Rectal culture screening for vancomycin-resistant enterococcus in chronic haemodialysis patients: false-negative rates and duration of colonisation

Park, I.; Park, R.W.; Lim, Seung Kwan; Lee, W.; Shin, Joon-Han; Yu, Sebastian; Shin, Gyu‐Tae; Kim, H.

doi:10.1016/j.jhin.2011.04.011

Cited by 20 publications

(18 citation statements)

References 16 publications

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“…Since transfer of patients between different hospitals may not fully explain the widespread dissemination, it may be the case that hospital-associated lineages are also carried in the community. Individuals can carry VRE for weeks to years after hospital discharge (Park et al 2011;Karki et al 2013;Sohn et al 2013), and VRE can survive on environmental surfaces for at least 3 mo (Neely and Maley 2000), making transmission within the …”

Section: Discussionmentioning

confidence: 99%

A decade of genomic history for healthcare-associated Enterococcus faecium in the United Kingdom and Ireland

et al. 2016

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Vancomycin-resistant Enterococcus faecium (VREfm) is an important cause of healthcare-associated infections worldwide. We undertook whole-genome sequencing (WGS) of 495 E. faecium bloodstream isolates from 2001-2011 in the United Kingdom and Ireland (UK&I) and 11 E. faecium isolates from a reference collection. Comparison between WGS and multilocus sequence typing (MLST) identified major discrepancies for 17% of isolates, with multiple instances of the same sequence type (ST) being located in genetically distant positions in the WGS tree. This confirms that WGS is superior to MLST for evolutionary analyses and is more accurate than current typing methods used during outbreak investigations. E. faecium has been categorized as belonging to three clades (Clades A1, hospital-associated; A2, animal-associated; and B, community-associated). Phylogenetic analysis of our isolates replicated the distinction between Clade A (97% of isolates) and Clade B but did not support the subdivision of Clade A into Clade A1 and A2. Phylogeographic analyses revealed that Clade A had been introduced multiple times into each hospital referral network or country, indicating frequent movement of E. faecium between regions that rarely share hospital patients. Numerous genetic clusters contained highly related vanA-positive and -negative E. faecium, which implies that control of vancomycin-resistant enterococci (VRE) in hospitals also requires consideration of vancomycin-susceptible E. faecium. Our findings reveal the evolution and dissemination of hospital-associated E. faecium in the UK&I and provide evidence for WGS as an instrument for infection control.

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Section: Discussionmentioning

confidence: 99%

A decade of genomic history for healthcare-associated Enterococcus faecium in the United Kingdom and Ireland

et al. 2016

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“…However, others have reported that prolonged fecal VRE carriage is dependent on several factors, including recent exposure to antibiotics, longer length of hospital stay, repeated hospital admissions, surgery, and high-risk patient groups, such as those on dialysis (10,11).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Carriage of Vancomycin-Resistant Enterococci in Patients Discharged from Hospitals: a 12-Year Retrospective Cohort Study

et al. 2013

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e Contact precautions are recommended in hospitals to prevent the transmission of vancomycin-resistant enterococci (VRE); however, there is no clear policy for how long patients should be under contact precautions due to a lack of information on the duration of carriage of these organisms. We conducted a retrospective cohort study to understand the duration of carriage of VRE (by screening of a single stool culture) and associated factors among patients who had been identified with VRE infection and/or colonization since the year 2000 at our health facilities. Of the 345 eligible participants, 136 did not respond, 90 declined to participate, and 16 did not send in the required specimens. Of the 103 remaining participants, 13 were found to have current VRE fecal carriage. The proportion of colonized patients fell from 40% (2/5) in the first year to 23.3% (7/30) in year 4. None of the 40 patients who had VRE detected >4 years prior were found to be colonized at the time of the study. The longest duration of detected VRE positivity was 46.5 months. Univariate analysis revealed that recent exposure to any antibiotics (P ‫؍‬ 0.016), multiple antibiotics (P ‫؍‬ 0.001), amoxicillin-clavulanic acid (P ‫؍‬ 0.021), piperacillin-tazobactam (P ‫؍‬ 0.007), glycopeptides (P < 0.001), meropenem (P ‫؍‬ 0.007), aminoglycosides (P ‫؍‬ 0.021), or fluoroquinolones (P ‫؍‬ 0.021), being the index case in a clinical specimen (P ‫؍‬ 0.016), and recent hospitalization (P < 0.001) were significantly associated with continued carriage on follow-up. In the surviving outpatients, a significant proportion appeared to clear VRE carriage. Our results suggest that in the absence of recent risk factors, such as hospitalization or antibiotic use, patients with a remote history of colonization (>4 years) may no longer require contact isolation precautions.

