Outbreak of Vancomycin-Resistant<i>Enterococcus faecium</i>in a Neonatal Intensive Care Unit

Rupp, Mark E.; Marion, Nedra; Fey, Paul D.; Bolam, David Lloyd; Iwen, Peter C.; Overfelt, C.M.; Chapman, Lucinda

doi:10.1086/501905

Cited by 44 publications

(19 citation statements)

References 11 publications

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“…18 Available information about epidemiology of enterococcal infections indicates that E. faecium is usually a low-level pathogen causing disease only in specific and rather limited number of patients: cancer patients, 2 children with renal failure, 9 and premature infants. 7,8 This is confirmed by our own data 22 showing that no child infected with the PFGE II clone during the hospital outbreak experienced a shock-like syndrome that characterized episodes of infection in this patient. Thus, it would be of academic interest to search for the virulence genes specific for the PFGE type I clone.…”

Section: Phenotypes Of Virulent and Nonvirulent Strainssupporting

confidence: 83%

“…Similar to adults with chronic diarrhea, or incontinence, 4,21 young children may contaminate their environment and spread the microorganism while in contact with one another. 22 Nosocomial enterococcal disease is viewed as a two-stage process: an initial, usually asymptomatic gastrointestinal colonization is followed by tissue invasion in selected group of patients. 23 Host and microbial virulence factors contribute to enhanced ability to breach containment in the gastrointestinal tract.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Episodes of Shock-like Syndrome Caused by the Same Strain of Vancomycin-ResistantEnterococcus faeciumin a Pediatric Patient

Papp

McNeeley

Projan

et al. 2003

Microbial Drug Resistance

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We present the case of a hospitalized pediatric patient with short bowel syndrome who was dependent upon total parenteral nutrition for 17 months. Shortly after admission she became colonized with vancomycin-resistant Enterococcus faecium (VRE) and developed 12 distinct episodes of serious infection associated with it. The course of VRE colonization and infections in this patient was studied through analysis of 40 representative isolates obtained from different sites during distinct episodes of infection. Standard microbiological techniques, automated ribosomal DNA typing, polymerase chain reaction, and pulsed-field gel electrophoresis (PFGE) were used. All isolates except for the one associated with the initial episode of bacteremia were VRE, and were multidrug resistant. The last four episodes of infection were caused by isolates resistant to all tested antibiotics except for intermediate susceptibility to chloramphenicol. The vanA genotype was a source of vancomycin resistance in all VRE isolates. Both ribotyping and PFGE showed two distinct clones of VRE in clinical and stool surveillance isolates: one was associated with clinical illness and the other was not associated with infection. Recurrent VRE infections occur as a consequence of prolonged gastrointestinal colonization. Morbidity is associated with host factors, the presence of co-pathogens, and possibly intrinsically more virulent VRE strain.

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Section: Phenotypes Of Virulent and Nonvirulent Strainssupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Recurrent Episodes of Shock-like Syndrome Caused by the Same Strain of Vancomycin-ResistantEnterococcus faeciumin a Pediatric Patient

Papp

McNeeley

Projan

et al. 2003

Microbial Drug Resistance

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“…In response to recent concern about the growing impact of antibiotic resistance in clinical practice (79,86,225,274), it is now widely accepted that more stringent measures, intended to reduce antibiotic misuse, are urgently required to deal with this problem (232,307). Working parties across Europe and elsewhere are developing strategies aimed at reducing antibiotics in animal feeds and controlling antibiotic prescribing in humans more effectively (68,96,265).…”

Section: Discussionmentioning

confidence: 99%

Potential Impact of Increased Use of Biocides in Consumer Products on Prevalence of Antibiotic Resistance

2003

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There has recently been much controversy surrounding the increased use of antibacterial substances in a wide range of consumer products and the possibility that, as with antibiotics, indiscriminate use of biocides might contribute to the overall pattern of susceptibility in the general environment and in the clinic. Such speculation, based on the isolation of resistant mutants from in vitro monoculture experiments, is not reflected by an emergence of biocide-resistant strains in vivo. This review provides a broad coverage of the biocide and resistance literature and evaluates the potential risks, perceived from such laboratory monoculture experiments, against evidence gathered over 50 years of field studies. An explanation for the continued effectiveness of broad-spectrum biocidal agents against the decline in efficacy of therapeutic agents is provided based on the fitness costs of resistance and the ubiquity of naturally occurring substances that possess antibacterial effect. While we conclude from this review of the literature that the incorporation of antibacterial agents into a widening sphere of personal products has had little or no impact on the patterns of microbial susceptibility observed in the environment, the associated risks remain finite. The use of such products should therefore be associated with a clear demonstration of added value either to consumer health or to the product life. Hygienic products should therefore be targeted to applications for which the risks have been established

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“…Although risk factors for glycopeptide-resistant E. faecium, such as prolonged hospitalisation and prolonged use of vancomycin [8], are prevalent in neonatal intensive care, and whilst several outbreaks of glycopeptide-resistant E. faecium have been reported in this setting [9][10][11], little is known about the use of linezolid in critically ill very low birth weight premature infants [12][13][14][15][16]. We therefore report the dosing, safety, efficacy and plasma concentrations of linezolid in two very low birth weight premature infants who received linezolid for presumed invasive infections by glycopeptideresistant E. faecium.…”

Section: Introductionmentioning

confidence: 99%

Linezolid treatment of glycopeptide-resistant Enterococcus faecium in very low birth weight premature neonates

Hoehn

Groll

Schaefer

et al. 2006

International Journal of Antimicrobial Agents

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Outbreak of Vancomycin-ResistantEnterococcus faeciumin a Neonatal Intensive Care Unit

Cited by 44 publications

References 11 publications

Recurrent Episodes of Shock-like Syndrome Caused by the Same Strain of Vancomycin-ResistantEnterococcus faeciumin a Pediatric Patient

Recurrent Episodes of Shock-like Syndrome Caused by the Same Strain of Vancomycin-ResistantEnterococcus faeciumin a Pediatric Patient

Potential Impact of Increased Use of Biocides in Consumer Products on Prevalence of Antibiotic Resistance

Linezolid treatment of glycopeptide-resistant Enterococcus faecium in very low birth weight premature neonates

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