Author/Editor		Ribič, Helena; Grmek-Košnik, Irena; Kramar, Zdenka; Rus, Igor
Title		Naše izkušnje s proti vankomicinu odpornim eneterokokom v SPlošni bolnišnici Jesenice
Translated title		Our experiences with vancomycin-resistant enterococci in Jesenice general hospital
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 76, št. 11
Publication year		2007
Volume		str. 701-7
Language		slo
Abstract		Background Vancomycin-resistant enterococci (VRE) present a great problem in health care, especially because of their resistance to many groups of antibiotics and because of the way of their spreading in health care and long-term care institutions. Genes responsible for resistance to vancomycin can be transmitted to other species of enterococci and also to other grampositive cocci, for example Staphylococcus aureus. Experts anticipate that failure to control methicilin-resistant S. aureus and VRE may make control of vancomycin-resistant S. aureus impossible. Methods In the medical microbiology laboratory of Institute Public Health Kranj we perform microbiology diagnosis for Jesenice General Hospital, where surveillance culturing for VRE started in May 2007. Until 15th June, 364 surveillance samples for VRE were taken from 92 patients. We also analysed the results of enterococci that were isolated in our laboratory during routine work in the period from 2004 to 2006. Results In the three-year period we isolated 1593 strains of enterococci and among them 7 strains were VRE. In the Jesenice General Hospital, the first strain of vancomycin-resistant Enterococcus faecium was isolated in May 2007 in a patient, treated in internal intensive care unit. Nine strains of VRE with the same resistance type in nine patients followed the first case. The first four patients with VRE were moved from the same hospital. Among next six patients the common risk factor was contact with VRE positive patient. Conclusions Control of VRE strains claims for intensive action. Active surveillance of colonised and infected patients, contact precautions with barrier isolation, intensive hand hygiene measures, aggressive environmental decontamination and prudent use of antimicrobials are needed.
Summary		Izhodišča Proti vankomicinu odporni enterokoki (VRE) so velik problem v zdravstvu, predvsem zaradi odpornosti na številne antibiotike in zaradi širjenja sevov v bolnišnicah in drugih ustanovah za nego bolnih. Geni za odpornost proti vankomicinu se lahko iz VRE širijo na druge enterokoke in tudi na druge po Gramu pozitivne koke, npr. Staphylococcus aureus. Strokovnjaki predvidevajo, da bi neuspešno obvladovanje sevov na meticilin odpornih S. aureus in VRE lahko pripeljalo do neobvladljivosti na vankomicin odpornih sevov S. aureus. Metode V Laboratoriju za medicinsko mikrobiologijo Zavoda za zdravstveno varstvo Kranj izvajamo mikrobiološko diagnostiko za Splošno bolnišnico Jesenice. Nadzorne kužnine, usmerjene na osamitev VRE, smo začeli prejemati v maju 2007. Do 15. junija smo prejeli 364 kužnin, odvzetih 92 bolnikom. Pregledali smo tudi rezultate enterokokov, ki smo jih v laboratoriju osamili pri rednem delu v letih od 2004 do 2006 iz vzorcev vseh naročnikov. Rezultati V triletnem obdobju smo med 1593 izolati enterokokov osamili 7 sevov VRE. Bakterijo VRE smo v Splošni bolnišnici Jesenice zaznali v mesecu maju 2007, ko smo pri bolniku na oddelku interne intenzivne medicine osamili sev E. faecium. Temu sevu je sledilo še devet sevov VRE z istim tipom odpornosti pri devetih bolnikih. Štirje bolniki, pri katerih smo najprej osamili VRE, so bili pred tem premeščeni iz iste bolnišnice, pri ostalih šestih bolnikih pa je bil skupen nevarnostni dejavnik ‐ stik z VRE pozitivnim bolnikom. Zaključki Obvladovanje bakterije VRE zahteva intenzivno ukrepanje. Potrebno je dejavno iskanje koloniziranih in okuženih, dosledno izvajanje osamitve bolnikov z bakterijo VRE in njihovih stikov, intenzivno izvajanje ukrepov za higieno rok, čiščenje in razkuževanje površin in opreme ter pravilna raba protimikrobnih zdravil.
Descriptors		GRAM-POSITIVE BACTERIAL INFECTIONS VANCOMYCIN DRUG RESISTANCE, MICROBIAL ENTEROCOCCUS