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“…The lower sensitivity of a culture, therefore, should be taken into consideration when following the HICPAC recommendation to terminate isolation following three negative cultures (2). Multiple studies have also shown that spontaneous decolonization occurs only in a limited number of patients; however, reappearance of the VRE within a few weeks of decolonization is common (12,18,19). All Xpert vanA-positive discordant results were tested by a second independent laboratory-developed real-time PCR to confirm that the false-positive results were truly due to the presence of the vanA gene.…”

Section: Discussionmentioning

confidence: 99%

Performance Characteristics of the Cepheid Xpert vanA Assay for Rapid Identification of Patients at High Risk for Carriage of Vancomycin-Resistant Enterococci

Babady¹,

Gilhuley²,

Cianciminio-Bordelon³

et al. 2012

J Clin Microbiol

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We compared the performance characteristics of culture and the Cepheid Xpert vanA assay for routine surveillance of vancomycin-resistant enterococci (VRE) from rectal swabs in patients at high risk for VRE carriage. The Cepheid Xpert vanA assay had a limit of detection of 100 CFU/ml and correctly detected 101 well-characterized clinical VRE isolates with no cross-reactivity in 27 non-VRE and related culture isolates. The clinical sensitivity, specificity, positive predictive value, and negative predictive value of the Xpert vanA PCR assay were 100%, 96.9%, 91.3%, and 100%, respectively, when tested on 300 consecutively collected rectal swabs. This assay provides excellent predictive values for prompt identification of VRE-colonized patients in hospitals with relatively high rates of VRE carriage. Vancomycin-resistant enterococci (VRE) are recognized as nosocomial pathogens alongside methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Vancomycin resistance in enterococci species is conferred mainly by the presence of the vanA or vanB gene, although the presence of other genes, including vanC, vanD, vanE, and vanG, can also result in a resistant phenotype (7,25). In North America, the vanA gene is the most prevalent resistance marker in enterococci species, followed by the vanB gene, which can be found in bacteria other than enterococci (4, 10). Both the vanA and vanB genes are carried on transposable plasmids, and transfer of these plasmids to other enterococci and S. aureus has been shown both in vitro and in vivo (7).Several reports have shown that in allogeneic hematopoietic stem cell transplant recipients, VRE colonization, prior to stem cell transplantation, is a significant risk factor for the development of VRE bacteremia, which is associated with poor clinical outcomes (3,14,22,24). In order to decrease the spread of VRE in hospital settings, the Hospital Infection Control Practices Advisory Committee (HICPAC) recommends a multipronged approach that includes rapid identification and reporting of VRE-positive stools or rectal swabs by the microbiology laboratory in order to ensure prompt isolation of colonized patients (2).Currently, VRE surveillance is performed at our institution using traditional culture. This procedure requires 48 to 96 h to obtain a final result and involves multiple media and incubation steps. Recently, the Food and Drug Administration (FDA) approved a rapid molecular assay, the Xpert vanA (Cepheid, Sunnyvale, CA), for the detection of VRE directly from rectal swab specimens only. The assay is a real-time, one-step PCR assay performed on the GeneXpert instrument and provides results in less than 1 h, compared to 48 to 96 h with culture. In addition to providing rapid results for timely isolation of colonized patients, rapid and more sensitive detection of VRE may also result in the timely identification of patients at risk for the development of VRE bacteremia. The objective of the present study was to evaluate the performance characteristics of this novel P...

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Rectal culture screening for vancomycin-resistant enterococcus in chronic haemodialysis patients: false-negative rates and duration of colonisation

Cited by 20 publications

References 16 publications

A decade of genomic history for healthcare-associated Enterococcus faecium in the United Kingdom and Ireland

A decade of genomic history for healthcare-associated Enterococcus faecium in the United Kingdom and Ireland

Long-Term Carriage of Vancomycin-Resistant Enterococci in Patients Discharged from Hospitals: a 12-Year Retrospective Cohort Study

Performance Characteristics of the Cepheid Xpert vanA Assay for Rapid Identification of Patients at High Risk for Carriage of Vancomycin-Resistant Enterococci

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