Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit

Malik, Rushdah; Montecalvo, Marisa A.; Reale, M; Li, K.; Maw, Myint; Muñoz, José; Gedris, Cheryl; Horn, K. Van; Carnevale, Kerry; Levi, Michael H.; Dweck, Harry S.

doi:10.1097/00006454-199904000-00009

Cited by 75 publications

(37 citation statements)

References 20 publications

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“…Duration of hospital stay, use of vancomycin, third-generation cephalosporins, and central venous catheters were reported as the risk factors in NICU [7]. In our study duration of total antimicrobial therapy in VRE colonized patients were significantly longer as compared to negative cases.…”

Section: Discussionsupporting

confidence: 40%

“…Vancomycin-resistant enteroccocci has become an important nasocomial pathogen and thread for the last decade [7]. From its initial discovery in 1986, VRE has been reported worldwide [1,2,16] mostly responsible for colonizations, and less often as a nasocomial pathogen [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…Emerging VRE colonization in neonatal intensive care units (NICU) has been reported more often than before [1,[5][6][7]. Vancomycin usage, third-generation cephalosporin antibiotics, presence of central-venous catheters, increased length of hospital stay has been reported as risk factors for colonization in NICU [1].…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

et al. 2010

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AbstractWe aimed to evaluate the risk factors for VRE colonization in neonatal intensive care units. In December 2007, we identified a neonate with VRE infection (urinary tract infection and we performed blood and stool cultures for VRE until the last colonized patient was discharged from our clinic. All the neonates hospitalized in NICU during December 2007 to January 2008. Active surveillance cultures for VRE fecal carriage was carried out in neonatal intensive care unit. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factors. Totally 54 infants in NICU were screened for VRE colonization. Totally 11 infants (20%) were colonized with vancomycin-resistant enterococci. The average duration of all antimicrobial therapy was significantly longer in colonized patients. The infants who were hospitalized for more than 10 days were found to be significantly more colonized with VRE when compared to the infants with shorter hospital stay (p<0.05). There were no statistically significant differences between VRE colonized and non-colonized infants in respect to sex, to third generation cephalosporin usage, glycopeptide usage, presence of prematurity, presence of mechanical ventilation(p> 0.05). The premature infants and the mature infants were under risk of VRE colonization. Longer duration of hospitalization and antimicrobial usage were the prominent risk factors. Since infants in neonatal intensive care units were under risk of infections, periodic active surveillance cultures should be combined with logical antimicrobial therapy.

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Section: Discussionsupporting

confidence: 40%

Section: Discussionmentioning

confidence: 99%

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Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

et al. 2010

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“…Rapid spread of VRE among NICU patients was documented by Malik et al, who reported the spread of related strains of VRE to 40% of the NICU patient population (305). Two preterm infants developed bloodstream infection, and 33, including 11 of 13 babies who shared a room with the bacteremic babies, became colonized with VRE.…”

Section: Vol 17 2004 Infections In Very-low-birth-weight Infants 649mentioning

confidence: 96%

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

2004

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Twenty percent of very-low-birth-weight (<1500 g) preterm infants experience a serious systemic infection, and despite advances in neonatal intensive care and antimicrobials, mortality is as much as threefold higher for these infants who develop sepsis than their counterparts without sepsis during their hospitalization. Outcomes may be improved by preventative strategies, earlier and accurate diagnosis, and adjunct therapies to combat infection and protect the vulnerable preterm infant during an infection. Earlier diagnosis on the basis of factors such as abnormal heart rate characteristics may offer the ability to initiate treatment prior to the onset of clinical symptoms. Molecular and adjunctive diagnostics may also aid in diagnosing invasive infection when clinical symptoms indicate infection but no organisms are isolated in culture. Due to the high morbidity and mortality, preventative and adjunctive therapies are needed. Prophylaxis has been effective in preventing early-onset group B streptococcal sepsis and late-onset Candida sepsis. Future research in prophylaxis using active and passive immunization strategies offers prevention without the risk of resistance to antimicrobials. Identification of the differences in neonatal intensive care units with low and high infection rates and implementation of infection control measures remain paramount in each neonatal intensive care unit caring for preterm infants

