| 词条 | Vancomycin-resistant Enterococcus |
| 释义 |
| name = | synonyms = | image = Vancomycin-Resistant Enterococcus 01.jpg | alt = | caption = SEM micrograph of vancomycin-resistant enterococci | pronounce = | field = Microbiology | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = Screen with peri-rectal swab[1] | treatment = Linezolid [2] | medication = | prognosis = | frequency = | deaths = }}Vancomycin-resistant Enterococcus, or vancomycin-resistant enterococci (VRE), are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin.[1] Mechanism of acquired resistanceSix different types of vancomycin resistance are shown by enterococcus: Van-A, Van-B, Van-C, Van-D, Van-E and Van-G.[2] The significance is that Van-A VRE is resistant to both vancomycin and teicoplanin,[3] Van-B VRE is resistant to vancomycin but susceptible to teicoplanin,[4][5] and Van-C is only partly resistant to vancomycin The mechanism of resistance to vancomycin found in enterococcus involves the alteration of the peptidoglycan synthesis pathway.[6] The D-alanyl-D-lactate variation results in the loss of one hydrogen-bonding interaction (four, as opposed to five for D-alanyl-D-alanine) being possible between vancomycin and the peptide. The D-alanyl-D-serine variation causes a six-fold loss of affinity between vancomycin and the peptide, likely due to steric hindrance.[7][8] {{clear}}DiagnosisOnce the individual has VRE, it is important to ascertain which strain.[9] ScreeningScreening for VRE can be accomplished in a number of ways. For inoculating peri-rectal/anal swabs or stool specimens directly, one method uses bile esculin azide agar plates containing 6 µg/ml of vancomycin. Black colonies should be identified as an enterococcus to species level and further confirmed as vancomycin resistant by an MIC method before reporting as VRE.[1] Vancomycin resistance can be determined for enterococcal colonies available in pure culture by inoculating a suspension of the organism onto a commercially available brain heart infusion agar (BHIA) plate containing 6 µg/ml vancomycin. The National Committee for Clinical Laboratory Standards (NCCLS) recommends performing a vancomycin MIC test and also motility and pigment production tests to distinguish species with acquired resistance (vanA and vanB) from those with vanC intrinsic resistance.[10] Treatment of infectionCephalosporin use is a risk factor for colonization and infection by VRE, and restriction of cephalosporin usage has been associated with decreased VRE infection and transmission in hospitals.[11] Lactobacillus rhamnosus GG (LGG), a strain of L. rhamnosus, was used successfully for the first time to treat gastrointestinal carriage of VRE.[12] In the US, linezolid is commonly used to treat VRE.[13]HistoryTo become vancomycin-resistant, vancomycin-sensitive enterococci typically obtain new DNA in the form of plasmids or transposons which encode genes that confer vancomycin resistance.[14] This acquired vancomycin resistance is distinguished from the natural vancomycin resistance of certain enterococcal species including E. gallinarum and E. casseliflavus.[15] High-level vancomycin-resistant E. faecalis and E. faecium are clinical isolates first documented in the 1980s.[16] In the United States, vancomycin-resistant E. faecium was associated with 4% of healthcare-associated infections reported to the Centers for Disease Control and Prevention National Healthcare Safety Network from January 2006 to October 2007.[17] VRE can be carried by healthy people who have come into contact with the bacteria, usually in a hospital[18] (nosocomial infection),[19] although it is thought that a significant percentage of intensively farmed chicken also carry VRE.[20] Other regions have noted a similar distribution, but with increased incidence of VRE. For example, a 2006 study of nosocomial VRE revealed a rapid spread of resistance among enterococci along with an emerging shift in VRE distribution in the Middle East region, such as Iran. Treatment failures in enterococcal infections result from inadequate information regarding glycopeptide resistance of endemic enterococci due to factors such as the presence of VanA and VanB. The study from Iran reported the first case of VRE isolates that carried VanB gene in enterococcal strains from Iran. This study also noted the first documented isolation of nosocomial E. raffinosus and E. mundtii in the Middle East region.[21] See also
