Natural History of Colonization with Vancomycin-Resistant <i>Enterococcus Faecium</i>

Montecalvo, Marisa A.; Lencastre, Hermı́nia de; Carraher, Margaret; Gedris, Cheryl; Chung, Marilyn; VanHorn, Ken; Wormser, Gary P.

doi:10.1086/647041

Cited by 119 publications

(116 citation statements)

References 26 publications

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“…It has been demonstrated that colonisation with the same strain of VRE may persist for at least a year [20,30,35] and that there is a signi®cant association between gastro-intestinal colonisation and the subsequent development of invasive infection [6, 10, 20, 30± 32]. Colonisation rates appear to be ten times more prevalent than infection rates [16,20,30].…”

Section: Discussionmentioning

confidence: 99%

“…Although Enterococcus faecalis is the most prevalent species causing invasive enterococcal infection, E. faecium has been reported as the species accounting for most glycopeptide resistant infection, in particular E. faecium strains with the Van A resistance phenotype [10,14,19,20,27,30,35].…”

Section: Discussionmentioning

confidence: 99%

“…In the 6 months following their instigation, only two further cases of VRE colonisation have been identi®ed (one of which harboured the outbreak strain). Previous reports have shown varying success in reducing the incidence of VRE carriers following the introduction of infection control measures [3,6,20,30,39,47].…”

Section: Discussionmentioning

confidence: 99%

“…An intense educational programme about VRE, mode of spread and methods of prevention was commenced for all patients and parents, medical, nursing, portering and household sta. Because of the reported possible association of enterococcal colonisation and infection with the use of cephalosporins [29,49] and the reported association of VRE colonisation and infection with the use of glycopeptides [4,10,19,30,32,39,41,45], the unit empiric therapy for febrile neutropenia was modi®ed. Prior to the outbreak, piperacillin and amikacin were used as ®rst line therapy with substitution of ceftazidime at 48 h and the subsequent addition of teicoplanin if fever persisted.…”

Section: Infection Control Measuresmentioning

confidence: 99%

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Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation

et al. 1998

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Risk factors for VRE colonization in paediatric oncology patients included duration of neutropenia, duration of any antibiotic therapy, exposure to ceftazidime, amikacin or teicoplanin and the number of antibiotics used. The study suggests that environmental contamination played an important role in patient-to-patient transmission of VRE and interventions including implementation of infection control measures were associated with a decreased incidence of gastro-intestinal colonisation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Infection Control Measuresmentioning

confidence: 99%

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Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation

et al. 1998

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“…According to data from the National Nosocomial Infections Surveillance System, by the end of 1999 about 25% of all enterococci involved in nosocomial infections were vancomycin resistant (1). Once colonized, patients become long-term carriers (2). Patients can be colonized with VRE before they are actively infected with such organisms, and, once infected, mortality is increased (3).…”

mentioning

confidence: 99%

Effect of Lactobacillus rhamnosus GG Administration on Vancomycin-Resistant Enterococcus Colonization in Adults with Comorbidities

Doron

Hibberd

Goldin

et al. 2015

Antimicrob Agents Chemother

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c Vancomycin-resistant enterococci (VRE) are endemic in health care settings. These organisms colonize the gastrointestinal tract and can lead to infection which is associated with increased mortality. There is no treatment for VRE colonization. We conducted a randomized, double-blind, placebo-controlled clinical trial to examine the safety and efficacy of administration of the probiotic Lactobacillus rhamnosus GG (LGG) for the reduction or elimination of intestinal colonization by VRE. Colonized adults were randomized to receive LGG or placebo for 14 days. Quantitative stool cultures for LGG and VRE were collected at baseline and days 7, 14, 21, 28, and 56. Day 14 stool samples from some subjects were analyzed by quantitative PCR (qPCR) for LGG. Patients were closely monitored for adverse events. Eleven subjects, of whom 5 received LGG and 6 received placebo, were analyzed. No differences in VRE colony counts were seen at any time points between groups. No decline in colony counts was seen over time in subjects who received LGG.LGG was detected by PCR in all samples tested from subjects who received LGG but was only isolated in culture from 2 of 5 subjects in the LGG group. No treatment-related adverse events were seen. We demonstrated that LGG could be administered safely to patients with comorbidities and is recoverable in some patients' stool cultures. Concomitant administration of antibiotics may have resulted in an inability to recover viable organisms from stool samples, but LGG DNA could still be detected by qPCR. LGG administration did not affect VRE colonization in this study. (This study was registered at Clinicaltrials.gov under registration no. NCT00756262.) S ince their first appearance in 1988, vancomycin-resistant enterococci (VRE) have become endemic in hospitals and other health care settings throughout the United States. According to data from the National Nosocomial Infections Surveillance System, by the end of 1999 about 25% of all enterococci involved in nosocomial infections were vancomycin resistant (1). Once colonized, patients become long-term carriers (2). Patients can be colonized with VRE before they are actively infected with such organisms, and, once infected, mortality is increased (3). Elimination of the VRE carrier state is desirable to reduce transmission and thus infection, but no known treatment exists.Lactobacillus rhamnosus GG (LGG) (ATCC strain 53103) was isolated by Gorbach and Goldin in 1985 from a healthy human (4). They sought to isolate a strain based on selected characteristics thought to be required for an organism to promote health. LGG has been extensively studied in humans and has been shown to be safe and nonpathogenic (5). Studies of LGG have demonstrated decreased duration and frequency of diarrhea in children (6, 7), prevention of Clostridium difficile-associated (antibiotic-associated) diarrhea relapses (8), and prevention of travelers' diarrhea (9, 10). Large-scale clinical trials and use of LGG in yogurt and as a food supplement have also demonstrated the ...

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Role of Environmental Contamination as a Risk Factor for Acquisition of Vancomycin-Resistant Enterococci in Patients Treated in a Medical Intensive Care Unit

Martínez

Ruthazer²,

Hansjosten³

et al. 2003

Arch Intern Med

201

117

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Natural History of Colonization with Vancomycin-Resistant Enterococcus Faecium

Abstract: VREF colonization is at least 10-fold more prevalent than infection among oncology patients. Colonization often persists throughout lengthy hospitalizations and may continue for long periods following hospitalization.

Cited by 119 publications

References 26 publications

Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation

Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation

Effect of Lactobacillus rhamnosus GG Administration on Vancomycin-Resistant Enterococcus Colonization in Adults with Comorbidities

Role of Environmental Contamination as a Risk Factor for Acquisition of Vancomycin-Resistant Enterococci in Patients Treated in a Medical Intensive Care Unit

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