ABSTRACT

Vancomycin-resistant enterococci infections are of great public health significance due to limited therapeutic options. We investigated epidemiological trends and risk factors of vancomycin resistance in enterococci isolates from patients with bloodstream infections in the EU/EEA from 2012 to 2018. Routine vancomycin susceptibility data of clinical E. faecium (n = 67,022) and E. faecalis (n = 103,112) blood isolates from the European Antimicrobial Resistance Surveillance Network were analysed using descriptive statistics and multivariable regression analyses. In Europe, proportions of vancomycin-resistant E. faecium (VREFm) increased from 8.1% (95%CI 6.7–9.7%) in 2012 to 19.0% (95%CI 16.8–21.5%) in 2018. Rising VREFm proportions were observed across all European regions, both genders and all age groups except children and adolescents (1–19 years). Adults (20–59 years) and elderly (≥60 years) had an increased likelihood of VREFm compared to children and adolescents (1–19 years) (OR: 1.99 [95%CI 1.42–2.79, p < 0.001] and OR: 1.56 [95%CI 1.09–2.23, p = 0.014], respectively). Inpatients hospital units, including internal medicine and ICUs, were associated with an increased likelihood of VREFm (OR: 2.29 (95%CI 1.58–3.32, p < 0.001) compared to the emergency department which reflects patients with community origin of E. faecium infections. The mean proportion of vancomycin-resistant E. faecalis in Europe was found to be low (1.1% [95%CI 0.9–1.4%]). Local and regional authorities should intensify efforts directed at diagnostic and antimicrobial stewardship for vancomycin and all last resort drugs for the management of VREFm, particularly for hospitalized elderly patients.

 抽象的

由于治疗选择有限，万古霉素耐药肠球菌感染具有重要的公共卫生意义。我们调查了 2012 年至 2018 年欧盟/欧洲经济区血流感染患者肠球菌分离株万古霉素耐药的流行病学趋势和危险因素。临床屎肠球菌(n = 67,022) 和粪肠球菌(n = 103,112) 的常规万古霉素敏感性数据）使用描述性统计和多变量回归分析对欧洲抗菌药物耐药性监测网络的血液分离株进行了分析。在欧洲，耐万古霉素屎肠球菌(VREFm) 的比例从 2012 年的 8.1% (95%CI 6.7–9.7%) 增加到 2018 年的 19.0% (95%CI 16.8–21.5%)。所有欧洲地区，不限性别，不限年龄组，儿童和青少年（1-19 岁）除外。与儿童和青少年（1-19 岁）相比，成人（20-59 岁）和老年人（≥60 岁）发生 VREFm 的可能性更高（OR：1.99 [95% CI 1.42-2.79，p < 0.001]，OR： 1.56 [95%CI 1.09–2.23，p = 0.014]，分别）。与急诊科相比，住院病房（包括内科和 ICU）的 VREFm 可能性增加相关（OR：2.29（95%CI 1.58–3.32，p < 0.001），这反映了社区起源的屎肠球菌感染的患者发现欧洲耐万古霉素粪肠球菌的平均比例较低（1.1% [95%CI 0.9–1.4%]）。地方和地区当局应加强针对万古霉素和所有抗生素的诊断和抗菌管理工作。用于治疗 VREFm 的度假药物，特别是对于住院的老年患者。