古黴素抗藥性腸球菌-在南台灣某教學醫院五年經驗

Vancomycin-resistant Enterococcus：a five-year Experience at a Teaching Hospital in Southern Taiwan

隨著抗生素的不適當使用，對萬古黴素有抗藥性的腸球菌vancomycin-resistant Enterococcus（簡稱VRE）陸續出現，衍生出一系列治療上和感染管制問題。這是回溯性研究，收集從2003年1月到2007年12月五年間，任何檢體培養出VRE的住院病人，紀錄這些人的特徵、潛在性疾病（underlying disease）和預後。共23人納入此研究，男性11入、女性12人，平均年齡71.6歲。2003年至2007年VRE的比率從0.23%上升至2.22%。E. faecium的比率從2005年至2007年上升4.8倍的（從1.48%到7.11%）。尿液培養陽性最多，有10人。13（56.5%）人曾住加護病房，16（69.6%）入接受過廣效性抗生素，cephalosporin類最多。罹患糖尿病最多，有9個人。7（30.4%）入是侵襲性感染，5個人死亡，且多是年老、住院時間長、曾經入住加護病房，及使用過廣效性抗生素。我們將持續追蹤VRE的盛行率，進行感染管制教育及合理的抗生素使用，希望能改善相關問題。

Vancomycin-resistant enterococcus (VRE) had emerged continually and brought problems of treatment and infection control. From January 2003 through December 2007, all patients with cultures positive for VRE from clinical specimens at Chang Gung Memorial Hospital-Chiayi were reviewed retrospectively. We recorded the clinical characteristics of these patients, underlying diseases and outcomes. A total of 23 patients were identified. 11 were males and 12 were females. The mean age was 71.6 years. From 2003 through 2007, the percentage of VRE increased from 0.23% to 2.22%。The percentage of E. faecium increased 4.8-fold from 2005 through 2007 (from 1.48% to 7.11%). The most common isolation site was from urine. Thirteen (56.5%) patients had been hospitalized at intensive care unit (ICU). Sixteen (69.6%) patients received broad-spectrum antibiotics, and most were cephalosporins. Nine patients had diabetes mellitus, and it was the most common underlying disease. Seven (30.4%) patients had invasive infections and five of them died. The patients who dried tended to be elderly, longer hospital stay, prior ICU admission and broad spectrum antibiotic use. Closely monitoring the prevalence of VRE, education for infection control and rational antimicrobial usage were encouraged to improve VRE-associated problems.