Role of Environmental Contamination as a Risk Factor for Acquisition of Vancomycin-Resistant Enterococci in Patients Treated in a Medical Intensive Care Unit

Martínez, José Antonio Sánchez; Ruthazer, Robin; Hansjosten, Karen; Barefoot, Laurie; Snydman, David R.

doi:10.1001/archinte.163.16.1905

Cited by 201 publications

(127 citation statements)

References 59 publications

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“…The study by Martinez et al showed significant relationship between antibiotic usage (vancomycin, cephalosporin, metronidazole and quinolones) and emergence of VRE (28).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Susceptibility Pattern and Virulence Genes in Enterococcus spp. Isolated From Clinical Samples of Milad Hospital of Tehran, Iran

Arbabi

Boustanshenas

Rahbar

et al. 2016

Arch Clin Infect Dis

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Background: Enterococcus spp. are part of the normal flora of humans and animals. The nosocomial pathogenicity of Enterococcus spp. has emerged in recent years and has caused great concern due to developing of resistance to many antimicrobial agents. Objectives: The current study aimed to determine the resistance pattern and the type of virulence genes in Enterococcus spp. isolated from Milad hospital of Tehran, Iran. Materials and Methods: The current observational study was conducted from Apr 2014 to Feb 2015 on a total of 149 Enterococcus species isolated from Milad hospital in Tehran, Iran. The antibiotic susceptibility pattern of the bacteria was determined by the disc diffusion method for eight antibiotics. Minimum inhibitory concentration (MIC) of vancomycin was also done using agar-dilution assay by clinical and laboratory standards institute (CLSI) recommendations. The sodA, esp, cyl, ace and gelE genes were detected by polymerase chain reaction (PCR) assay. Results: About 37.5%, 73%, 86.6%, 35.8%, 69%, 60.8%, 45% and 79% of the isolates were resistant to vancomycin, tetracycline, gentam-

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“…The study by Martinez et al showed significant relationship between antibiotic usage (vancomycin, cephalosporin, metronidazole and quinolones) and emergence of VRE (28).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Susceptibility Pattern and Virulence Genes in Enterococcus spp. Isolated From Clinical Samples of Milad Hospital of Tehran, Iran

Arbabi

Boustanshenas

Rahbar

et al. 2016

Arch Clin Infect Dis

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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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“…High acquisition and environmental contamination rates and survival characteristics of E. faecium that may increase the risk for acquisition of this opportunistic pathogen in hospital settings have previously been described [3,6,7]. In a previous study, we have found extensive in vitro survival of VREfm for approximately 4 years [8].…”

Section: Introductionmentioning

confidence: 69%

“…This means that this bacterium can re-emerge from hidden places in a presumed 'AREfm-free ward' by colonising susceptible patients. This stresses the importance of adequate environmental decontamination of patient rooms to break the chain of patient-to-patient cross-transmission of multidrugresistant nosocomial pathogens [6].…”

Section: Discussionmentioning

confidence: 99%

Environmental survival of vancomycin-sensitive ampicillin-resistant Enterococcus faecium (AREfm)

Wagenvoort

Brauwer

Penders

et al. 2015

Eur J Clin Microbiol Infect Dis

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Ampicillin-resistant Enterococcus faecium (AREfm) has gained increased footholds in many hospital intensive care units (ICUs) and belongs to specific hospitaladapted E. faecium sub-populations. Three AREfm strains survived in an in vitro survival setting for approximately 5.5 years. These findings have important consequences for the epidemiology of AREfm in hospital settings and stress the importance of maintaining a good level of hospital hygiene.

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Role of Environmental Contamination as a Risk Factor for Acquisition of Vancomycin-Resistant Enterococci in Patients Treated in a Medical Intensive Care Unit

Abstract: Among all other factors associated with VRE transmission, VRE acquisition may depend on room contamination, even after extensive cleaning. This study underscores the need for better cleaning and the role of the environment in transmission of VRE.

Cited by 201 publications

References 59 publications

Antibiotic Susceptibility Pattern and Virulence Genes in Enterococcus spp. Isolated From Clinical Samples of Milad Hospital of Tehran, Iran

Antibiotic Susceptibility Pattern and Virulence Genes in Enterococcus spp. Isolated From Clinical Samples of Milad Hospital of Tehran, Iran

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

Environmental survival of vancomycin-sensitive ampicillin-resistant Enterococcus faecium (AREfm)

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