of vancomycin and amino-glycoside use, duration of invasive catheter use, and diarrhea. Among the VRE-positive environmental cultures was a blood pressure cuff wash that was used on several patients.
We hypothesize that a VRE strain was introduced into our hospital environment and was spread by personnel or contaminated equipment. As a consequence of this study, a hospital-wide VRE policy was implemented.
直到1995年，我们大学医院尚未发现耐万古霉素肠球菌（VRE）病例。1995年5月至1996年8月，我们调查了10例表型为Van B型的屎肠球菌病例群。
将患者与在病例发生VRE之前至少在同一病房住了7天的对照进行匹配。对照患者尽可能在年龄和性别上匹配，住院时间至少与患者VRE检测呈阳性所需的天数相同。我们使用Epi-info 6版分析了16个独立危险因素。在5例患者所在的MICU采集了环境培养物。对所有10株患者分离株和环境分离株进行脉冲场凝胶电泳（PFGE）分析。
PFGE证实了所有10株患者分离株和环境分离株的基因相关性。VRE阳性组更可能免疫抑制且接触过3名医生。在MICU，VRE的显著（P<0.05）危险因素包括较高的急性生理与慢性健康状况评分系统（Apache）评分、与VRE病例相邻的位置、万古霉素和氨基糖苷类药物的使用时间、侵入性导管的使用时间以及腹泻。在VRE阳性的环境培养物中有一个用于多名患者的血压袖带洗液。
我们推测一株VRE菌株被引入我们医院环境，并通过人员或受污染的设备传播。作为这项研究的结果，实施了一项全院范围的VRE防控政策。
