北部某醫學中心內科加護病房萬古黴素抗藥性腸球菌群突發調查報告

Outbreak of Vancomycin-Resistant Enterococci in a Medical Intensive Care Unit of Medical Center in Northern Taiwan

自1988年萬古黴素抗藥性腸球菌 （vancomycin-resistant enterococci; VRE） 被發現後， VRE 已成為醫療照護相關感染最重要的抗藥性菌種之一。北部某醫學中心內科加護病房以往未曾發生過 VRE 個案，但自2007年起發生 vancomycin-resistant Enterococcus faecium 感染及移生之個案，並有明顯持續增加情形，且於2007年9月共有4位符合醫療照護相關感染定義之案例，判斷為 VRE 群突發感染，故展開調查並進行環境採檢及執行相關感染管制措施。以回溯性研究法調查內科加護病房之病人，發現2007年7月至9月共有8位病人感染或移生 VRE，其中5位肛門拭子 VRE 呈陽性，採集同室病人肛門拭子共10件， VRE 陽性者2位，環境採檢81件皆未發現 VRE，將15件 VRE 陽性檢體經脈衝式膠質電泳分析 （PFGE） 分型進行比對，結果顯示內科加護病房之 VRE 共有3種分型，其中相同基因型共13件，包含7位病人臨床分離菌株及其肛門拭子5件及4件同室接觸者，確定為一群突發。經由傳播途徑之阻斷並由細菌室快速傳達檢驗結果，立即採取隔離措施，制訂正確的清潔程序及督促清潔人員執行完整的環境清潔常規，若未依程序則要求停止並重新開始，使此次群突發能得到控制。（感控雜誌 2009; 19: 229-39）。

Vancomycin-resistant enterococci (VRE) had been reported since1988 and became an important clinical issue. However, it was not found in the medical intensive care unit (MI CU) of our hospital before 2007. In September 2007, health care-associated infection due to vancomycin-resistant Enterococcus faecium were found in 4 cases in the MICU and an outbreak of VRE was suspected. Retrospective review found 8 clinical isolates each in 8 patients from July through September 2007. Relevant survey revealed that 5 of 8 patients and 2 of their 10 roommates were found with bowel carriage of VRE. However, none of the 81 specimens collected from patient-related surroundings yielded VRE. The 15 isolates were classified into three patterns of phenotypes by Pulsed-field gel electrophoresis (PFGE). Thirteen of the 15 isolates were in the same phenotype. Seven patients and 1 roommate were found in this group and an outbreak was confirmed. The outbreak was resolved by strict performance of contact isolations and bowel precautions according to in-time microbiological information. The authors emphasized that strict performance of environmental cleaning at ward and contact precaution were mandatory for controlling VRE outbreak. (Infect Control J 2009;19:229-39).