The emergence of vancomycin-resistant enterococci at haematological patients of General Faculty Hospital Prague and The Institute of Hematology and Blood Transfusion
Abstract
Enterococci are part of the normal intestinal flora. These bacteria may colonize the oral cavity, genito-urethral tract and skin.
Colonized patients , especially immunosuppressed pacients, are at risk of infection. The most frequent enterococcal infections are urinary tract infections, intra-abdominal infections, and bloodstream infections.
Most infections are caused by E. faecalis and E. faecium. E. faecalis strains exhibit very low resistance to ampicillin and vancomycin.
E. faecium strains show high level of resistance to ampicilin and increasing resistance to vancomycin. Our department carries out regular screening of haematological patients of General Faculty Hospital and the Institute of Hematology and Blood Transfusion (IHBT).
We follow up the emergence of vancomycin - resistant enterococci (VRE) in the upper respiratory tract and the gastrointestinal tract. At the First Internal Clinic of General Faculty Hospital the consumption of vancomycin was reduced and the amount of VRE decreased from 27% to 4%.
At the IHBT the consumption of antibiotics remains consistently very high and the incidence of VRE is around 42%. Active searching for reservoirs of VRE is one of the most important ways to prevent the spread of VRE.
Another option is to reduce the consumption of antibiotics. Therefore, the cooperation of the attending physician with a clinical microbiologist should be an essential part of the care of critically ill patients.