A Hospital Epidemic of Vancomycin-Resistant Enterococcus Risk Factors and Control

Byers, Karin E.; Anglim, Anne M.; Anneski, Cynthia J.; Germanson, Teresa P.; Gold, Howard S.; Durbin, Lisa J.; Simonton, Barbara M.; Farr, Barry M.

doi:10.1086/501880

Cited by 112 publications

(110 citation statements)

References 39 publications

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“…Edmond et al [16] reported various risk factors for contracting VRE: extended hospitalization, ICU hospitalization, transplantation, hematological disease and use of antibiotics. Byers et al [17], during an epidemic period, found 6% colonization in ICUs and wards, indicating as risk factors: proximity to an unisolated case of VRE, polytraumatism and use of metronidazol. We did not find association of VRE with the use of metronidazol or any other antimicrobial drug, though it was reported in other studies [18,19].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Furtado¹,

Martins²,

Coutinho³

et al. 2005

Braz J Infect Dis

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Vancomycin-resistant enterococci (VRE) are important pathogens causing nosocomial infections, and there is reason for concern about their resistance and great ability to spread in hospital environments, especially intensive-care units (ICU). To determine the prevalence of rectal colonization by VRE, and the risk factors associated with their presence, rectal surveillance swabs were taken from patients under treatment in two intensive-care units (one medical and another both medical and surgical) at São Paulo Hospital, over a two-year period. Thirty-three percent of the 147 patients evaluated had VRE. The only significant variable in the logistic regression was the length of stay in the ICU.

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Section: Discussionmentioning

confidence: 99%

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Furtado¹,

Martins²,

Coutinho³

et al. 2005

Braz J Infect Dis

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“…12,14 Previous studies have also demonstrated that VRE is transmitted between patients on the hands and clothing of healthcare workers 14 and indirectly from the contaminated environment. 28 Our early screening revealed heavy environmental contamination associated with positive patients.…”

Section: May 2004mentioning

confidence: 99%

“…10,11 Maintenance of lowlevel endemicity after a large outbreak has been achieved 12,13 as has eradication following a small outbreak 14 and in specific units. [15][16][17] Successful control has also been reported in a healthcare region that included long-term-care facilities.…”

mentioning

confidence: 99%

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Christiansen

Tibbett

Beresford

et al. 2004

Infect. Control Hosp. Epidemiol.

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Objective:To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.Interventions:Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistantEnterococcus faeciumdespite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection ofvanA andvanBresistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).Results:A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistantE. faecium.Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).Conclusion:Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.

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“…11,30 " 36 For example, during the initial VRE outbreak at the University of Virginia Hospital, one ICU was found to have a 100% prevalence of VRE. 35 This was reduced to 0% and kept there for the next year using active surveillance cultures and contact precautions, but these measures were being applied throughout the hospital to control spread wherever colonized patients could be detected, not just in a single unit.…”

Section: More Is Morementioning

confidence: 99%

More Is More

Calfee

2003

Infect. Control Hosp. Epidemiol.

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A Hospital Epidemic of Vancomycin-Resistant Enterococcus Risk Factors and Control

Abstract: VRE was transmitted between patients during a hospital epidemic, with proximity to previously unisolated VRE patients being an important risk factor. Weekly surveillance cultures and contact isolation of colonized patients significantly reduced spread

Cited by 112 publications

References 39 publications

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

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