Two episodes of vancomycin-resistant Enterococcus faecium outbreaks caused by two genetically different clones in a newborn intensive care unit
Two episodes of vancomycin-resistant Enterococcus faecium outbreaks caused by two genetically different clones in a newborn intensive care unit
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DOI：
10.1078/1438-4639-00304
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发表时间：
2004-09-01
影响因子：
6
通讯作者：
Heeg, P
中科院分区：
文献类型：
--
作者：
Borgmann, S;Niklas, DM;Heeg, P
2001年，在德国西南部一所大学医院的新生儿重症监护病房（NICU）观察到两次vana型耐万古霉素粪肠杆菌（VRE）暴发事件（1 - 3月和6 - 7月）。为了确定最初的传染源和传播途径，对环境样本以及患者和工作人员的粪便样本进行了检查。环境样本中未发现VRE。然而，24名住院儿童的粪便样本检测呈阳性，并通过基于small的宏观限制分析评估细菌克隆性。此外，还检测了esp基因和万古霉素耐药基因的携带以及细菌素的产生。PCR分析结果显示，24株菌株均携带vanA基因簇，编码对万古霉素和替可普兰耐药。然而，5株vana阳性分离株对万古霉素耐药，但对teicoplanin不耐药。这5株菌株均产生细菌素，但均未检测到esp基因。PFGE显示，这两次爆发都是由两个不同的克隆引起的。首次发作的患者已被确定，而第二次发作的起源仍不清楚。从40个工作人员粪便样本中分离出VRE。该菌株与夏季爆发的克隆有关。总之，发生了两次独立的自限性VRE暴发，极有可能在病房传播。
In 2001 two outbreak episodes (January-March and June-July) caused by vancomycin-resistant E. faecium (VRE) of the VanA-type were observed at a neonatal intensive care unit (NICU) of a university hospital in south-west Germany. To identify the initial source and the route of transmission environmental samples were examined as well as stool samples from patients and the staff. VRE was not found in environmental samples. However, stool samples from 24 hospitalised children tested positive and bacterial clonality was assessed by Smal-based macro restriction analysis. Furthermore, esp gene and vancomycin resistance gene carriage were examined as well as bacteriocin production. PCR analysis showed that all 24 isolates carried vanA gene cluster, encoding resistance to vancomycin and teicoplanin. However, five of the vanA-positive isolates were resistant to vancomycin but not to teicoplanin. Only these five isolates produced bacteriocin, but in none of the isolates esp gene was detected. PFGE revealed that both outbreaks were caused by two different clones. The patient initiating the first episode, was identified whereas the origin of the second episode remained unknown. From one of the 40 staff stool samples VRE was isolated. This strain was related to the clone of the summer outbreak. In conclusion there were two independent episodes of self limiting VRE outbreaks and transmission on the ward is highly probable.