按一下以編輯母片
第二層
第三層
第四層
第五層
‹#›
29
reservoir
reservoir
它可以存活於惡劣環境。造成VRE的危險因子:※長期住院、高齡、抗生素濫用而改變正常腸道菌的病人、重病、接近VRE病患。※臨床上常引起泌尿道感染、敗血症、骨盆感染及傷口感染。在歐美地區已是重要的院內感染致病菌，本院近來有多起群突發事件，為防範VRE散播，有特殊管制措施。Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases - Chapter 201 - Enterococcus Species, Streptococcus bovis Group, and Leuconostoc Species         7th ed.Enterococci are organisms that have developed well-adapted mechanisms to survive in the gastrointestinal tract of humans. The human colonic flora comprises about 1014 commensal bacteria per gram of contents encompassing more than 100 culturable bacterial species with a predominance of anaerobes.[12] Enterococci are clearly outnumbered by the amount of anaerobic commensals, and in a normal host, they appear to establish a symbiotic relationship with the immune system and the other bacteria. However, one of the main effects that antibiotics have in the human gut is to alter the dynamics of colonization in favor of enterococci, which are naturally tolerant to a number of antimicrobial compounds (see later). Antibiotics that are excreted in the bile or have substantial antianaerobic activity without inhibiting enterococci (e.g., various cephalosporins) have been shown to increase colonization of the gastrointestinal tract by enterococci (e.g., vancomycin-resistant enterococci, VRE).[13-15] Moreover, it has been shown that the administration of broad-spectrum antibiotics also favors the emergence of vancomycin-resistant enterococci by downregulating the intestinal expression of the intestinal antimicrobial peptide RegIIIγ (a bactericidal lectin produced by intestinal epithelial and Paneth cells), which has activity against gram-positive intestinal organisms. This effect appears to be due to broad-spectrum antibiotics eradicating the competing gram-negative organisms (mainly anaerobic) in the gut that are responsible for the activation of the signals necessary for the production of the RegIIIγ peptide through the lipopolysaccharide present in their outer membranes.[16] Other factors that may also play a role in favoring outgrowth of enterococci in the gut include the increased stomach pH, usually secondary to the administration of proton pump inhibitors, a strategy commonly used in critically ill patients to reduce the incidence of aspiration pneumonitis.抗生素在人體腸道的主要影響之一，是移生菌叢動態改變而有利於腸球菌。被排泄到膽汁或具有相當的抗厭氧菌活性而不抑制腸球菌抗生素（例如，各種頭孢菌素類cephalosporins），已被證明能增加腸球菌（例如，萬古黴素抗藥性腸球菌）的胃腸移生。此外，廣效抗生素已被證明有利於萬古黴素抗藥性腸球菌的出現，是藉由下調(downregulating )腸道表達的腸道抗菌肽(peptide) RegIIIγ，它是一種腸上皮細胞和潘氏細胞產生的殺菌凝集素lectin，具有對抗腸道革蘭氏陽性菌的活性。由於廣效抗生素根除競爭的革蘭氏陰性菌（主要是厭氧菌），而革蘭氏陰性菌外膜脂多醣負責活化生產的RegIIIγ肽所必需的信號。其他有利於腸球菌在腸道增生的因素，包括提高胃的pH值，通常是質子泵抑製劑(proton pump inhibitors)效果，常用於重症病人以減少吸入性肺炎的發生率。
*它可以存活於惡劣環境。
*造成VRE的危險因子:
     ※長期住院、高齡、抗生素濫用而改變
正常腸道菌的病人、重病、接近VRE病患。
     ※臨床上常引起泌尿道感染、敗血症、骨盆感染及傷口感染。
*在歐美地區已是重要的院內感染致病菌，本院近來有多起群突發事件，為防範VRE散播，有特殊管制措施。
*
*Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases - Chapter 201 - Enterococcus Species, Streptococcus bovis Group, and Leuconostoc Species         7th ed.       
*
*Enterococci are organisms that have developed well-adapted mechanisms to survive in the gastrointestinal tract of humans. The human colonic flora comprises about 1014 commensal bacteria per gram of contents encompassing more than 100 culturable bacterial species with a predominance of anaerobes.[12] Enterococci are clearly outnumbered by the amount of anaerobic commensals, and in a normal host, they appear to establish a symbiotic relationship with the immune system and the other bacteria. However, one of the main effects that antibiotics have in the human gut is to alter the dynamics of colonization in favor of enterococci, which are naturally tolerant to a number of antimicrobial compounds (see later). Antibiotics that are excreted in the bile or have substantial antianaerobic activity without inhibiting enterococci (e.g., various cephalosporins) have been shown to increase colonization of the gastrointestinal tract by enterococci (e.g., vancomycin-resistant enterococci, VRE).[13-15] Moreover, it has been shown that the administration of broad-spectrum antibiotics also favors the emergence of vancomycin-resistant enterococci by downregulating the intestinal expression of the intestinal antimicrobial peptide RegIIIγ (a bactericidal lectin produced by intestinal epithelial and Paneth cells), which has activity against gram-positive intestinal organisms. This effect appears to be due to broad-spectrum antibiotics eradicating the competing gram-negative organisms (mainly anaerobic) in the gut that are responsible for the activation of the signals necessary for the production of the RegIIIγ peptide through the lipopolysaccharide present in their outer membranes.[16] Other factors that may also play a role in favoring outgrowth of enterococci in the gut include the increased stomach pH, usually secondary to the administration of proton pump inhibitors, a strategy commonly used in critically ill patients to reduce the incidence of aspiration pneumonitis.  
*
*抗生素在人體腸道的主要影響之一，是移生菌叢動態改變而有利於腸球菌。被排泄到膽汁或具有相當的抗厭氧菌活性而不抑制腸球菌抗生素（例如，各種頭孢菌素類cephalosporins），已被證明能增加腸球菌（例如，萬古黴素抗藥性腸球菌）的胃腸移生。此外，廣效抗生素已被證明有利於萬古黴素抗藥性腸球菌的出現，是藉由下調(downregulating )腸道表達的腸道抗菌肽(peptide) RegIIIγ，它是一種腸上皮細胞和潘氏細胞產生的殺菌凝集素lectin，具有對抗腸道革蘭氏陽性菌的活性。由於廣效抗生素根除競爭的革蘭氏陰性菌（主要是厭氧菌），而革蘭氏陰性菌外膜脂多醣負責活化生產的RegIIIγ肽所必需的信號。其他有利於腸球菌在腸道增生的因素，包括提高胃的pH值，通常是質子泵抑製劑(proton pump inhibitors)效果，常用於重症病人以減少吸入性肺炎的發生率。