The Role of "Colonization Pressure" in the Spread of Vancomycin-Resistant Enterococci

Bonten, Marc J. M.; Slaughter, Sarah; Ambergen, A.W.; Hayden, Mary K.; Voorhis, Jean van; Nathan, Catherine; Weinstein, Robert A.

doi:10.1001/archinte.158.10.1127

Cited by 417 publications

(291 citation statements)

References 22 publications

Supporting

Mentioning

273

Contrasting

Unclassified

Order By: Relevance

“…This comparison again emphasizes the direct link between VRE colonization and infection ("colonization pressure"; Bonten et al, 1998) and the important role of early recognition, wide screening and the implementation of infection control measures to reduce the burden of VRE infections. Compared to conventional culture the BD GeneOhm™ VanR Assay had twice as many vanB results than vanA results (29% vanA, 71% vanB) which, in the light of the results just mentioned, indeed suggests a vanB reservoir in non-enterococcal, intestinal colonizers.…”

Section: Discussionmentioning

confidence: 96%

“…Colonization often precedes subsequent infection; consequently, "colonization pressure" is a critical term and unique for each kind of pathogen ( [Bonten et al, 1998] and [Donskey, 2004]). For vancomycin-resistant enterococci, the ratio of colonization to infection is quite high, meaning a single patient with a vancomycin-resistant enterococci (VRE) infection corresponds to a larger number of colonized persons surrounding the index patient and the more patients are colonized, the higher is the risk of an increasing number of infected patients ( [de Regt et al, 2008] and [Olivier et al, 2008]).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of direct cultivation on a selective solid medium, polymerase chain reaction from an enrichment broth, and the BD GeneOhm™ VanR Assay for identification of vancomycin-resistant enterococci in screening specimens

Werner

Serr

Schütt

et al. 2011

Diagnostic Microbiology and Infectious Disease

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Comparison of direct cultivation on a selective solid medium, polymerase chain reaction from an enrichment broth, and the BD GeneOhm™ VanR Assay for identification of vancomycin-resistant enterococci in screening specimens

Werner

Serr

Schütt

et al. 2011

Diagnostic Microbiology and Infectious Disease

View full text Add to dashboard Cite

show abstract

“…The metrics for exposure burden track the amount of exposure that patients in a health care facility have to patients who are either colonized or in fected with an MORO and who could potentially transmit the MORO to them. This colonization pressure is an inde pendent risk factor for healthcare acquisition of MRSA 48 and VRE, 49 and has been calculated in several ways in research studies. We recommend a simple approach that should help healthcare facilities gauge whether exposure levels are high and should potentially explain any ongoing transmission of MDROs.…”

Section: Description Of Moro Metricsmentioning

confidence: 99%

Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position Paper

Cohen

Calfee

Fridkin

et al. 2008

Infect. Control Hosp. Epidemiol.

Self Cite

161

118

View full text Add to dashboard Cite

EXECUTIVE SUMMARYMonitoring multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare setting is important to detect newly emerging antimicrobial resistance profiles, to identify vulnerable patient populations, and to assess the need for and effectiveness of interventions; however, it is unclear which metrics are the best, because most of the metrics are not standardized. This document describes useful and prac tical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of in fection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in docu menting trends over time within their facility and should not be used for interfacility comparison.The following MDROs are addressed: (1) methicillin-re sistant Staphylococcus aureus; (2) vancomycin-resistant En terococcus species; (3) multidrug-resistant gram-negative ba cilli; and (4) vancomycin-resistant S. aureus. We convened a working group of experts that reviewed current practices, the peer-reviewed literature, and existing guidelines on surveil lance strategies and key metrics.We propose that healthcare facilities use the following 4 routine metrics to monitor MDROs and the infections they cause: (1) an MORO-specific line list for tracking patients who have acquired an MDRO; (2) an antibiogram for mon itoring susceptibility patterns of isolates recovered from pa tients; (3) the incidence of hospital-onset MDRO bacteremia, which is an objective, laboratory-based metric that is highly associated with invasive disease and does not require chart review to estimate infection burden; and ( 4) clinical culture results, to measure incidence of infection or colonization, to quantify the number of people whose MORO acquisition is healthcare associated. In addition, healthcare facilities may want to calculate both the overall prevalence of carriage and the prevalence of carriage at admission, the latter of which can be useful in detecting importation of methicillin-resistant S. aureus into healthcare facilities, to estimate the exposure burden. Active surveillance testing can augment and increase the accuracy of some metrics. Healthcare facilities not per forming active surveillance testing might wish to consider point-prevalence screening, to help assess how much the number of positive clinical culture results underestimates the hidden reservoir of MDROs. It is important to understand the limitations of all proxy metrics. Because of the paucity of published research findings focused on this area of study, most recommendations were based on opinion and were heavily influenced by the perceived usefulness and simplicity of the metric for assessing MDROs in the hospital setting and for determining the impact of interventions.

