Recurrence of Vancomycin-Resistant<i>Enterococcus</i>Stool Colonization During Antibiotic Therapy

Donskey, Curtis J.; Hoyen, Claudia K.; Das, Sarbani M.; Helfand, Marion S.; Hecker, Michelle

doi:10.1086/502081

Cited by 48 publications

(28 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We did not culture patients after ICU discharge, so we did not evaluate whether patients who were culture negative after three cultures remained culture negative long-term. Despite these limitations, this study supports the observation that colonization with VRE, and MRSA to a much lesser extent, may persist despite three initial negative cultures (1,3,7,11,13). It may be prudent to monitor previously colonized, high-risk patients for the reemergence of antibiotic-resistant bacteria.…”

supporting

confidence: 73%

“…To prevent spread, national guidelines recommend that health care providers use contact precautions during care of colonized and infected patients until it can be demonstrated that they are no longer colonized (5,10,14). Colonization with VRE can be prolonged (1,3,7), so the current recommendation by the Hospital Infection Control Practices Advisory Committee (HICPAC) is that isolation precautions should be maintained until VRE-negative results are documented with at least three consecutive negative cultures collected a minimum of 1 week apart (6,14,15). Persistent carriage with MRSA is also well documented (11,13).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Predicting Clearance of Colonization with Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus by Use of Weekly Surveillance Cultures

2009

View full text Add to dashboard Cite

We analyzed surveillance cultures for vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) collected during a multicenter trial to determine if three negative cultures collected at weekly intervals would predict clearance of VRE or MRSA from colonized patients. Seventy-two percent of VRE-colonized patients and 94% of MRSA-colonized patients were culture negative after three consecutive negative cultures.Infections with oxacillin (methicillin)-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have increased dramatically in recent years, and together, they cause 12% of all health care-associated infections (2,8,16). Patients infected with MRSA or VRE, as well as asymptomatically colonized patients, serve as a reservoir for transmission of these bacteria to other hospitalized patients. To prevent spread, national guidelines recommend that health care providers use contact precautions during care of colonized and infected patients until it can be demonstrated that they are no longer colonized (5,10,14). Colonization with VRE can be prolonged (1, 3, 7), so the current recommendation by the Hospital Infection Control Practices Advisory Committee (HICPAC) is that isolation precautions should be maintained until VRE-negative results are documented with at least three consecutive negative cultures collected a minimum of 1 week apart (6,14,15). Persistent carriage with MRSA is also well documented (11, 13). Criteria for documenting clearance of MRSA from colonized patients are not established, although the standard of three negative weekly cultures is commonly applied to this population.The National Institute of Allergy and Infectious Diseases (NIAID) supported a large, cluster-randomized trial assessing strategies to reduce transmission of VRE and MRSA in 19 intensive care units (ICUs) (W. C. Huskins, C. M. Huckabee, N. P. O'Grady, P. R. Murray, H. Kopetskie, L. Zimmer, M. E. Walker, R. L. Sinkowitz-Cochran, J. A. Jernigan, M. Samore, D. Wallace, and D. A. Goldmann, submitted for publication). Stool or perianal swabs for VRE and anterior nasal swabs for MRSA were collected at all ICU sites from patients upon admission, weekly thereafter, and on discharge and were processed at a central laboratory. More than 22,000 swabs from approximately 9,900 patients were collected for VRE culture, and a similar number was collected for MRSA, during the 18-month study period. The trial did not include any systematic effort to "decolonize" patients, and topical antimicrobial agents (e.g., mupirocin, chlorhexidine, and vancomycin) were used infrequently in the participating ICUs. The systematic collection of specimens from ICU populations at multiple geographic sites presented an opportunity to evaluate the HICPAC recommendations for VRE and their applicability for MRSA colonization.Stool or perianal swabs for VRE were inoculated into bileesculin azide broth supplemented with 8 g/ml vancomycin and incubated at 35°C for 18 to 24 h. Broths were subcultured onto bile-...

show abstract

supporting

confidence: 73%

mentioning

confidence: 99%

Predicting Clearance of Colonization with Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus by Use of Weekly Surveillance Cultures

2009

View full text Add to dashboard Cite

show abstract

“…In this study, we characterized the epidemiology of colonization with the outbreak strain, comparing risk factors for acquisition of the outbreak strain versus nonepidemic VREF strains. In addition, VREF colonization was monitored in carriers of both the outbreak strain and nonepidemic VREF strains for a 6-month period starting from the date of first isolation of VREF, since several studies have demonstrated that many patients colonized by VREF became persistent fecal carriers, especially those who received antibiotic therapy (6,10,19,22).…”

mentioning

confidence: 99%

Acquisition and Duration of Vancomycin-Resistant Enterococcal Carriage in Relation to Strain Type

Mascini¹,

Jalink²,

Kamp-Hopmans³

et al. 2003

J Clin Microbiol

View full text Add to dashboard Cite

In May 2000, the first outbreak of vancomycin-resistant Enterococcus faecium (VREF) was detected in the University Medical Center Utrecht in the nephrology ward. The question arose why some VREF strains spread among hospitalized patients, whereas other strains do not. Thirty patients who were found to be colonized with VREF between May and November 2000 were included in the study. Molecular typing confirmed that 19 of them carried an identical epidemic strain which harbored the esp gene while 11 were colonized by nonepidemic strains that were all esp negative. Acquisition of the outbreak strain was significantly associated with diabetes mellitus, renal transplantation, and extensive use of antibiotics, especially cephalosporins, in the 2-month period before the first isolation of VREF. To establish the duration of colonization, prospective surveillance of VREF carriage for a 6-month period starting from the first isolation of VREF was realized for 20 patients. After 6 months, VREF was still recovered from 60% of carriers of the outbreak strain versus 20% of carriers of nonepidemic strains (P < 0.01). However, antibiotic use during the follow-up period was significantly higher by carriers of the outbreak strain than by carriers of nonepidemic strains. The fact that the outbreak strain was recovered for a longer period of time than nonepidemic strains may facilitate dissemination of the strain. The results support a careful restrictive antibiotic policy for wards at risk for spread of VREF and implementation of isolation precautions for patients who are colonized with esp-positive outbreak strains.

show abstract

“…The Hospital Infection Control Practices Advisory Committee recommends three consecutive negative cultures, at least 1 wk apart, for determining clearance of VRE from a previously colonized patient (30); however, it is known that VRE may be detectable for a prolonged period, sometimes after numerous negative follow-up cultures (27,31), especially after antibiotic treatment that may favor VRE digestive discharge in seemingly negative patients (31,32). We therefore decided to maintain isolation precautions during more than 12 mo for patients who were colonized by outbreak strains, regardless of the rectal swab results (13,(31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

Recurrence of Vancomycin-ResistantEnterococcusStool Colonization During Antibiotic Therapy

Abstract: Antibiotic therapy may be associated with recurrent high-density VRE stool colonization in many patients who have previously had three consecutive negative stool cultures. These patients should be screened for recurrent stool colonization when antibiotic therapy is administered.

Cited by 48 publications

References 19 publications

Predicting Clearance of Colonization with Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus by Use of Weekly Surveillance Cultures

Predicting Clearance of Colonization with Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus by Use of Weekly Surveillance Cultures

Acquisition and Duration of Vancomycin-Resistant Enterococcal Carriage in Relation to Strain Type

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

Contact Info

Product

Resources

About