References1. ^{{Cite web|title = Vancomycin-resistant Enterococci (VRE) in Healthcare Settings |publisher=CDC |work=VRE in Healthcare Settings - HAI |url = https://www.cdc.gov/HAI/organisms/vre/vre.html |accessdate = 2015-06-09}} 2. ^{{Cite book|title = Antimicrobial Resistance and Implications for the 21st Century|url = https://books.google.com/?id=E4JuhqT9JzgC&pg=PA26&dq=different+types+of+vancomycin+resistance+are+shown+by+enterococcus+:+Van-A,+Van-B,+Van-C,+Van-D,+Van-E+and+Van-F#v=onepage&q=different%252520types%252520of%252520vancomycin%252520resistance%252520are%252520shown%252520by%252520enterococcus%252520%25253A%252520Van-A%25252C%252520Van-B%25252C%252520Van-C%25252C%252520Van-D%25252C%252520Van-E%252520and%252520Van-F&f=false|publisher = Springer Science & Business Media|date = 2007-11-15|isbn = 9780387724188|first = I. W.|last = Fong|first2 = Karl|last2 = Drlica}} 3. ^{{Cite book|title = Science and Technology Against Microbial Pathogens: Research, Development and Evaluation, Proceedings of the International Conference on Antimicrobial Research (ICAR2010), Valladolid, Spain 3 - 5 November 2010|url = https://books.google.com/?id=cVAft_EP8kUC&pg=PA360&dq=Van-A+VRE+is+resistant+to+both+vancomycin+and+teicoplanin,#v=onepage&q=Van-A%252520VRE%252520is%252520resistant%252520to%252520both%252520vancomycin%252520and%252520teicoplanin%25252C&f=false|publisher = World Scientific|date = 2011|isbn = 9789814354868|first = A.|last = Mendez-Vilas}} 4. ^{{Cite book|title = New Strategies Combating Bacterial Infection|url = https://books.google.com/?id=Hrdzorisyp8C&pg=PA17&dq=Van+B+susceptible+to+teicoplanin#v=onepage&q=Van%252520B%252520susceptible%252520to%252520teicoplanin&f=false|publisher = John Wiley & Sons|date = 2008-11-21|isbn = 9783527622948|first = Iqbal|last = Ahmad|first2 = Farrukh|last2 = Aqil}} 5. ^{{Cite book|title = Kucers' The Use of Antibiotics Sixth Edition: A Clinical Review of Antibacterial, Antifungal and Antiviral Drugs|url = https://books.google.com/?id=XR3cBQAAQBAJ&pg=PA575&dq=Van+c+is+partly+resistant+susceptible+to+teicoplanin#v=onepage&q=Van%252520c%252520is%252520partly%252520resistant%252520susceptible%252520to%252520teicoplanin&f=false|publisher = CRC Press|date = 2010-10-29|isbn = 9781444147520|first = M. Lindsay|last = Grayson|first2 = Suzanne M.|last2 = Crowe|first3 = James S.|last3 = McCarthy|first4 = John|last4 = Mills|first5 = Johan W.|last5 = Mouton|first6 = S. Ragnar|last6 = Norrby|first7 = David L.|last7 = Paterson|first8 = Michael A.|last8 = Pfaller}} 6. ^{{Cite journal|title = Figure 4 : The rise of the Enterococcus: beyond vancomycin resistance : Nature Reviews Microbiology|journal = Nature Reviews Microbiology|volume = 10|issue = 4|pages = 266–278|doi = 10.1038/nrmicro2761|pmid = 22421879|pmc = 3621121|year = 2012|last1 = Arias|first1 = Cesar A.|last2 = Murray|first2 = Barbara E.}} 7. ^{{Cite journal|title = Structural and Functional Characterization of VanG d-Ala:d-Ser Ligase Associated with Vancomycin Resistance in Enterococcus faecalis♦|journal = The Journal of Biological Chemistry|date = 2012|issn = 0021-9258|pmc = 3488035|pmid = 22969085|pages = 37583–37592|volume = 287|issue = 45|doi = 10.1074/jbc.M112.405522|first = Djalal|last = Meziane-Cherif|first2 = Frederick A.|last2 = Saul|first3 = Ahmed|last3 = Haouz|first4 = Patrice|last4 = Courvalin}} 8. ^{{Cite book|title = Antibiotic Resistance|url = https://books.google.com/?id=Zctja6ZwaccC&pg=PA48&dq=The+D-alanyl-D-lactate+variation+++vancomycin#v=onepage&q=The%252520D-alanyl-D-lactate%252520variation%252520%252520%252520vancomycin&f=false|publisher = Springer Science & Business Media|date = 2012-08-31|isbn = 9783642289507|first = Anthony R. M.|last = Coates}} 9. ^{{Cite web|url=https://www.niaid.nih.gov/research/vre-diagnosis|title=Vancomycin-Resistant Enterococci (VRE) Diagnosis {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=www.niaid.nih.gov|language=en|access-date=2017-03-24}} 10. ^1 2 {{cite web|title=Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory|url=https://www.cdc.gov/hai/settings/lab/vreclinical-laboratory.html|publisher= Centers for Disease Control and Prevention |accessdate=21 May 2017|language=en-us}} {{PD-notice}} 11. ^{{Cite journal|title = Association of Vancomycin-Resistant Enterococcus Bacteremia and Ceftriaxone Usage|journal = Infection Control and Hospital Epidemiology|date = 2012|issn = 0899-823X|pmc = 3879097|pmid = 22669234|volume = 33|issue = 7|doi = 10.1086/666331|first = James A.