Vancomycin-resistente Enterokokken – Epidemiologie, Diagnostik, Typisierung, Trends

Kernaussagen

• Enterokokken/VRE sind klassische opportunistische Infektionserreger mit ausdrücklich hohem Ausbreitungspotenzial im nosokomialen Umfeld.

• vanA- und vanB-Typ-VRE sind nahezu ausschließlich E. faecium.

• Einer VRE-Infektion geht meist eine intestinale Besiedlung in Kombination mit weiteren Risikofaktoren (z. B. Antibiotikabehandlung) voraus.

• Die Inzidenz ist von disponierenden Faktoren des Patienten und dem Aufenthalt in Risikobereichen abhängig.

• Hospital-assoziierte E. faecium/VRE sind verantwortlich für Häufungen und Ausbrüche in Gesundheitseinrichtungen; diese Stämme unterscheiden sich von kommensalen E. faecium Stämmen (vancomycin-sensibel).

• Die Ursachen des Auftretens und Häufungen von VRE sind multifaktoriell und können medizinische, hygienische wie auch mikrobiologische Gründe haben.

• Derzeit vorliegende Infektionspräventions- und Kontrollmaßnahmen orientieren sich weitgehend an MRSA; ein geeigneter Maßnahmenkatalog für VRE sowie dessen Einsatzbereich (z. B. besiedelte/infizierte Patienten, nur Intensivpatienten) wird derzeit kontrovers diskutiert.

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