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:10.1086/647028

Cited by 98 publications

(80 citation statements)

References 5 publications

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“…20 -23 In an MRSA or VRE epidemic situation, widespread contamination of inanimate surfaces in rooms of affected patients has been documented. 13,17 Rutala and colleagues 29 showed that during an MRSA epidemic in a burn unit, MRSA comprised 16, 31 and 40% of all bacteria growth from air, elevated surfaces and floors, respectively. However, interestingly, investigations into epidemics have not confirmed that patients were infected due to the surrounding environmental contamination.…”

Section: Discussionmentioning

confidence: 99%

Distribution of multi-resistant Gram-negative versus Gram-positive bacteria in the hospital inanimate environment

Lemmen

Häfner

Zolldann

et al. 2004

Journal of Hospital Infection

228

145

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Section: Discussionmentioning

confidence: 99%

Distribution of multi-resistant Gram-negative versus Gram-positive bacteria in the hospital inanimate environment

Lemmen

Häfner

Zolldann

et al. 2004

Journal of Hospital Infection

228

145

View full text Add to dashboard Cite

mentioning

confidence: 99%

“…Reported incidence of VRE infections is believed to grossly underestimate the true prevalence because many patients act as carriers of enterococci (7)(8)(9). Molecular epidemiological studies of early endemic infections suggested clonal outbreaks (8). More recent ICU studies have appeared to involve more than one clone, perhaps demonstrating frequent introductions from other parts of the hospital (9)(10)(11).…”

mentioning

confidence: 99%

“…The commensal nature of enterococci had generated the belief that new outbreaks in hospital settings were a consequence of endogenous sources. Recent studies, however, have demonstrated that transmission via the susceptible patient contact with the hands of contaminated health care workers (HCWs) is a very important determinant of the spread and persistence of VRE (8,9,12).…”

mentioning

confidence: 99%

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Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs

Austin

Bonten

Weinstein

et al. 1999

Proc. Natl. Acad. Sci. U.S.A.

333

276

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Vancomycin-resistant enterococci (VRE) recently have emerged as a nosocomial pathogen especially in intensive-care units (ICUs) worldwide. Transmission via the hands of health-care workers is an important determinant of spread and persistence in a VRE-endemic ICU. We describe the transmission of nosocomial pathogens by using a microepidemiological framework based on the transmission dynamics of vector-borne diseases. By using the concept of a basic reproductive number, R 0 , defined as the average number of secondary cases generated by one primary case, we show quantitatively how infection control measures such as hand washing, cohorting, and antibiotic restriction affect nosocomial cross-transmission. By using detailed molecular epidemiological surveillance and compliance monitoring, we found that the estimated basic reproductive number for VRE during a study at the Cook County Hospital, Chicago, was approximately 3-4 without infection control and 0.7 when infection control measures were included. The impact of infection control was to reduce the prevalence from a predicted 79% to an observed 36%. Hand washing and staff cohorting are the most powerful control measures although their efficacy depends on the magnitude of R 0 . Under the circumstances tested, endemicity of VRE was stabilized despite infection control measures, by the constant introduction of colonized patients. Multiple stochastic simulations of the model revealed excellent agreement with observed pattern. In conjunction with detailed microbiological surveillance, a mathematical framework provides a precise template to describe the colonization dynamics of VRE in ICUs and impact of infection control measures. Our analyses suggest that compliance for hand washing significantly in excess of reported levels, or the cohorting of nursing staff, are needed to prevent nosocomial transmission of VRE in endemic settings.

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“…Although the usefulness of contact precautions and isolation as part of a concerted infection control effort to control the spread of GRE during a clonal outbreak has been reported by many centers over the past several years, the specific contribution of contact precautions is unknown [34,44,45]. Furthermore, the usefulness of contact precautions for GRE-colonized or -infected patients once GRE becomes endemic is unknown.…”

Section: Control Of Glycopeptide-resistant Enterococcimentioning

confidence: 99%

An update on the emergence of glycopeptide resistance in enterococci

Gardam

Conly

1999

Curr Infect Dis Rep

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Glycopeptide resistance may be either constitutive or transferable (on plasmids or as a transposon), and four phenotypes (van A, B, C, D) have been described to date. Recent data suggest solid media screening protocols appear to be insensitive at detecting low levels of carriage, and up to 40% of colonized patients may be falsely glycopeptide-resistant enterococci (GRE) negative. Managing GRE-colonized or -infected patients using contact precautions appears to be useful in controlling clonal outbreaks, but may be of limited utility once GRE is endemic. Alternate strategies to manage GRE-colonized patients with prolonged carriage and in outpatient or home health settings include using risk-based transmission assessment to limit the logistic and psychosocial difficulties associated with the use of continuous contact precautions. The therapeutic options for treating GRE infection remain limited. Attempts to decolonize GRE-colonized patients with bacitracin appear to be of limited utility.

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Controlling Vancomycin-Resistant Enterococci

Cited by 98 publications

References 5 publications

Distribution of multi-resistant Gram-negative versus Gram-positive bacteria in the hospital inanimate environment

Distribution of multi-resistant Gram-negative versus Gram-positive bacteria in the hospital inanimate environment

Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs

An update on the emergence of glycopeptide resistance in enterococci

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