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

Abstract

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.

Vancomycin-resistant vanB-type Enterococcus faecium isolates expressing varying levels of vancomycin resistance and being highly prevalent among neonatal patients in a single ICU

“…A similar resistance gene cluster was shown to be prevalent among various E. faecalis and E. faecium strains in 16 hospitals in Chile [32] although in general vanA -type resistance seemed most prevalent among Latin American VRE isolates (Peru, Colombia, Ecuador, Venzuela)[33]. A number of reports described vanB type VRE outbreaks in recent years among hospital patients in Spain and France representing European low VRE prevalence countries according to EARS-Net data [4,34-36]. Whereas the outbreaks in Spain remained at a local level (hospital outbreaks) and did not feed substantially the overall surveillance numbers; increasing VRE frequencies in France in 2008 are mainly attributed to a marked increase in a number of vanB outbreaks in the North of the country [4].…”

A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associatedC. difficileand multidrug-resistant organisms

“…8,25,41 Case-control analysis was done in 7 studies. 22,35,53,72,82,93,98 Most were performed in tertiary-care hospitals (n = 75), followed by secondary (n = 7), 33,35,44,47,80,88,97 primary (n = 2), 4,58 and specialty hospitals (n = 3; eg, military hospital or research institute). 57,73,74 Furthermore, 29 studies were carried out in the ICU 7,8,[19][20][21]26,28,30,43,44,48,50,52,55,[57][58][59][60]62,66,67,70,71,74,77,[88][89][90]…”

“…We identified 17 that included cohorting as part of a strategy to help control VRE infection. 4,5,25,30,48,55,61,63,[68][69][70]79,82,87,92,94,96 All but 3 studies 4,68,70 were performed in the setting of a VRE outbreak. There was a significant decline in VRE numbers or incidence after enhanced infection control measures, with the exception of 1 study.…”

Reconsidering Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus

“…for VRE. The literature [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] abounds with publications reporting the benefit of CP in terminating VRE outbreaks. As with the MRSA literature, CP as an intervention to decrease VRE acquisition was rarely studied separately from other interventions or compared with standard precautions as the only intervention.…”