THE CHALLENGE OF VANCOMYCIN-RESISTANT ENTEROCOCCI - A CLINICAL AND EPIDEMIOLOGY STUDY

被引：90

作者：

LAM, S ^{[1
]}

SINGER, C ^{[1
]}

TUCCI, V ^{[1
]}

MORTHLAND, VH ^{[1
]}

PFALLER, MA ^{[1
]}

ISENBERG, HD ^{[1
]}

机构：

[1] ALBERT EINSTEIN COLL MED,LONG ISL JEWISH MED CTR,DEPT MED,DIV INFECT DIS,NEW HYDE PK,NY 11040

来源：

AMERICAN JOURNAL OF INFECTION CONTROL | 1995年 / 23卷 / 03期

关键词：

D O I：

10.1016/0196-6553(95)90038-1

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background: Vancomycin-resistant enterococci have been recovered with increasing frequency from hospitalized patients. Risk factors, mode of nosocomial transmission, extent of colonization in hospitalized patients, and treatment options for these organisms have not been completely delineated. Methods: We studied 53 patients (group A) with vancomycin-resistant enterococci isolated from various clinical specimens and also surveyed for vancomycin-resistant enterococci in stool specimens submitted for Clostridium difficile toxin assays (group B). Stool specimens submitted for identification of bacterial pathogens and stool specimens from hospital employees were also analyzed for vancomycin-resistant enterococci. Results: Seventy-six isolates of vancomycin-resistant enterococci were recovered in group A. Five of these patients harbored vancomycin-resistant enterococci on admission. Fifty-three of 289 group B stool specimens submitted for C. difficile toxin assays yielded vancomycin-resistant enterococci. Cephalosporins and vancomycin were the most common antimicrobial agents received by both groups of patients. Enterococcus faecium isolates were more resistant than Enterococcus faecalis isolates to antimicrobial agents. All isolates exhibited high-level aminoglycoside resistance and were not p-lactamase producers. There were at least 15 different molecular clones of E. faecium and three of E. faecalis. Vancomycin-resistant enterococcal bacteremia was associated with a 100% in-hospital mortality rate. Conclusions: Multidrug-resistant and vancomycin-resistant enterococci have become important nosocomial pathogens that are difficult to treat. Vancomycin-resistant enterococcal bacteremia was associated with a poor prognosis. We found a high rate of colonization in patients with suspected C. difficile toxin colitis. Judicious use of vancomycin and broad-spectrum antibiotics is recommended, and strict infection control measures must be implemented to prevent nosocomial transmission of these organisms.

引用

页码：170 / 180

页数：11

共 40 条

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