Risk Factors for Colonization With Vancomycin-Resistant Enterococci in a Melbourne Hospital

MacIntyre, C. Raina; Empson, Marianne; Boardman, Charlotte; Sindhusake, Doungkamol; Lokan, Julie; Gv, Brown

doi:10.1086/501833

Cited by 29 publications

(31 citation statements)

References 33 publications

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“…Numerous studies have identified antibiotic therapy as a risk factor for VRE acquisition (4,8,(11)(12)(13)(14)(15); however, controversies remain on the association between previous intravenous vancomycin use and VRE carriage (16). We confirmed such an association in univariate analysis, but, like other reports (11,17), we found that the only antibiotic group associated with VRE carriage by multivariate analysis was large-spectrum ␤-lactams.…”

Section: Discussionsupporting

confidence: 80%

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

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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.

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Section: Discussionsupporting

confidence: 80%

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

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“…While our study evaluated the risk of contracting a particular outbreak strain among all patients who acquired VREF, most other studies addressed risk factors for the acquisition of any VREF strain. Several of these studies also identified antibiotic therapy, especially treatment with antianaerobic antibiotics, vancomycin, and expanded-spectrum cephalosporins (5,11,(15)(16)20) as risk factors for acquisition of VREF. It is thought that antibiotics promote the overgrowth of VREF in the intestinal tract, primarily through the inhibition of intestinal anaerobes.…”

Section: Discussionmentioning

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

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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.

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“…Hepatopathy includes liver cirrhosis (3) and acute hepatitis (2). Others include atrial fibrillation, pulmonary edema, angina, myocardial infarction, cellulitis, meningitis, and malignancy, § Cerebrovascular diseases include subarachnoid hemorrhage (12), intracerebral and/or intraventricular hemorrhage (12), and cerebral infarction (1). Spine diseases encompass.…”

Section: Incidence and Demographicsmentioning

confidence: 99%

“…In spite of this, the result suggests that appropriate use of specific cephalosporin and vancomycin in terms of dosage and period, should be recognized and commanded to minimize nosocomial VRE colonization or infection 8,19) . Prolonged hospitalization and direct admission to ICU were also associated with higher VRE colonization rate 12) . These results simply reflect an increased severity of illness in the population studied.…”

Section: Risk Factors Of Vre Infection In Neurosurgical Practicementioning

confidence: 99%

Incidence and Risk Factors of Infection Caused by Vancomycin-Resistant Enterococcus Colonization in Neurosurgical Intensive Care Unit Patients

et al. 2009

J Korean Neurosurg Soc

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Objective : This study was aimed to identify the incidence and risk factors of vancomycin-resistant enterococcus (VRE) colonization in neurosurgical practice of field, with particular attention to intensive care unit (ICU). Methods : This retrospective study was carried out on the Neurosurgical ICU (NICU), during the period from January. 2005 to December. 2007, in 414 consecutive patients who had been admitted to the NICU. Demographics and known risk factors were retrieved and assessed by statistical methods. Results : A total of 52 patients had VRE colonization among 414 patients enrolled, with an overall prevalence rate of 6.1%. E. faecium was the most frequently isolated pathogen, and 92.3 % of all VRE were isolated from urine specimen. Active infection was noticed only in 2 patients with bacteremia and meningitis. Relative antibiotic agents were third-generation cephalosporin in 40%, and vancomycin in 23%, and multiple antibiotic usages were also identified in 13% of all cases. Multivariate analyses showed Glasgow coma scale (GCS) score less than 8, placement of Foley catheter longer than 2 weeks, ICU stay over 2 weeks and presence of nearby VRE-positive patients had a significantly independent association with VRE infection. Conclusion : When managing the high-risk patients being prone to be infected VRE in the NICU, extreme caution should be paid upon. Because prevention and outbreak control is of ultimate importance, clinicians should be alert the possibility of impending colonization and infection by all means available. The most crucial interventions are careful hand washing, strict glove handling, meticulous and active screening, and complete segregation.

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Risk Factors for Colonization With Vancomycin-Resistant Enterococci in a Melbourne Hospital

Abstract: Our findings are consistent with an acute hospital outbreak. Monitoring and control of antibiotic use, particularly metronidazole, may reduce VRE in our hospital. Ongoing surveillance and staff education also are necessary.

Cited by 29 publications

References 33 publications

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

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

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

Incidence and Risk Factors of Infection Caused by Vancomycin-Resistant Enterococcus Colonization in Neurosurgical Intensive Care Unit Patients

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