萬古黴素抗藥性腸球菌感染症之治療藥物介紹

Antimicrobial Therapy for Infection Caused by Vancomycin-resistant Enterococci

萬古黴素抗藥性腸球菌（vancomycin-resistant enterococci；VRE）是院內感染重要的病原菌之一，近年來抗藥性菌株盛行率有逐年上升的趨勢，本文探討VRE的流行病學、抗藥性、危險因子、藥物敏感性及抗藥性篩檢試驗及治療性抗生素的選用考量，提供目前臨床上VRE感染症治療性抗生素的選用參考。VRE菌株篩選試驗，依據臨床與實驗室標準協會（Clinicaland Laboratory Standards Institute；CLSI）所制定的試驗標準為主。危險因子包括先前vancomycin大量使用、疾病的嚴重度、住院過久及使用導管裝置等。大部份文獻顯示ampicillin、aminoglycosides、fosfomycin、nitrofurantoin、chloramphenicol、doxycycline及baci-tracin等治療藥物，臨床上不建議用於VRE感染症的治療。Daptomycin、linezolid、quinupristin/dalfopristin及tigecycline抗生素對VRE菌株具有不錯的敏感性，但臨床上仍需審慎使用，以降低VRE抗藥性菌株的產生。

Vancomycin-resistant enterococci (VRE) have emerged as important pathogens causing nosocomial infections. The prevalence rate of VRE infection has been clearly increasing in the recent years. The aim of this review is to assess the epidemiology, antibiotic-resistance, risk factors, and drug susceptibility data of VRE isolates and determine the appropriate antibiotic for clinical treatment of VRE infection. The screening test for vancomycin resistance in Enterococcus spp. strains was based on the methodology described in the Clinical and Laboratory Standards Institute (CLSI) guidelines. The risk factors for VRE infection include prior antibiotic use (particularly vancomycin), disease severity, length of stay in ICU, intubation, mechanical ventilation, and catheterization. Many studies have shown that ampicillin, aminoglycosides, chloramphenicol, fosfomycin, nitrofurantoin, doxycycline, and bacitracin should not be recommended to treat VRE infections for clinical use, even in cases showing apparent susceptibility. The new antimicrobial agents such as daptomycin, linezolid, quinupristin/dalfopristin, and tigecycline showed good in vitro activity against most VRE isolates, but clinicians must choose the antibiotics appropriately and judiciously to decrease the possibility of generating resistant strains in the future.