Control of Vancomycin-Resistant Enterococcus in Health Care Facilities in a Region

Ostrowsky, Belinda; Trick, William E.; Sohn, Annette H.; Quirk, Stephen; Holt, Stacey C.; Carson, Loretta A.; Hill, Bertha C.; Arduino, Matthew J.; Kuehnert, Matthew J.; Jarvis, William R.

doi:10.1056/nejm200105103441903

Cited by 281 publications

(197 citation statements)

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“…During the last decade, vancomycin-resistant enterococci (VRE) have become common causes of nosocomial infections in Western Europe and in United States [4][5][6][7][8][9][10]. The number of infections caused by this microorganism that have been reported to the Centers for Disease Control and Prevention's (CDC's) National Nosocomial Infections Surveillance system increases from 0.3% in 1989 to 7.9% in 1993 [11,12], more than 20-fold during the last decade [13].…”

mentioning

confidence: 99%

“…The occurrence of colonization with VRE and MRSA appears to be common among patients requiring intensive care [9,19]. Infections caused by strains of Staphylococcus aureus with reduced susceptibility to vancomycin (minimum inhibitory concentration = 8 µg/mL) were described in Japan and United States, each case occurred following a prolonged course of vancomycin therapy [20][21][22].…”

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confidence: 99%

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Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

Melo¹,

Sasaki²,

Grinbaum³

2007

Braz J Infect Dis

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confidence: 99%

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confidence: 99%

Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

Melo¹,

Sasaki²,

Grinbaum³

2007

Braz J Infect Dis

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“…Repeated point prevalence surveys can demonstrate de creased prevalence over time in response to active infection prevention and control interventions, as was shown in a large study of VRE by Ostrowsky et al 51 Such surveys can be an important adjunct to ongoing, monthly surveillance, because they can be used in addition to recommended metrics and can help the staff of a healthcare facility gauge the magnitude by which clinical cultures alone underestimate prevalence at a given institution. The results of point prevalence surveys could help identify areas with high MORO endemicity where heightened surveillance or AST would be helpful.…”

Section: Description Of Moro Metricsmentioning

confidence: 92%

Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position Paper

Cohen

Calfee

Fridkin

et al. 2008

Infect. Control Hosp. Epidemiol.

161

118

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EXECUTIVE SUMMARYMonitoring multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare setting is important to detect newly emerging antimicrobial resistance profiles, to identify vulnerable patient populations, and to assess the need for and effectiveness of interventions; however, it is unclear which metrics are the best, because most of the metrics are not standardized. This document describes useful and prac tical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of in fection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in docu menting trends over time within their facility and should not be used for interfacility comparison.The following MDROs are addressed: (1) methicillin-re sistant Staphylococcus aureus; (2) vancomycin-resistant En terococcus species; (3) multidrug-resistant gram-negative ba cilli; and (4) vancomycin-resistant S. aureus. We convened a working group of experts that reviewed current practices, the peer-reviewed literature, and existing guidelines on surveil lance strategies and key metrics.We propose that healthcare facilities use the following 4 routine metrics to monitor MDROs and the infections they cause: (1) an MORO-specific line list for tracking patients who have acquired an MDRO; (2) an antibiogram for mon itoring susceptibility patterns of isolates recovered from pa tients; (3) the incidence of hospital-onset MDRO bacteremia, which is an objective, laboratory-based metric that is highly associated with invasive disease and does not require chart review to estimate infection burden; and ( 4) clinical culture results, to measure incidence of infection or colonization, to quantify the number of people whose MORO acquisition is healthcare associated. In addition, healthcare facilities may want to calculate both the overall prevalence of carriage and the prevalence of carriage at admission, the latter of which can be useful in detecting importation of methicillin-resistant S. aureus into healthcare facilities, to estimate the exposure burden. Active surveillance testing can augment and increase the accuracy of some metrics. Healthcare facilities not per forming active surveillance testing might wish to consider point-prevalence screening, to help assess how much the number of positive clinical culture results underestimates the hidden reservoir of MDROs. It is important to understand the limitations of all proxy metrics. Because of the paucity of published research findings focused on this area of study, most recommendations were based on opinion and were heavily influenced by the perceived usefulness and simplicity of the metric for assessing MDROs in the hospital setting and for determining the impact of interventions.

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“…L'incapacité des équipes américaines à contrôler les épi-démies a été attribuée à la diffusion trop tardive des recommandations et à leur application hétérogène selon les établissements, bien que les mesures soient efficaces quand elles sont appliquées [14]. …”

Section: Situation éPidémiologiqueunclassified

Les entérocoques résistants aux glycopeptides

Cattoir

Leclercq

2010

Med Sci (Paris)

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> Enterococcus faecium a développé une multirésistance aux antibiotiques dont les glycopeptides. Les glycopeptides (vancomycine et teicoplanine) agissent sur les entérocoques en se fixant sur les précurseurs de la paroi bacté-rienne dont ils empêchent ainsi la formation. La résistance est due à l'acquisition d'un opé-ron de gènes coopérant pour synthétiser des précurseurs sans affinité pour les glycopeptides. Des épidémies sont survenues récemment en milieu hospitalier dues à des souches de E. faecium appartenant à un complexe clonal (CC17) adapté à l'hôpital. Les épidémies peuvent être contrôlées par des mesures appropriées et de nouveaux antibiotiques qui sont disponibles. La dissémination de souches adaptées aux conditions hospitalières nécessite leur surveillance étroite. < Centre national de référence de la résistance aux antibiotiques, Laboratoire associé entérocoques, service de microbiologie,

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Control of Vancomycin-Resistant Enterococcus in Health Care Facilities in a Region

Abstract: An active infection-control intervention, which includes the obtaining of surveillance cultures and the isolation of infected patients, can reduce or eliminate the transmission of vancomycin-resistant enterococci in the health care facilities of a region.

Cited by 281 publications

References 13 publications

Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position Paper

Les entérocoques résistants aux glycopeptides

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