摘要：Enterococci with acquired resistance to vancomycin and other glycopeptides (VRE) have emerged and s preadrapidly through Europe and the United States since 1988. The first isolate of VRE in Australia occu rred in 1994.Only one case was noted in 1995. Since March 1996 there has been a steady increase in the number of reports ofVRE throughout the country. To August 1998 there have been 69 documented strains or clusters of str ains detectedin patients with documented infection, and about 3 times as many strains have been detected through screeningprocedures of contacts or in risk groups. 19% of strains whose source was known were blood isolates , while 34%came from urine and 47% came from other specimens. The strains have been found in 26 institutions i n 10 widelyseparated cities or regions of the country (in 6/8 states or territories), without any obvious temp oral associations intheir appearance. All strains appear to have arisen locally except for one strain imported from the United Kingdom. Furthermore there was no direct evidence of interhospital transfer of strains. All clinical strains were examined byPCR to confirm species and to test for the presence of known vancomycin-resistance genes. Of the 69 strains, 42were vanB E. faecium , 12 were vanA E. faecium , 9 were vanB E. faecalis, 3 were vanA E. faecalis. Three werenegative for vanA , vanB , vanC1 , vanC2/C3 and vanD . PGFE profiles on 38 strains have revealed at least 8 types ofvanB E. faecium , 6 of vanA E. faecium , 4 of vanB E. faecalis and 2 of vanA E. faecalis . Isolates containing vanAalways had different profiles from those containing vanB . Clinical clustering was confirmed by PFGE, andsupported by extended antibiogram. 14 of 15 E. faecalis were ampicillin susceptible compared to only 2 of 54 E.faecium . One E. faecalis strain was .-lactamase positive. The epidemiology of VRE in Australia appears to bedifferent from that of Europe or the United States, since vanB E. faecium predominates and strains have appearedin diverse locations independently and are highly polyclonal