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“…Assim é que mais de 80% das cepas de Staphylococcus epidermidis e pelo menos 60% das cepas de Staphylococcus aureus causadores de infecção nosocomial em unidades neonatais são resistentes à meticilina-oxacilina, ou seja, a antibióticos betalactâmicos, incluindo outras penicilinas, cefalosporinas, carbapenêmicos e combinação de drogas que contenham inibidores de beta-lactamases. A emergência de cepas de enterococcus resistentes à vancomicina tem sido documentada em unidades de terapia intensiva 42 , o que é temerário, pois estas bactérias são resistentes a todos os antibióticos disponíveis e têm o potencial de servirem como reservató-rios de genes de resistência a glicopeptídeos, que podem ser transferidos a outros patógenos ainda mais virulentos.…”

Section: Uso De Antimicrobianos E Infecção Hospitalar: a Necessidade unclassified

Neonatal nosocomial infections

Mussi-Pinhata

Nascimento²

2001

J Pediatr (Rio J)

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ResumoObjetivos: realizar revisão sobre infecções hospitalares neonatais, salientando aspectos dos mecanismos de colonização, defesa imunológica e infecção no recém-nascido, dos modos de transmissão, da epidemiologia e da vigilância e prevenção destas infecções. Revisar, ainda, particularidades sobre agentes etiológicos e recomendações preventivas.Métodos: busca eletrônica, nos bancos de dados Medline e LILACS, de artigos publicados nos últimos 10 anos, selecionandose aqueles que trouxessem informações atuais e relevantes.Resultados: as várias peculiaridades que causam maior susceptibilidade à infecção em recém-nascidos e a sobrevivência de recém-nascidos prematuros às custas da permanência em unidades de terapia intensiva neonatal, onde são submetidos a procedimentos invasivos e ao uso de antimicrobianos de largo espectro, são responsáveis por taxas de incidência de infecções hospitalares neonatais tão elevadas quanto 9,3 a 25,6%. Tais infecções atingem pelo menos 50% daqueles de peso ao nascer inferior a 1.500g, causando elevada mortalidade. Recém-nascidos a termo apresentam mais freqüente-mente lesões cutâneas e de tecidos moles, causadas por bactérias gram-positivas. Nas unidades de terapia intensiva, sepse e pneumonia freqüentemente são diagnosticadas (principalmente causadas por S. aureus, S. epidermidis, E. coli, K. pneumonia e E. cloacae).A resistência a múltiplas drogas antimicrobianas tem sido identificada com freqüência crescente. Um programa de vigilância epidemiológica adaptado às características da unidade neonatal permite a identificação de surtos de infecção, o uso racional de antibacterianos e a aplicação de medidas preventivas.Conclusões: as infecções hospitalares neonatais representam problema relevante cujo controle depende de medidas que se aplicam à gestante, ao ambiente hospitalar, à equipe assistencial e ao próprio recém-nascido. Apesar de terem surgido novas propostas para a redução do risco de infecção hospitalar em recém-nascidos pré-termo, estas são de custo elevado e não substituem a vigilância epidemiológica contínua nas unidades neonatais. AbstractObjective: to review the current medical literature on neonatal nosocomial infections, emphasizing aspects of neonatal colonization, immune system and infection mechanisms, modes of transmission, epidemiology, surveillance and prevention of these infections, in addition to assessing peculiarities about etiologic agents and prophylactic recommendations.Sources: electronic search in the Medline and LILACS databases, with selection of the most relevant articles published within the last ten years.Summary of the findings: the several peculiarities that cause greater susceptibility to infection in newborns, and the survival of preterm infants due to the invasive procedures and treatment with broad spectrum antibiotics at intensive care units are responsible for prevalence rates of neonatal nosocomial infections between 9.3 and 25.6%. Neonatal nosocomial infections affect at least 50% of newborns who weigh less than 1500 g, which ends up incre...

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Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit

Abstract: VRE can spread rapidly among newborns in a regional neonatal intensive care unit. Strict infection control measures can reduce the rate of VRE colonization among neonates.

Cited by 75 publications

References 20 publications

Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

Neonatal nosocomial infections

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