Editorial Commentary: For Nosocomial Vancomycin‐Resistant Enterococcal Infections: The Ounce of Prevention or the Pound of Cure?

Farr, Barry M.

doi:10.1086/382891

Cited by 5 publications

(13 citation statements)

References 18 publications

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“…Approximately 800 weekly screening tests performed per year could be eliminated, provided that other elements of the policy are kept in place and represent a real saving of both human and economic resources. These findings support a study by Perenevich et al that demonstrated the benefit of admission isolation, active surveillance culture and contact precautions for colonized patients to reduce the spread of VRE in intensive care [49,50]. Absence of discharge screening did not result in an increased number of cross-transmission events in the ICU or an increase in the number of patient-days under isolation.…”

Section: Discussionsupporting

confidence: 88%

Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit

Hall

Barrass²,

Pittet

et al. 2012

J. R. Soc. Interface.

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Intensive care units (ICUs) play an important role in the epidemiology of methicillin-resistant Staphyloccocus aureus (MRSA). Although successful interventions are multi-modal, the relative efficacy of single measures remains unknown. We developed a discrete time, individual-based, stochastic mathematical model calibrated on cross-transmission observed through prospective surveillance to explore the transmission dynamics of MRSA in a medical ICU. Most input parameters were derived from locally acquired data. After fitting the model to the 46 observed cross-transmission events and performing sensitivity analysis, several screening and isolation policies were evaluated by simulating the number of cross-transmissions and isolation-days. The number of all cross-transmission events increased from 54 to 72 if only patients with a past history of MRSA colonization are screened and isolated at admission, to 75 if isolation is put in place only after the results of the admission screening become available, to 82 in the absence of admission screening and with a similar reactive isolation policy, and to 95 when no isolation policy is in place. The method used (culture or polymerase chain reaction) for admission screening had no impact on the number of cross-transmissions. Systematic regular screening during ICU stay provides no added-value, but aggressive admission screening and isolation effectively reduce the number of cross-transmissions. Critically, colonized healthcare workers may play an important role in MRSA transmission and their screening should be reinforced.

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Section: Discussionsupporting

confidence: 88%

Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit

Hall

Barrass²,

Pittet

et al. 2012

J. R. Soc. Interface.

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“…The infection rate by VRE in ICUs has ranged from 7% to 45%. 37,38 In India, 3.7% of the VRE isolates were from the ICU. [39][40][41] The observed rates of penicillin (86.5%) and ampicillin (53.2%) resistance are comparable to other studies The rate of ciprofloxacin resistance (79.5%) is much higher than what has been reported.…”

Section: Discussionmentioning

confidence: 99%

A profile of vancomycin-resistant enterococcal infections and a comparison of resistance detection methods

Mathew¹

2020

IJMR

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Scope: Vancomycin-resistant enterococci (VRE) are being increasingly reported from hospitals across the world. This study provides a profile of enterococcal infections and compares various methods of detecting vancomycin resistance. Materials and Methods: All clinically significant isolates of enterococci over a 2-year period were included. Antibiotic susceptibility was carried out as per CLSI guidelines. Vancomycin resistance was detected by 3 methods: disk diffusion, agar screen, E-test. The 3 methods were compared. Results: 156 clinical samples yielded Enterococcus spp. over the study period. Maximum resistance was noted to penicillin, erythromycin, and ciprofloxacin. E. faecium strains showed a higher percentage of resistance to the antibiotics tested. 15 (9.6%) enterococcal strains were resistant to vancomycin; 10 (6.4%) strains were intermediate. Compared to E-test, disk diffusion and agar screen had sensitivities of 100%. Disk diffusion had 97.2% specificity and agar screen demonstrated 92.9% specificity. Conclusion: Prevalence of VRE in Indian hospitals is increasing. Though disk diffusion had a higher specificity than the agar screen at identifying resistant isolates, intermediate strains were identified as sensitive. BHI agar containing 6 µg/ml of vancomycin can be used to screen for VRE, and E-test can be used to confirm resistance.

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“…Transmission has been associated with animal and water exposure. 1 Recreational exposures have included white water rafting, 2 kayaking, 3,4 canoeing, hunting, and riding trail bikes through puddles. 1 Recreational 5,6 and competitive [7][8][9] swimming in outdoor water has also resulted in leptospirosis.…”

Section: Introductionmentioning

confidence: 99%

“…1 Recreational exposures have included white water rafting, 2 kayaking, 3,4 canoeing, hunting, and riding trail bikes through puddles. 1 Recreational 5,6 and competitive [7][8][9] swimming in outdoor water has also resulted in leptospirosis. Caving, which can include water and animal urine exposure, may be a special risk.…”

Section: Introductionmentioning

confidence: 99%

“…10,14 The organism is excreted in urine into water and then enters the human host through contact with mucous membranes, the conjunctiva, or abraded skin. 1,15 Risk may be higher in times of high precipitation or Corresponding author: Roger B. Mortimer, MD, Department of Family Practice, University of California, San Francisco, Fresno Medical Education Program, 445 S Cedar, Fresno, CA 93702 (e-mail: rmortimer@fresno.ucsf.edu). flooding.…”

Section: Introductionmentioning

confidence: 99%

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Leptospirosis in a Caver Returned from Sarawak, Malaysia

Mortimer

2005

Wilderness & Environmental Medicine

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This article describes a case of leptospirosis in a man who returned from caving in Sarawak, Malaysia, and includes a discussion of epidemiology, pathophysiology, diagnosis, prevention, and treatment. The patient presented with symptoms of leptospirosis, which was confirmed by microhemagglutination titers. He became infected despite taking doxycycline daily for malaria prophylaxis. Leptospirosis is an important consideration in any returned traveler with fever. The spirochete spreads from animals to humans via water. Caving in tropical endemic zones may increase exposure risk due to the combination of multiple skin abrasions with immersions. Water in caves may increase infection risk because of increased water pH. Standard prophylaxis may be inadequate in cases of high-risk exposures.

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Editorial Commentary: For Nosocomial Vancomycin‐Resistant Enterococcal Infections: The Ounce of Prevention or the Pound of Cure?

Cited by 5 publications

References 18 publications

Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit

Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit

A profile of vancomycin-resistant enterococcal infections and a comparison of resistance detection methods

Leptospirosis in a Caver Returned from Sarawak, Malaysia

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