Vancomycin-resistant Enterococcus: Inpatient

Описание: Enterococcus faecalis and Enterococcus faecium together account for the vast majority of Enterococcus isolates. Enterococcus is an anaerobic bacterial genus that is a commensal inhabitant of the human intestine. Because of their intrinsic drug resistance, Enterococci are an important pathogen in the hospital environment and are a major cause of nosocomial (health care--associated) infections. Although colonization with resistant strains is the norm, physically debilitated patients can develop endocarditis, surgical wound, urinary tract or bloodstream infections.

The series depicts the evolution of vancomycin-resistant Enterococcus (VRE) rates for inpatient samples, combining the rates for E. faecalis and E. faecium. Vancomycin is a glycopeptide antibiotic, one of few that inhibits the growth of enterococci, which is why CDC guidelines recommend for its "prudent use." Before the development of newer antibiotics (linezolid, daptomycin, and tigecycline), treatment alternatives for VRE infections were severely limited.

The maps show considerable regional variation. Vancomycin-resistance generally increases over time, with highest rates generally in the northeastern are of the country, but by 2008--09, increasing resistance rates begin to spread south and west. Throughout the decade areas of the country experience resistance rates greater than 35%.

The National Nosocomial Infections Surveillance (NNIS) also reports Enterococcus resistance rates around 25% at the beginning of the decade, following a steep rise in the 1990s. The 2003 NNIS survey reports increasing resistance (29%), which is even higher in the 2006--2007 National Healthcare Safety Network (NHSN) data summary (33%). The rise of VRE rates is disconcerting because the bug can share its resistance genes with S. aureus, giving rise to vancomycin resistance in that organism (a new superbug known as VRSA). In addition, with the emergence of linezolid resistance to VRE, future treatment alternatives are becoming fewer and more expensive.

The national average resistance level for the sample was 26%, rising from 24.1% in 2000 to 26.4% in 2009.

The sample consists of 257,579 inpatient isolates of Enterococcus faecalis and Enterococcus faecium tested for vancomycin resistance. Data are not available from the following states: AR (2000--2003, 2008--2009), GA (2007--2009), IA (2008--2009), IN (2007--2009), KY (2007--2009), MS (2006--2009), NV (2009), RI (2000--2004), SD (2005--2009), UT (2007--2009), CO, CT, NH, MT, VT, and WY.