|last = McKinnell|first2 = Danielle F.|last2 = Kunz|first3 = Eric|last3 = Chamot|first4 = Mukesh|last4 = Patel|first5 = Rhett M.|last5 = Shirley|first6 = Stephen A.|last6 = Moser|first7 = John W.|last7 = Baddley|first8 = Peter G.|last8 = Pappas|first9 = Loren G.|last9 = Miller|pages=718–724}} 12. ^{{Cite book|title = Novel Antimicrobial Agents and Strategies|url = https://books.google.com/?id=BWBhBAAAQBAJ&pg=PT226&dq=Lactobacillus+rhamnosus+GG++treat++VRE#v=onepage&q=Lactobacillus%252520rhamnosus%252520GG%252520%252520treat%252520%252520VRE&f=false|publisher = John Wiley & Sons|date = 2014-08-25|isbn = 9783527676156|first = David A.|last = Phoenix|first2 = Frederick|last2 = Harris|first3 = Sarah R.|last3 = Dennison}} 13. ^1 {{Cite journal|title = Systematic Review and Meta-Analysis of Linezolid versus Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bacteremia|url = http://aac.asm.org/content/58/2/734|journal = Antimicrobial Agents and Chemotherapy|date =2014|issn = 0066-4804|pmid = 24247127|pages = 734–739|volume = 58|issue = 2|doi = 10.1128/AAC.01289-13|first = Eleni P.|last = Balli|first2 = Chris A.|last2 = Venetis|first3 = Spiros|last3 = Miyakis|pmc=3910884}} 14. ^{{Cite book|title = Infection Prevention and Control: Applied Microbiology for Healthcare|url = https://books.google.com/?id=pv4cBQAAQBAJ&pg=PA17&dq=vancomycin+resistant+enterococcus+occurs+new+plasmids#v=onepage&q=vancomycin%252520resistant%252520enterococcus%252520occurs%252520new%252520plasmids&f=false|publisher = Palgrave Macmillan|date = 2008-08-20|isbn = 9781137045928|first = Dinah|last = Gould|first2 = Christine|last2 = Brooker}} 15. ^{{Cite web |title = VRE and the Clinical Laboratory - HAI |work=Healthcare-associated Infections |url = https://www.cdc.gov/HAI/settings/lab/VREClinical-Laboratory.html |publisher=CDC |accessdate = 2015-06-09}} 16. ^{{Cite book|title = Bacterial Population Genetics in Infectious Disease|url = https://books.google.com/?id=MPWJIcTxcyQC&pg=PA196&dq=E.+faecalis+and+E.+faecium+++vancomycin+resistant+1980%252527s#v=onepage&q=E.%252520faecalis%252520and%252520E.%252520faecium%252520%252520%252520vancomycin%252520resistant%2525201980's&f=false|publisher = John Wiley & Sons|date = 2010-03-16|isbn = 9780470600115|first = D. Ashley|last = Robinson|first2 = Edward J.|last2 = Feil|first3 = Daniel|last3 = Falush}} 17. ^{{cite journal |vauthors=Hidron AI, Edwards JR, Patel J, etal |title=NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007 |journal=Infect Control Hosp Epidemiol |volume=29 |issue=11 |pages=996–1011 |date=November 2008 |pmid=18947320 |doi=10.1086/591861 |url=}} 18. ^{{Cite web|title = Diseases and Organisms in Healthcare Settings |work=Healthcare-associated Infections (HAIs) |url = https://www.cdc.gov/HAI/organisms/organisms.html |publisher=CDC |accessdate = 2015-06-09}} 19. ^{{Cite journal|title = Nosocomial Infections: The Definition Criteria |journal = Iranian Journal of Medical Sciences|date = 2012|pmc = 3470069|pmid = 23115435|pages = 72–73|volume = 37|issue = 2|first = Farideh|last = Kouchak|first2 = Mehrdad|last2 = Askarian}} 20. ^{{Cite journal | title = Vancomycin resistant enterococci in farm animals – occurrence and importance |journal = Infection Ecology & Epidemiology |date = 2012 |pmc = 3426332|pmid = 22957131 |volume = 2 |pages = 16959 |doi = 10.3402/iee.v2i0.16959 | first = Oskar|last = Nilsson}} 21. ^{{cite journal |title=Frequency of Vancomycin-Resistant Enterococci from Three Hospitals in Iran |journal=Daru |year=2006 |last=Fathollahzadeh |first=Bahram |last2=Hashemi |first2=Farhad B. |last3=Emaneini |first3=Mohammad |last4=Aligholi |first4=Marzieh |last5=Nakhjavani |first5=Farrokh A. |volume=14 |issue=3 |pages=141–146 |url=http://daru.tums.ac.ir/index.php/daru/article/download/281/281 |format=PDF |accessdate=2015-12-30 }} Further reading
External links-{{Medical resources| ICD9 = V09.8 | ICDO = | OMIM = | DiseasesDB = | MedlinePlus = 000476 | eMedicineSubj = | eMedicineTopic = | MeSH = | GeneReviewsNBK = | GeneReviewsName = | Orphanet = }}
3 : Lactobacillales|Antibiotic-resistant bacteria|Healthcare-associated infections |
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