Hospital-acquired Infection with Vancomycin-resistant <i>Enterococcus faecium</i> Transmitted by Electronic Thermometers

Livornese, Lawrence L.; Dias, Susan; Samel, Carol; Romanowski, Barbara; Taylor, Shirley; May, Phyllis L.; Pitsakis, Peter G.; Woods, Gail L.; Kaye, Donald; Levison, Matthew E.; Johnson, Caroline C.

doi:10.7326/0003-4819-117-2-112

Cited by 483 publications

(234 citation statements)

References 22 publications

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“…The vast majority of VRE appear to have been acquired nosocomially or institutionally, and spread of epidemic strains both within and between institutions is welldocumented (Livornese et al 1992). From 1989 to 1998, the proportion of enterococcal isolates from intensive care units (ICUs) that were resistant to vancomycin increased from 0.3% to 23.9% (Kaye et al 2000).…”

Section: Discussionmentioning

confidence: 99%

Susceptibility Patterns of Enterococci Causing Infections

Öncü

Punar

Eraksoy

2004

Tohoku J. Exp. Med.

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Enterococci are among the common organisms associated with hospital-acquired infections. We examined in vitro activities of different antibiotics to 103 enterococcal isolates. Minimal inhibitory concentrations (MICs) of penicillin G, ampicillin, gentamicin, ciprofloxacin, ofloxacin, levofloxacin, grepafloxacin, trovafloxacin and gemifloxacin were determined by broth microdilution testing method. Among the isolates 71 (69%) were identified as E. faecalis and 32 (31%) as E. faecium. While over 75% of E. faecium isolates were resistant to penicillin and ampicillin, approximately 25% of E. faecalis isolates were resistant to penicillin and ampicillin. None of the E. faecalis and E. faecium isolates were resistant to vancomycin. While 17 (52%) of E. faecium isolates exhibited high-level gentamicin resistance (HLGR), high level streptomycin resistance (HLSR) was detected in 24 (74%) of the isolates. In contrast, HLGR and HLSR rates for E. faecalis were 14 (20%) and 22 (31%), respectively. Both HLGR and HLSR were detected with higher frequency in ampicillin resistant isolates. Among fluoroquinolones, gemifloxacin and trovafloxacin were the most potent antibiotics tested. There was no increase in MIC 90 values of the fluoroquinolones in ampicillin resistant isolates in comparison with ampicillin susceptible isolates. Our data suggest newer fluoroquinolones would be good alternative agents to use especially for combination drug therapy where enterococci with ampicillin resistance and HLAR are prevalent.enterococci; susceptibility; infection

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Section: Discussionmentioning

confidence: 99%

Susceptibility Patterns of Enterococci Causing Infections

Öncü

Punar

Eraksoy

2004

Tohoku J. Exp. Med.

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“…VRE outbreaks have been well described as resulting from cross-contamination through lapses in infection control practices and high colonization pressure, with contaminated equipment and health care workers' hands being the most common modes of transmission. [36][37][38] In a study of VRE bloodstream infections (BSIs) in children, 36% were proven through pulse-field electrophoresis to have resulted from nosocomial spread, and both individual and aggregate vancomycin use was not associated with VRE BSI, indicating that nosocomial spread is the largest driving force for VRE infections in children. 39 The significant rise in hospitalizations for VRE infection in children observed in our study is worrisome and highlights the importance of strict adherence to infection control policies.…”

Section: Discussionmentioning

confidence: 99%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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A B S T R A C T OBJECTIVE:Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization. METHODS:A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a high-dimensional propensity score match to evaluate death, length of stay, and cost of hospitalization. RESULTS: Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizationsper million in 1997 to 120 in 2012 (P , .001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P , .001) and higher hospitalization costs (AD $8233, P 5 .004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47).CONCLUSIONS: VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations.

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“…31,32 These organisms have been identified on doors, bedrails, linen, electronic thermometers, electrocardiography monitors and sphygmomanometer cuffs. [33][34][35] Various strategies have been employed to reduce nosocomial spread of VRE. These include strict hand washing by hospital employees with antiseptic soaps, restriction of empiric vancomycin usage, and performance of weekly stool surveillance culture for VRE among hospitalized patients.…”

Section: Tablementioning

confidence: 99%

Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation

Kapur

Dorsky

Feingold

et al. 2000

Bone Marrow Transplant

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Summary:A retrospective evaluation of 321 consecutive recipients of high-dose chemotherapy (HDC) and autologous peripheral blood stem cell transplantation (PBSCT) was conducted to ascertain the incidence and outcome of vancomycin-resistant enterococcal (VRE) bacteremia. Ten patients developed VRE bacteremia at a median of 6 days following PBSCT. Nine isolates were Enterococcus faecium and one was E. faecalis. The median duration of bacteremia was 5 days. The central venous catheter was removed in seven individuals. Nine patients were treated with a variety of antimicrobial agents including quinupristin-dalfopristin, chloramphenicol, doxycycline, oral bacitracin, co-trimoxazole, and nitrofurantoin. Bacteremia resolved without adverse sequelae in seven patients. Two individuals who died of other causes had persistent or relapsed bacteremia at the time of death. An additional patient suffered multiple relapses of VRE bacteremia and died as a result of VRE endocarditis 605 days following PBSCT. Mortality as a direct result of VRE bacteremia was 10% in this series. The optimal type and duration of treatment of VRE bacteremia has not been clearly defined. Therefore, we perform weekly stool surveillance cultures for VRE in our hospitalized transplant population and apply strict barrier precautions in those individuals in whom stool colonization has been identified. Furthermore, the empiric use of vancomycin has been restricted. Bone Marrow Transplantation (2000) 25, 147-152.

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Hospital-acquired Infection with Vancomycin-resistant Enterococcus faecium Transmitted by Electronic Thermometers

Abstract: This nosocomial outbreak of infection due to a highly vancomycin-resistant strain of Enterococcus is the first epidemic in which an electronic thermometer has been implicated as the vehicle of transmission for an infectious agent.

Cited by 483 publications

References 22 publications

Susceptibility Patterns of Enterococci Causing Infections

Susceptibility Patterns of Enterococci Causing Infections

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation

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