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 Original Articles |
| Recent Prevalence and Clinical Spectrum of Vancomycin resistant enterococci(from Jan. 1991 to Dec. 1997) |
| Koo Yeop Kim, Sang Phil Chang, Hee Joo Lee*, and Hwan Jo Suh |
| Department of Internal Medicine and Clinical Pathology*, College of Medicine, Kyung-Hee University, Seoul, Korea |
Vol.16 Num.4 (p351~359)
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Background : Enterococci are normal residents of the human gastrointestinal and biliary tracts. It was well known that enterococci cause endocarditis and urinary tract infection. Enterococcal colonization appears to be enhanced by the use of newer broad-spectrum β-lactam antibiotics for prolonged periods. Nosocomial outbreaks have occurred most frequently in areas of the hospital in which antimicrobial use is high. Because enterococci are resistant to a range of antibiotics, particularly in nosocomial infections, glycopeptides (vancomycin or teicoplanin) are required for the treatment of severe enterococcal infections. Since 1986, strains resistant to glycopeptide have been described in USA and since 1992, those have been described in Korea. The frequency of vancomycin-resistant enterococci (VRE) is increasing for several years because use of vancomycin for MRSA has increased.
In order to analyze the frequency and clinical spectrum of vancomycin-resistant enterococcal infections, we performed this study.
Methods : We retrospectively reviewed the medical records of patients with the vancomycin-resistant enterococcal infections a t Kyung-Hee University Hospital for 7 years (from Jan. 1991 through Dec. 1997).
Results :
1. There was no case of VRE m 1991 and 1992, but 35 cases occurred in 1993, 6 casee m 1994, 29 cases in 1995, 2 cases in 1996, 7 cases m 1997. Number of total cases is 79 eases. 74 cases of 79 cases were E. fecalis and 5 cases of 79 cases were E. faecium.
2. Elderly patients (more than 50 years old) have more frequent enterococcal infections and male patients had more frequent infection than female patients; 6:4 (M:F).
3. Urine is the most frequent source of entrococccal infections. Also pus of soft tissue is frequent source of infection.
4. Underlying disesases are malignancy (13 cases), cardivascular diseases (22 cases), diabetes mellitus (14 cases), chronic renal failure (7 cases). However, 12 cases had no underlying diseases.
5. Frequency of antibiotics resistance is 17.9% in ampicillin, 80.6% in erythromycin and 50.7% in ciprofloxacin.
6. 48 cases of 79 cases were nosocomial infection (60.8 %)
Conclusion : The strategy for prevention of vancomycin-resistant enterococcal infection is required because the number of strains with vancomycin resistance may be expected to increase in the future. Monitoring of the antimicrobial susceptibility of Enterococcus species continues to be important. Emerging pattern of resistance must be monitored by prospective surveillance of antimicrobial resistance in enterococcal isolates.
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Keywords : Vancomycin-resistant enterococci (VRE), Nosocomial infection, Glycopeptide |
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