Controlling Vancomycin-Resistant Enterococci

Boyce, John M.; Mermel, Leonard A.; Zervos, Marcus J.; Rice, Louis B.; Potter-Bynoe, Gail; Giorgio, Christina; Medeiros, Antone A.

doi:10.2307/30141115

Cited by 84 publications

(21 citation statements)

References 6 publications

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“…This was the first outbreak of VRE at our institution, and similar to outbreaks described in several cities in the United States, it was associated with vanB VRE. [4][5][6][7][8][9] Colonization with VRE is a problem for liver and kidney transplant recipients. Clearance of VRE colonization in this patient population has not been well described.…”

Section: Discussionmentioning

confidence: 99%

Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients

Patel¹

2001

Liver Transplantation

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T he natural history of vancomycin-resistant enterococcus (VRE) infection is such that VRE colonization, predominantly of the gastrointestinal tract, typically precedes infection. At Mayo Medical Center (Rochester, MN), routine aerobic bacterial throat, rectal, wound, biliary, and urinary surveillance cultures have been collected from liver transplant recipients as part of a selective bowel antibiotic decontamination program for liver transplant patients. Beginning in 1995, as a result of these surveillance cultures, VRE colonization was identified in liver and kidney transplant patients. The purpose of this study is to describe the natural history of VRE colonization in liver and kidney transplant patients. Methods Cultures for VRERoutine surveillance aerobic bacterial throat, rectal, wound, biliary, and urinary cultures have been collected from hospitalized liver transplant recipients as part of a selective bowel decontamination program for liver transplant patients since the inception of the liver transplant program at Mayo Medical Center in 1985. Surveillance cultures were originally obtained twice weekly for 1 week posttransplantation and then weekly until selective bowel decontamination was discontinued (ϳ3 weeks). Through these surveillance cultures, VRE colonization was detected in the liver transplant population.Beginning November 1995, admission and twice-weekly rectal surveillance cultures were collected from all patients admitted to the adult liver, kidney, and kidney/pancreas transplant unit. These specimens were cultured on primary sheep blood agar or subculture of enriched brain heart infusion broth to Columbia colistin-nalidixic acid (CNA) agar. Subsequent to the identification of the first patient with VRE colonization, some of these cultures were ordered as "VRE screens" and cultured on selective media, as follows. Beginning October 1995, in-house CNA agar with 16 g/mL of vancomycin was used. In June 1996, Enterococcosel agar with 8 g/mL of vancomycin (Becton Dickinson, Cockeysville, MD) was substituted. The study period extended from 1985 through December 1997. Selective Bowel DecontaminationSelective bowel decontamination was performed using a mixture of 80 mg of gentamicin, 100 mg of polymyxin E, and 2 million U of nystatin administered orally or by nasogastric tube 4 times daily, beginning at least 2 days before liver transplantation and discontinued at the time of discharge from the initial hospitalization. This regimen was resumed when patients were rehospitalized. Orabase paste (Colgate, Surgery, ‡Hepatology, and §Clinical Microbiology, Mayo Clinic and Foundation, Rochester, MN; and ʈCorixa Corporation, From the *Divisions of Infectious Diseases, †Transplantation

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Section: Discussionmentioning

confidence: 99%

Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients

Patel¹

2001

Liver Transplantation

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“…Hospital outbreaks of infection or colonization have been reported with both VanA and VanB isolates (29). Such outbreaks may involve clonal dissemination of strains indistinguishable by pulsed-field gel electrophoresis (PFGE), not only within hospitals but also among several local hospitals (180).…”

Section: Geographic Distribution and Spread Within Hospitalsmentioning

confidence: 99%

“…Multiple clones are often encountered, and sporadic isolates of unrelated strains may coexist with a predominant clone suspected of institutional spread (30,147). In hospitals in which VRE outbreaks have been detected at an early stage, cases often have been caused by a single strain (29,30,51,121,164,176). When VRE have been present in a hospital or community for months or years, molecular typing of isolates often reveals that vancomycin resistance has spread by plasmids or transposons to many different clones (51,122,167,181,235).…”

Section: Geographic Distribution and Spread Within Hospitalsmentioning

confidence: 99%

Vancomycin-Resistant Enterococci

Çetinkaya

Falk

Mayhall

2000

Clinical Microbiology Reviews

643

344

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“…Increased mortality, longer duration of hospitalization, and increased costs are the basis of recommendations for surveillance for VRE and contact precautions recommended by the Healthcare Infection Control Practices Advisory Committee (HICPAC) (368). Also influencing these recommendations are reports of two VRE outbreaks in the early 1990s that were aborted after contact precautions were instituted, including the mandatory use of gowns and gloves by anyone in contact with infected or colonized patients (32,33,275).…”

Section: Vancomycin-resistant Enterococcusmentioning

confidence: 99%

Hospital Epidemiology and Infection Control in Acute-Care Settings

2011

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SUMMARY Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program.

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Controlling Vancomycin-Resistant Enterococci

Cited by 84 publications

References 6 publications

Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients

Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients

Vancomycin-Resistant Enterococci

Hospital Epidemiology and Infection Control in Acute-Care Settings

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