Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci

Drees, Marci; Snydman, David R.; Schmid, Christopher H.; Barefoot, Laurie; Hansjosten, Karen; Vue, Padade M.; Cronin, Michael; Nasraway, Stanley A.; Golan, Yoav

doi:10.1086/527394

Cited by 260 publications

(203 citation statements)

References 42 publications

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“…Furthermore, the capacity of enterococci to survive outside the human body for prolonged periods of time contributes to cross-contamination through the hands of healthcare workers, leading to outbreaks [1,2]. The hospital environment can be a reservoir of resistant bacteria, and the role of a possible dissemination of these bacteria, especially vancomycin-resistant enterococci (VRE) via inanimate surfaces and equipment, has been documented by several researchers [3][4][5][6]. Moreover, the cross-transmission, between patients via contaminated hands and surfaces, of multidrug-resistant microorganisms increases length of stays in hospitals, healthcare costs, and mortality [7,8].…”

Section: Introductionmentioning

confidence: 99%

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Dziri

Lozano

Saïd

et al. 2016

J Infect Dev Ctries

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Introduction: The role of the hospital environment as a reservoir of resistant bacteria in Tunisia has been poorly investigated; however, it could be responsible for the transmission of multidrug-resistant bacteria. The objective was to study the prevalence of Enterococcus in the environment of a Tunisian hospital and the antibiotic resistance phenotype/genotype in recovered isolates, with special reference to vancomycin resistance. Methodology: A total of 300 samples were taken (March-June, 2013) and inoculated in Slanetz-Bartley agar plates supplemented or not supplemented with 8 µg/mL of vancomycin. Antibiotic resistance genes were tested by polymerase chain reaction (PCR). The clonal relatedness of the vanA isolates was assessed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence testing (MLST). Results: Enterococci were recovered in 33.3% of tested samples inoculated in SB medium. E faecium was the most prevalent species, followed by E. faecalis and E. casseliflavus. Antimicrobial resistance genes detected were as follows (number of isolates): erm(B) (71), tet(M) (18), aph(3')-IIIa (27), ant(6)-Ia (15), cat(A) (4), and van(C2) (6). Vancomycin-resistant-enterococci (VRE) were recovered from 14 samples (4.7%), when tested in SB-VAN. The 14 VRE (one per positive sample) were identified as E. faecium and contained the van(A),erm(B), tet(M), ant(6)-Ia, and aph(3')-IIIa genes. Thirteen of the VRE strains were ascribed by PFGE and MLST to a novel clone (new ST910), and only one VRE strain was typed as ST80 included in CC17. Conclusions: The emergence and spread of new clones of VRE, especially in the hospital environment in this country, could become particularly problematic.

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Section: Introductionmentioning

confidence: 99%

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Dziri

Lozano

Saïd

et al. 2016

J Infect Dev Ctries

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“…The authors showed that the presence of a VRE-colonized patient in the previous 2 weeks or a previous positive environmental culture were highly predictive for VRE acquisition by the subsequent occupant of the room 13 . In our study, the majority of the patients (73%) were cared for in just 4 wards and, conversely to the reported literature [14][15][16] , with the exception of the Trauma unit, these wards were not involved in intensive care.…”

Section: Resultsmentioning

confidence: 99%

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

Rossini

Fagnani

Leichsenring

et al. 2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.

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“…The extent to which such susceptible patients' environments act as a reservoir for infections is contradictory with some authors [3,8,10,16] suggesting that transmission of HCAIs by this route is plausible. Some studies described that the contribution of the environment is negligible [7,9,12,14,18].…”

Section: Introductionmentioning

confidence: 90%

An Exploratory Study of Staphylococcus epidermidis Isolates from Environment and Patient Blood Cultures from an Intensive Care Unit

Damaceno¹,

Oliveira²,

Randle³

2014

Infections Journal

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This exploratory study determined the epidemiological characteristics of Staphylococcus epidermidis from near touch sites and blood cultures in one Intensive Care Unit (ICU) between July and October 2009 in a large teaching hospital in Brazil. Five different touch sites around the environment of two different patients were sampled over four days and 24 blood cultures from 24 patients were obtained and analyzed. Isolates from near touch sites and blood cultures were compared by means of the repetitive extragenic palindromic sequence-based polymerase chain reaction (rep-PCR) and analyzed by the unweighted pair-group method with arithmetic mean (UPGMA) (BioNumerics, 6.0). Results found that ciprofloxacinresistant Staphylococcus epidermidis on stethoscopes, bed rails (P < .004), and patient blood cultures indicated similarity (60-65%; IC: 85%). The similarities among near touch sites and patient isolates are unsurprising due to the commensal nature of Staphylococcus epidermidis, however it does emphasize the need for further research into environmental contamination and cleaning.

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Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci

Abstract: We found that prior room contamination, whether measured via environmental cultures or prior room occupancy by VRE-colonized patients, was highly predictive of VRE acquisition. Increased attention to environmental disinfection is warranted.

Cited by 260 publications

References 42 publications

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

An Exploratory Study of Staphylococcus epidermidis Isolates from Environment and Patient Blood Cultures from an Intensive Care Unit

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