萬古黴素抗藥性腸球菌感染或移生個案之腸道移生情形分析

Vancomycin-resistant enterococci (VRE) intestinal colonization surveillance in 37 VRE-infected patients: A retrospective analysis

近幾年萬古黴素抗藥性腸球菌感染的快速增加，造成病人更多的併發症和醫療資源的消耗。本研究主要針對本院抗藥性腸球菌感染者的腸道移生情形，作一個回溯性分析。在2007年1月1日到同年12月31日之間，收集所有曾經分離出萬古黴素抗藥性腸球菌的病人共37位，包括38個感染個案及50個菌株被收入這個分析當中。在各類培養陽性的檢體中，以尿液為最常見（46%）。在38個感染個案中，只有3個感染個案因為三套培養陰性的糞便檢體，而得以被解除隔離。其他無法解除隔離的原因，最常見的是糞便檢體持續帶菌（63%）。此種持續帶菌的情況，和該病患曾於一個月內使用糖肽類抗生素有關（91% vs. 22%, P<0.05）。為減少抗藥性腸球菌的增加和醫療資源的消耗，嚴格管控糖肽類抗生素的使用和隔離措施的執行是必需的。（感控雜誌 2009;19:1-9）。

The rapid increase of infections caused by vancomycin-resistant enterococci (VRE) has resulted in the increase in morbidity, mortality and medical costs in recent years. We retrospectively analyzed intestinal colonization of VRE in patients infected by these pathogens in our hospital. Between January I and December 31, 2007, a total of 37 patients (with 38 episodes and 50 isolates) were collected and surveyed. Urine (46%) was the most frequently encountered specimen. Among the 38 episodes, the criteria for discontinuation of isolation care, which were three consecutive negative results for stool surveillance, could be met in only three episodes. For those being kept for isolation care, the major reason was due to the persistence of positive stool findings (63%)- Persistent stool carriage of VRE was associated with the use of glycopeptides antibiotics within one month of the infections (91% vs. 22%, p<0.05). In order to control the increase of VRE infections and to reduce medical expenses, judicious use of glycopeptide should be encouraged and a more stringent isolation policy should be implemented. (Infect Control J 2009:19:1-9).