萬古黴素抗藥性腸球菌之現況及治療

Current condition and therapy of vancomycin-resistant Enterococci

萬古黴素抗藥性腸球菌（vancomycin-resistant enterococci, VRE）在世界各國的醫療照護相關感染日趨嚴重，而 VRE 血流感染亦是病人死亡的獨立因子之一。罹患VRE血流感染的危險因子包括先前使用vancomycin或第三代cephalosporin、免疫不全或腎功能不全、長時間住院和接觸汙染環境。然而對VRE血流感染的治療尚未有明確指引，近期有數篇研究報告針對過去回溯性研究，進行多變項分析和系統性回顧，比較linzolid和daptomycin 治療的預後，發現使用linezoid治療VRE菌血症，其病人的死亡率在統計上有顯著下降。針對VRE感染，須找出確切的感染源（例如中心靜脈導管），移除感染源合併適當的抗生素，才能有效控制感染。

Healthcare-associated infections caused by vancomycin-resistant entercocci (VRE) have been of progressive concern worldwide. VRE bacteremia per se may lead to fatality. Risk factors for acquisition of VRE bacteremia include previous therapy with vancomycin and/or any 3rd-generation cephalosporins, immunocompromised status, impaired renal function, residence in long-term care facilities, and exposure to contaminated environmental surfaces. Guidelines for treatment of VRE bacteremia have not been reached. Recently published systematic reviews and meta-analyses of prior reprospective studies comparing the effects of linezolid and daptomycin in the treatment of VRE bacteremia disclosed a tendency suggesting possible superiority of linezolid in terms of patient survival. To tackle VRE bacteremia, in addition to antibiotic therapy, it is very important to identify the infection focus, and remove the catheter were it related to the infection.