Outbreak of Colonization and Infection With Vancomycin-Resistant<i>Enterococcus faecium</i>in a French University Hospital

Lesens, Olivier; Mihaila, Liliana; Robin, Frédéric; Baud., Olivier; Romaszko, J.-P.; Tourniac, O; Constantin, J.-M.; Souweine, Bertrand; Bonnet, Richard; Bouvet, Anne; Beytout, J.; Traoré, Ousmane; Laurichesse, H.

doi:10.1086/504932

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…Numerous studies have identified antibiotic therapy as a risk factor for VRE acquisition (4,8,(11)(12)(13)(14)(15); however, controversies remain on the association between previous intravenous vancomycin use and VRE carriage (16). We confirmed such an association in univariate analysis, but, like other reports (11,17), we found that the only antibiotic group associated with VRE carriage by multivariate analysis was large-spectrum ␤-lactams.…”

Section: Discussionsupporting

confidence: 80%

Rapid Curbing of a Vancomycin-Resistant Enterococcus faecium Outbreak in a Nephrology Department

Mercadal

Brossier

Venditto

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Vancomycin-resistant enterococci (VRE) are recovered with increasing frequency among patients with chronic renal failure, making VRE a major concern in nephrology departments, especially for patients who are treated by hemodialysis. We report herein the successful aggressive management of a VRE outbreak in a nephrology department.Design, setting, participants, & measurements: An Enterococcus faecium vanB strain was isolated from a peritoneal dialysis solution from an inpatient. Immediately, infection control measures were enforced and active screening was performed for all contact patients. Carriers were isolated, and patients were divided into three cohorts: Positive, contact, and noncontact patients. We then performed a case-control study to understand risk factors for VRE carriage comparing VRE carriers with contact patients who were negative for VRE.Results: A total of 14 VRE-positive and 125 VRE-negative contact patients were identified. VRE-positive patients were more likely to receive hemodialysis and have longer hospital stays in nephrology. VRE-positive patients more often had a central venous catheter for a longer period of time and received more antibiotics than VRE-negative patients. Treatment with large-spectrum ␤-lactams and number of days in the nephrology ward were significantly associated with a higher risk for VRE carriage by using multivariate analysis.Conclusions: These findings suggest that case mix, longer hospital stays, and antibiotic use are major risk factors for VRE acquisition. In addition, it demonstrates that strict enforcement of isolation precautions and cohorting associated with active screening are successful to curb the transmission of VRE in renal units despite continuous colonization pressure.

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Section: Discussionsupporting

confidence: 80%

Rapid Curbing of a Vancomycin-Resistant Enterococcus faecium Outbreak in a Nephrology Department

Mercadal

Brossier

Venditto

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…However, after full-text reading 3 more articles had to be excluded, two articles because they did not clearly distinguish between hematology/oncology patients and patients from other medical departments ( Kurup et al, 2008 ) ( Hwang et al, 1998 ) and one article because it described an endemic situation rather than an epidemic setting ( Park et al, 2011 ). Thus, eventually 35 articles ( Böröcz et al, 2005 ; Burnie et al, 2002 ; Chadwick et al, 1996 ; Chlebicki et al, 2006 ; Deplano et al, 2007 ; Edmond et al, 1995 ; Gambarotto et al, 2000 ; Hanna et al, 2001 ; Iosifidis et al, 2012 ; Kawalec et al, 2000 ; Kawalec et al, 2001 ; Kawalec et al, 2007 ; Knoll et al, 2005 ; Lavery et al, 1997 ; Lesens et al, 2006 ; Loeb et al, 1999 ; Marcade et al, 2014 ; McCarthy et al, 2000 ; Montecalvo et al, 1994 ; Nolan et al, 2009 ; Nourse et al, 1998 ; Oh et al, 2004 ; Ozorowski et al, 2009 ; Pendle et al, 2008 ; Rizkalla et al, 1997 ; Rubin et al, 1992 ; Sample et al, 2002 ; Schmidt-Hieber et al, 2007 ; Schuster et al, 1998 ; Singh-Naz et al, 1999 ; Timmers et al, 2002 ; Valdezate et al, 2012 ; Wardal et al, 2014 ; Worth et al, 2007 ; Yoo et al, 2005 ) were considered appropriate for inclusion for further analysis ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Outbreaks caused by vancomycin-resistant Enterococcus faecium in hematology and oncology departments: A systematic review

Ulrich

Vonberg

Gastmeier

2017

Heliyon

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BackgroundVancomycin-resistance in Enterococcus faecium (VRE) poses a major threat in health care settings. It is well known that patients in hematology and oncology departments are especially at risk of nosocomial VRE acquisition. This systematic review of the literature provides data on the main sources, transmission modes and potential risk factors for VRE acquisition as well as appropriate infection control measures in order to terminate such nosocomial outbreaks.MethodsData on nosocomial VRE outbreaks on hematology and oncology wards was retrieved from the Outbreak Database and PubMed.ResultsA total of 35 VRE outbreaks describing 757 affected patients and 77 deaths were included in this review. The most frequent site of pathogen detection were stool samples or rectal swabs (57% of all isolation sites), followed by blood cultures (30%). The most common outbreak source was an index patient. The main modes of transmission were 1) hands of health care workers, 2) contact to a contaminated environment and 3) patient-to-patient contact. The most common risk factor for VRE positivity was prior antibiotic treatment. The most common infection control measures performed were screening and isolating or cohorting of patients.ConclusionA rational use of antibiotics in hematology and oncology units is recommended in order to reduce selection pressure on resistant pathogens such as VRE. In addition the importance of hand hygiene should be stressed to all staff whenever possible.

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“…In France, the prevalence remains low (Ͻ2%) (12,17). However, an outbreak of VRE was observed in 2004 in the teaching hospital of Clermont-Ferrand (14). Since then, at least five others have been reported in French hospitals (8,15).…”

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confidence: 99%

Evaluation of a New Chromogenic Medium, chromID VRE, for Detection of Vancomycin-Resistant Enterococci in Stool Samples and Rectal Swabs

et al. 2007

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Outbreak of Colonization and Infection With Vancomycin-ResistantEnterococcus faeciumin a French University Hospital

Cited by 15 publications

References 10 publications

Rapid Curbing of a Vancomycin-Resistant Enterococcus faecium Outbreak in a Nephrology Department

Rapid Curbing of a Vancomycin-Resistant Enterococcus faecium Outbreak in a Nephrology Department

Outbreaks caused by vancomycin-resistant Enterococcus faecium in hematology and oncology departments: A systematic review

Evaluation of a New Chromogenic Medium, chromID VRE, for Detection of Vancomycin-Resistant Enterococci in Stool Samples and Rectal Swabs

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