OUTBREAK OF MULTIDRUG-RESISTANT ENTEROCOCCUS-FAECIUM WITH TRANSFERABLE VANB CLASS VANCOMYCIN RESISTANCE
OUTBREAK OF MULTIDRUG-RESISTANT ENTEROCOCCUS-FAECIUM WITH TRANSFERABLE VANB CLASS VANCOMYCIN RESISTANCE
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DOI：
10.1128/jcm.32.5.1148-1153.1994
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发表时间：
1994-05-01
影响因子：
9.4
通讯作者：
MEDEIROS, AA
中科院分区：
文献类型：
--
作者：
BOYCE, JM;OPAL, SM;MEDEIROS, AA
在一家拥有250张床位的大学附属医院的暴发中，从37名患者中回收了对氨苄西林、高水平庆大霉素和万古霉素耐药但对替考拉宁敏感（万古霉素B类耐药）的屎肠球菌菌株。万古霉素MIC范围为8至256 μ g/ml的三个分离株均与vanB探针杂交。染色体和质粒DNA的限制性内切酶分析表明，所有测试的菌株都来自一个单一的克隆。万古霉素耐药被证明是可转移的。获得流行株的危险因素包括接近另一个病例患者（P，0.0005）和接触护理另一个病例患者的护士（P，0.007）。当病例患者出现腹泻时，环境被流行株污染的发生率显著更高（P，0.001）。将病人安置在单独的病房，要求工作人员使用长袍作为手套，面纱作为手套，控制了疫情。具有可转移的vanB类万古霉素耐药性的屎肠菌菌株将成为重要的医院感染病原体。由于受影响的患者发生腹泻时可能会发生广泛的环境污染，因此一旦遇到这些病原体，应立即采取屏障预防措施，包括使用隔离衣和手套。
Enterococcus faecium strains resistant to ampicillin, high levels of gentamicin, and vancomycin but susceptible to teicoplanin (vanB class vancomycin resistance) were recovered from 37 patients during an outbreak involving a 250-bed university-affiliated hospital. Three isolates with vancomycin MICs ranging from 8 to 256 mu g/ml all hybridized with a vanB probe. Restriction endonuclease analysis of chromosomal and plasmid DNA suggested that all isolates tested were derived from a single clone. Vancomycin resistance was shown to be transferable. Risk factors for acquiring the epidemic strain included proximity to another case patient (P, 0.0005) and exposure to a nurse who cared for another case patient (P, 0.007). Contamination of the environment by the epidemic strain occurred significantly more often when case patients had diarrhea (P, 0.001). Placing patients in private rooms and requiring the use of gowns as,veil as gloves by personnel controlled the outbreak These findings suggest that multidrug-resistant E. faecium strains with transferable vanB class vancomycin resistance will emerge as important nosocomial pathogens. Because extensive environmental contamination may occur when affected patients develop diarrhea, barrier precautions, including the use of both gowns and gloves, should be implemented is soon as these pathogens are encountered.