Factors Associated With Acquisition of Vancomycin-Resistant Enterococci (VRE) in Roommate Contacts of Patients Colonized or Infected with VRE in a Tertiary Care Hospital

Zhou, Qian; Moore, Christine; Eden, Sarah; Tong, Agnes; McGeer, Allison

doi:10.1086/587187

Cited by 39 publications

(22 citation statements)

References 16 publications

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“…Risk factors for colonization and subsequent infection with VRE include having a hospital roommate colonized or infected with VRE, older age, duration of antibiotic use, specific types and numbers of antibiotics used, and the presence of a urinary catheter (320,368). Molecular and epidemiological data suggest that VRE may be transmitted to patients directly from contact with infected or colonized patients, from the hands of HCWs, or from contact with contaminated equipment or environmental surfaces (320).…”

Section: Vancomycin-resistant Enterococcusmentioning

confidence: 99%

“…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%

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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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Section: Vancomycin-resistant Enterococcusmentioning

confidence: 99%

Section: Vancomycin-resistant Enterococcusmentioning

confidence: 99%

Hospital Epidemiology and Infection Control in Acute-Care Settings

2011

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“…Older patients and patients receiving fluoroquinolones were more likely to transmit VRE to roommates. 71 Prior guidance suggests consideration of concurrent antibiotic use, particularly antibiotics with activity against VRE, when making decisions regarding discontinuation of CP. 1 …”

Section: Duration Of Colonizationmentioning

confidence: 99%

Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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purposeThis expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacteriaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)-producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism.Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as institutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms.Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authorsThe authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended useSpecial-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considerations, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respective rationales. We also conducted a survey of the SHEA Research Network (SRN).No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance DevelopmentThis EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ...

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“…Multi drug resistant or multi-resistant bacteria have predilection to effect SCI units more than general nursing wards include MRSA (methicillin resistant Staphylococcus aureus),vancomycinresistantEnterococcus(VRE),gram-negative bacilli that produce extended spectrum β lactamase(ESBL),and clostridium defficile.Roommate contacts of patients colonized or infected by any of these multi-resistant bacteria are at increased risk for acquiring those organisms [48].Of these multi-resistant organisms,MRSA is the most common; it is responsible for a large share of both hospital and community-acquired infections [49].Unlike MRSA, which could exist in almost every body organ, VRE is cultured mostly from the urine, particularly catheter-dependent patients. Although most episodes growth of VRE from urine cultures represent asymptomatic bacteremia and do not require antibiotic treatment,VRE colonization and residence in a longterm facility increase the risk for subsequent bacteremia [50].Catheter-dependent SCI patients are predisposed to develop urinary tract infection caused by ESBL-producing multi-resistant gram -negative bacilli, such as E.coli,andKlebsiella pneumoniae [51].Researchers in Malaysia reported that SCI patients with previous UTI, antibiotic usage during the past three months or history of hospitalization during past one -year were predisposed to develop infection with multi-resistant organisms [30].The frequent administration of antibiotics and relatively inadequate hygiene in SCI patients help explain the high risk of clinical infection by C.defficle.In patients with neurogenic bowel and defective sensation C.defficile associated gastrointestinal disease can remain clinically undetected until a catastrophe such as toxic megacolon or bowel perforation evolve [52].…”

Section: Infections Due To Multi-drug Resistant Organismsmentioning

confidence: 99%