show abstract

“…6 Risk factors for VRE colonization include host characteristics (immunosuppression, renal insufficiency and neutropenia), hospital factors (admission in an ICU or oncology ward) proximity to a VRE colonized patient, and extended duration of hospitalization and antimicrobial use. 7 VRE colonization independently increases a patient's risk of developing enterococcal infections, such as bloodstream infections (BSIs). Patients with end stage renal disease (ESRD) are susceptible to colonization and infections with MDR enterococci, because close proximity of patients in a hemodialysis unit for long duration provides an optimal setting for cross transmission of pathogens.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of Antibiotic Resistance and Virulence Factors in Enterococci Isolated From Patients With End Stage Renal Disease

Tellis

Muralidharan²

2012

Int Jour of Biomed Res

View full text Add to dashboard Cite

Introduction and objectives:Patients with end stage renal disease (ESRD) are at risk for colonization and infections with multidrug resistant (MDR) enterococci, which are a formidable challenge to treat. This study aims to speciate enterococci isolated from ESRD patients; determine their antibiogram and virulence factors. Methods: 50 isolates of enterococci obtained from ESRD patients were studied. Rectal swabs were screened for gastrointestinal VRE colonisation. Sample collection, processing and antibiotic susceptibility testing were performed according to standard guidelines. Vancomycin resistant enterococci (VRE) were characterized based on vancomycin MIC as VanA, VanB and VanC phenotypes. Presence of vanA and vanB genes was confirmed by polymerase chain reaction. Haemolysin, gelatinase, beta-lactamase and biofilm production were detected using standard methods. Results: out of the 50 isolates of enterococci 28(56%) were E.faecalis, 21(42%) E.faecium and 1(2%) was E.gallinarum. 12 isolates (E.faecium 33.33% and E.faecalis 17.85%) showed vancomycin resistance, of which 9 were VanA, 2 VanB and 1 VanD phenotype. 22(44%) isolates produced haemolysin, 16(32%) gelatinase, 19(38%) beta-lactamase and 12(24%) produced biofilms. 10/12(83.3%) patients with VRE infection showed gastrointestinal colonization with the same. Interpretation & conclusion: Colonization and infection caused by MDR enterococci and VRE are a significant clinical problem in patients with ESRD. Judicious use of vancomycin, careful screening and infection control precautions should be practiced to limit the transmission of VRE.

show abstract

The Role of "Colonization Pressure" in the Spread of Vancomycin-Resistant Enterococci

Abstract: Acquisition of VRE was affected by colonization pressure, the use of antibiotics, and the use of enteral feeding. However, once colonization pressure was high, it became the major variable affecting acquisition of VRE.

Cited by 417 publications

References 22 publications

Comparison of direct cultivation on a selective solid medium, polymerase chain reaction from an enrichment broth, and the BD GeneOhm™ VanR Assay for identification of vancomycin-resistant enterococci in screening specimens

Comparison of direct cultivation on a selective solid medium, polymerase chain reaction from an enrichment broth, and the BD GeneOhm™ VanR Assay for identification of vancomycin-resistant enterococci in screening specimens

Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position Paper

A Prospective Study of Antibiotic Resistance and Virulence Factors in Enterococci Isolated From Patients With End Stage Renal Disease

Contact Info

Product

Resources

About